Intro:
Before you begin
Step 1:
Understand frostbite
Step 2:
Prevent frostbite
Step 3:
Treat frostbite

2torial #0734:
Learn2 Avoid Frostbite

Jack Frost nipping off your toes...

There's a host of reasons to be outside in the dead of winter: work, for one, or any of those lovely Winter Wonderland activities like skiing or ice fishing. But no matter what takes you outside, don't forget this fact: once the temperatures outside drop below 32 degrees F (0 degrees C), you're in the frostbite zone.

Frostbite has a quaint name, but it's simply the overexposure of skin and soft tissue to cold. The result is an actual freezing of the skin, and depending on the severity of the frostbite, the freezing of subcutaneous tissues like fat deposits, blood vessels, muscle, nerve, tendon, and even bone. It's important to recognize the signs of each progressive stage of frostbite, because the treatment differs depending on the severity.

Due to certain facts about blood circulation and surface area-to-volume ratios, your extremities (hands and feet) and exposed facial areas (cheeks, nose, and ears) are most susceptible to this cold injury. It's therefore best to keep an eye on these areas, and use them to indicate your body's ability to keep itself warm.

But frostbite is no reason to stay indoors on a cold day, or even a very cold day. Most cases of frostbite could have been avoided with proper preparation--the kind of preparations suggested in this 2torial.

For all the potential discomfort and injury that frostbite can cause, it's surprisingly easy to avoid. For prevention, just remember to stay warm, dry, well fed, and well rested. And for treatment, there's an important fact: if you're in the backcountry and become frostbitten, don't thaw out any frostbitten area until you've reached a warm and stable shelter. If frostbitten tissue is thawed out and then re-exposed to freezing temperatures, even more serious injury can result. Until you can warm your entire body and keep it warm, protect the affected area from sources of heat like campfires and car heaters.

Understand frostbite

Your body is reacting (perhaps overreacting, in some cases) to the dropping of its core temperature (see Keywords). If an effort to reduce heat loss, it constricts the blood vessels in the extremities. This allows more blood to circulate in the core of the body (thus maintaining its temperature), but this action deprives the extremities of the warming effect of blood circulation. Without that support, fingers, toes, ears, and noses can't sustain proper body temperature, and eventually start to freeze.

So you can think of frostbite as a failure of blood circulation. Blood and other fluids in the affected area thicken and congeal as the temperature of the tissue drops. Warm blood from the rest of the body, which would normally maintain the proper body temperature, can't pass through the frozen tissue. If the tissue remains frozen long enough (as in severe cases of frostbite), the cells in the tissue will die, and the injured area will turn black and fall off.

Frostbite can develop in three distinct stages that are roughly similar to burn degrees: frostnip, which is not actually frostbite; superficial frostbite, and deep frostbite. Here's how to recognize them:

• Frostnip: This is the mildest form of cold injury (it's not actually frostbite). It usually appears on the ears, nose, or cheek as a whitish, waxy-looking patch of skin. This is commonly happens in situations with severe cold and wind chill (see Keywords), when the affected part is exposed for even a few minutes. Immediate warming of the area (fingertips placed under the armpits, for example) often results in a complete recovery. The area will become red and painful, feeling as if it were burned, and may blister.

• Superficial frostbite: When frostnipped skin isn't warmed up, it'll often develop into superficial frostbite. At this stage, the tissue under the skin has begun to freeze and will appear white and bloodless, although it'll remain soft and pliable when you touch it. Frostbitten tissue will often develop large blisters a day or so after the exposure; these blisters will harden and turn into eschar, a thick, black scar tissue that takes a few weeks to be replaced by new skin.
  

• Deep frostbite: This is a serious condition which occurs only in extreme climatic conditions: usually at high elevations or near polar caps. In this case the soft tissue below the skin freezes solid: the area turns deep red or purple, feels cold to the touch but itself has no sensitivity remaining. Deep tissue damage results, possibly leading to amputation. Fortunately the occurrence of deep frostbite is quite rare for the average outdoor enthusiast.

