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Signs, prevention and what to do if you have frostbite

Frostbite cold weather
A pedestrian makes her way through a cloud of snow being created by a snowblower on the Rideau Canal in Ottawa on January 5, 2015. THE CANADIAN PRESS/Sean Kilpatrick

Cold weather has arrived across Canada and residents are reminded to take caution and dress properly.

Frostbite is damage to the skin and underlying tissues caused by extreme cold.

First-degree cold injury (called frostnip) involves only the outer layers of the skin, turning it white and leaving it numb. Skin appears yellowish or white, but feels soft to the touch. Victims may experience painful tingling or a burning sensation.

READ MORE: Why extreme weather stops us cold

With second-degree frostbite, the skin is white or blue and feels frozen but the tissue underneath is not yet damaged.

Third-degree frostbite involves white, blotchy or blue skin with underlying tissue damage. Damage occurs when blood vessels constrict to prevent heat loss and crystals form inside tissue.

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In most cases, that cold air is hurting our extremities – think hands, feet, fingers, nose, or cheeks – because those areas are most exposed, and exposed skin is especially at risk for frostbite.

Signs of frost bite:

  • ‘Pins and needles’ sensation followed by numbness;
  • Skin may be throbbing or aching, but later on the affected part becomes insensitive;
  • Hard, pale and cold quality of skin;
  • White waxy skin that feels numb;
  • During re-warming there will be burning sensation to the affected area;
  • Skin will blister and swell and may turn red, blue or purple.
Frostbite bandage
British explorer Sir Ranulph Feinnes was evacuated from an Antarctica expedition because of frostbite in March 2013. LEON NEAL/AFP/Getty Images

Very severe frostbite may cause blisters, gangrene (blackened, dead tissue), and damage to deep structures such as tendons, muscles, nerves and bones.

Any part of the body may be affected by frostbite. If only the skin and underlying tissues are damaged, recovery may be complete. However, if blood vessels are affected, the damages are permanent, which may result in amputation of the affected part.

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Factors that increase the risk of frostbite include: smoking, beta-blockers, windy weather, diabetes, peripheral neuropathy, and Raynaud’s phenomenon.

Elderly people and children are at a higher risk of frostbite due to less muscle mass and as a result, generate less body heat. Children lose heat from their skin faster than adults, and they’re often not properly dressed for the cold. Parents and guardians should check their children regularly for visible signs of frostbite.

READ MORE: Why extreme weather stops us cold

First Aid:

1. Shelter the person in a warmer place. Remove any constricting jewellery and wet clothing. Look for signs of hypothermia (uncontrollable shivering, weakness and loss of coordination, confusion, drowsiness, slowed breathing or heart rate)and treat accordingly.

2. Wrap the affected areas in sterile dressings (remember to separate affected fingers and toes) and transport the person to an emergency department further care.

3. If immediate care is not available, use re-warming first aid. Soak the affected areas in warm (never hot) water, or repeatedly apply warm cloths to affected areas for 20 to 30 minutes. The recommended water temperature is 40-42.2 degrees Celsius. Keep circulating the water to aid the warming process. Severe burning pain, swelling, and color changes may occur during warming. Warming is complete when the skin is soft and sensation returns.

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If resources are limited, start at the outer extremities and use a person’s breath to warm the area. Tuck hands or feet inside warm clothing beside bare warm flesh (armpits and groin areas work best) to gently warm the tissue.

4. Apply dry sterile dressings to the frostbitten areas. Put dressing between frostbitten fingers or toes to keep them separated.

5. Move thawed areas as little as possible.

6. Refreezing of thawed extremities can cause more severe damage. Prevent refreezing by wrapping the thawed areas and keep the person warm. If protection from refreezing cannot be guaranteed, it may be better to delay initial warming process until a warm location is reached.

7. If the frostbite is extensive, give warm drinks to the person in order to replace lost fluids.

Contact a health care professional if normal feeling and colour do not return promptly after warming treatment. If new symptoms such as fever, malaise, discoloration or drainage form the affected body part also consult a medical professional.

READ MORE: Does cold weather help you catch a cold? Here’s what scientists found

What not to do:

  • Do not thaw out frostbitten area if it cannot be kept thawed. Refreezing may make tissue damage even worse;
  • Do not use direct dry heat (radiator, campfire, heating pad, or hair dryer) to thaw frostbitten areas. Keep in mind that numbness is a symptom of frostbite, so never apply direct heat from a hair dryer or a heater because you can burn the skin;
  • Do not rub or massage the affected area because this can move the ice crystals around, extending the damage;
  • Do not disturb blisters on frostbitten skin;
  • Do not smoke or drink alcoholic beverages during recovery as both can interfere with blood circulation
At extreme wind chill values of -40 frostbite on exposed skin may occur in less than 10 minutes. At values below -50 frostbite may occur in less than 5 minutes.
At extreme wind chill values of -40 frostbite on exposed skin may occur in less than 10 minutes. At values below -50 frostbite may occur in less than 5 minutes. Peter Quinlan / Skytracker

Frostbite prevention:

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  • Check the weather forecast;
  • Plan ahead;
  • Dress warmly;
  • Seek shelter (get out of the wind);
  • Stay dry (remove outer layers or open coat if you are sweating);
  • Keep active (running);
  • Be aware (watch for frostnip, frostbite, hypothermia).

Good quality clothing with high insulating properties traps air, creating a thicker boundary layer around the body which keeps in the heat. Layers of thin, breathable clothing are much more effective at keeping people warm and dry than bulky clothing.

Wet clothing and footwear lose their insulating properties, resulting in body-heat loss nearly equal to that of exposed skin.

Physical activity, such as walking or skiing increases metabolism, which generates more body heat. During recreational activities (snowmobiling, skiing, snowboarding) the use of a ski or face mask would be helpful against the wind chill.

Poor circulation can be caused by tight clothing or boots, cramped positions, fatigue, certain medications, smoking, alcohol, or diseases that affect the blood vessels such as diabetes.

Recommended attire includes: mittens not gloves, two pair of socks, ear protection and hats and toques to avoid substantial heat loss through the scalp.

Coldest temperature records

The coldest day recorded in Canada was on January 23rd, 1971 when the temperature reached -62.1 degrees Celsius in Snag, Yukon Territory.

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Canada’s coldest windchill was on January 13th, 1975 at Kugaaruk, Nunavut where the air temperature was -51 degrees Celsius and the wind was at 56 km/h, producing a bone-chilling wind chill of -78 degrees Celsius.

Vostok, Antarctica holds the world record for the coldest temperature at -89.2 degrees Celsius in 1983.