Avoiding, treating hypothermia and frostbite

In the wake of the recent death by hypothermia of a 31-year-old Australian soldier visiting the Adirondacks, apparently a suicide, I’ve received a number of inquiries about just what hypothermia is and about the dangers and symptoms of both hypothermia and frostbite. Most were from concerned parents of younger children.

My initial response is to tell them that very few northern New Yorkers believe that cold weather is a reason to stay indoors. And for North Country kids, winter is fun! It’s the season of snowmen, snowballs, snow forts, snow sculptures, sledding, tobogganing, tubing and ice skating. There’s also snowmobiling, snowshoeing, snowboarding, downhill skiing, cross-country skiing, dog sledding, ice fishing, ice climbing, winter hiking, winter camping, and winter carnival parades.

We’re not strangers to the cold. Many of us work outdoors or have friends or neighbors who work outdoors during the winter; on construction or logging crews or as farmers, truckers, police and firefighters. Others may travel considerable distances to and from work. All of these situations leave people vulnerable to exposure to adverse weather conditions for extended periods of time.

Most of us recognize that prolonged exposure to cold and wind can be extremely dangerous; even more so if you are not prepared. But many don’t realize that the danger of cold-related injuries is compounded if you have poor circulation, if you are tired, or if you’ve been drinking. Age, physical condition, smoking, and the use of certain medications are also factors that can increase risk.

To understand how and why cold injuries occur, we must first recognize that the body’s ability to generate heat and prevent heat loss is very limited. Core temperature (97.7 to 99.5 degrees) is maintained by the hypothalamus in the brain, which makes physiological adjustments in response to temperature receptors in the body’s shell. Cold injury occurs when the body’s ability to thermo-regulate becomes compromised.

Essentially, hypothermia is injury to the body’s core, systemic injury. Frostbite is injury to the shell, localized injury to a body part or parts. They often occur together. While both are preventable, knowing what to look for, and what to do should either of these conditions develop is critical.

Hypothermia occurs when the body is losing heat faster than it can generate it. Shivering is often the first sign; a warning, if you will. Slow or slurred speech, lethargy and drowsiness may follow. As the condition worsens, victims will often become disorientated and/or incoherent. Exhaustion will set in. Breathing will become reduced and heart rate will be lowered. In severe cases, the sufferer may lapse into a coma and/or die. Sweating or getting wet can increase the risk of hypothermia and accelerate the onset of the advanced stages.

First aid for hypothermia includes getting the victim out of the cold; inside if possible, and replacing cold or wet clothing with clothing that is warm and dry. You can use warm blankets (electric blankets work well), a sleeping bag, and / or body-to-body contact to provide additional warmth. Be sure to insulate the victim’s head and neck. Fifty percent of the body’s heat loss is through the head.

Do not massage the victim’s arms or legs. It will push cold blood toward the heart, possibly causing heart failure to occur. Elevating the feet and lowering the head will safely promote increased circulation to the chest.

A hypothermia sufferer that is fully conscious and able to sit upright on his or her own should drink warm, non-alcoholic, caffeine-free beverages.

Frostbite occurs when a part of the body actually freezes. It most commonly affects the extremities; the fingers, toes, ears, nose and cheeks. Mild or superficial frostbite injury entails the freezing of skin and subcutaneous tissue. There is often, but not always, some discomfort or mild pain. A victim’s skin may become slightly discolored. Some numbing may follow. As fluids freeze and ice crystals form in the tissue, blisters will develop.

Mildly frostbitten skin should be warmed slowly. One method is to blow on or hold warm hands against the affected area. Warm water may also be used, but never use hot water or excessive heat and do not rub or massage traumatized tissue. Once the injured tissue has been warmed, be extremely careful to avoid refreezing the area.

While mild frostbite seldom results in any lasting damage, deep or severe frostbite often does. Deep frostbite injuries can affect muscles, tendons, nerves, even bone. Immediate medical attention is recommended for severe frostbite.

If a victim is showing signs of both hypothermia and frostbite, treat the hypothermia first.

The absolute best thing you can do is avoid cold injury completely by wearing loose fitting, lightweight, layered clothing that will keep you warm and dry. The innermost garment should be made of a material that wicks moisture away from the body. The outermost layer should offer protection from the wind. In between layers should be made of wool or other warm materials. Wear wool socks, too. In fact, wear multiple layers of socks. And put on warm boots that fit properly. Be sure to protect your head and neck with a hat, scarf and/or a hood. And keep in mind that mittens will offer better hand protection than gloves. Stay dry.

Bear in mind that children are extremely vulnerable to frostbite and hypothermia because they do not recognize just how dangerous either of these conditions can be. And don’t forget that pets are susceptible to cold weather injury, too.