   

Know the combinations

If the last step has frightened you into never leaving the house on a cold dayäwell, you're overreacting. Most frostbite cases could have been avoided if proper preparation had been taken, and the majority of those cases result in a minor injury that heals within a few days. One way to avoid frostbite is to recognize the following risky situations, so that you may prepare for them:

• Temperatures below 20 degrees F (-7 degrees C).
  
• Moisture on the body, whether from snow, rain, or perspiration. Lab tests show that wet skin freezes twice as fast as dry skin. Keep it dry!
  
• Windchill: It doesn't take a gale, either. A constant light wind will drop temperatures considerably, and make any exposed skin susceptible to frostnip.
  
• High altitudes: Thin air makes the circulation system work harder, making it more difficult to get blood to the extremities.
  
• A history of frostbite: Once you get frostbite on a particular body part, that part is particularly susceptible to frostbite, and needs to be monitored carefully for any signs of frostbite.

What you can do

Dress right!

• Layering: Wearing several layers of loose, warm clothing will not only keep you from getting too cold, it'll prevent you from getting too warm. Once you start sweating, take off a layer. Otherwise your sweat will cool you down too much, and in an effort to conserve body heat, will force your body to draw blood away from the extremities.
  
• Cover up: Make sure your scalp, neck, face and ears are well-covered with any combination of hats, scarves or neck gaiters, and ski masks, especially on windy days.
  
• Extra, extra: Take extra socks and long underwear. Changing damp clothing is the best way to maintain body temperature and reduce frostbite.

Before you go...

• Fill 'er up: Before, during, and after your time outside, eat a lot of nutritious food; this isn't the time to avoid fats and skimp on portions. Through digestion your body turns food into heat and energy. Next time you're feeling a little tired and cold, eat something: you'll feel your warmth and energy increase within ten minutes.
  
• Get a weather report: If you're planning on being outside all day, make sure that the mother of all storms isn't coming your way.

While you're out there...

• Working: if you're working outside, go inside once an hour or so to warm up and change sweaty clothing.

• Do the whirl: Your fingers need some warm blood to keep from freezing; here's a way to send blood down to your fingers. Moving from the shoulder joint, whirl an arm in a circle 25 or 30 times. For your feet, try wriggling the toes regularly and hopping up and down lightly from foot to foot. (Don't stomp heavily, or you may damage cold-injured tissue). Some folks may think you're crazy, but you're improving the chances of keeping your toes on your foot.
  
• Fatigue: Once you're exhausted, you've greatly reduced your ability to stay warm. It may sound obvious, but some folks engage in a flurry of activity once they feel themselves getting cold. Keep active, yes; but pace yourself, or else you'll spend your energy reserves too quickly.

Items to avoid:

• Be very careful to avoid touching bare flesh to bare metal. This is know as conduction: metal transfers heat more easily than air, and bare metal will draw the heat right from your hand and leave frostbite in its place. Gasoline, which has a freezing point of -70 degrees F ( degrees C) will produce instant frostbite if it contacts bare flesh. Always use gloves and other protection before handling these types of materials.
  
• No boozing: Alcohol consumption and cold weather are a very bad mix. Aside from impairing your judgment (a crucial faculty to keep you alive in extreme weather), alcohol cools down your body by dilating the blood vessels near the surface of the skin. Your body just shut down those blood vessels because its core was in danger of getting to cold; ingesting alcohol thwarts the body's effort to protect itself. Nicotine in tobacco impairs blood circulation, so that's best avoided, too.
  

Treat frostbite

If you do develop frostbite (as opposed to frostnip, which you can treat yourself), seek professional medical attention as soon as possible. Whereas frostnip responds well to immediate warming, frostbite needs to be treated carefully, or permanent damage to the tissue can result.

If you get superficial or severe frostbite and medical attention is unavailable, here's how to do an effective home treatment. This isn't meant to substitute proper medical attention; all cases of frostbite should be examined by a health care professional as soon as possible.