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Outdoor First Aid

Got Frostbite? This Advice Might Save Your Fingers

Cold injury can lead to disability or even gangrene and amputation. But advances in its treatment over the last few decades could be a big help.

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I love teaching about frostbite. The science, treatments, and even the history fascinate me. Suffering it, less so: Frostbite inflicts intense pain, steals fingers and toes, and can lead to years of discomfort and disability. Thankfully it’s often preventable—or at least minimized—with some advance planning and prompt treatment.

Simply put, frostbite means that tissue has become frozen: Tiny ice crystals form in feet, hands, ears or other exposed parts leading to tissue damage and diminished circulation. Frostbite starts with pain and numbness, progresses to a pale, waxy appearance on the affected skin, and ultimately develops into a swollen, blistered mess when those tissues eventually warm up. An end game of chronic numbness, severe pain, gangrene or even amputation can follow. 

Unless you’re unexpectedly stuck in a severely cold environment, you should be able to prevent frostbite. Start with preventing hypothermia—dress appropriately for weather conditions and make sure you’re adequately fueled—then ensure that you and your partners never tolerate tissue pain or numbness while out in the cold (those four pairs of socks you’re wearing may be working against you, compressing your feet so much that blood can’t circulate properly).  Alcohol and tobacco don’t help, either. Exposed skin can begin to freeze in a matter of minutes—think taking off your gloves to light your stove in the beam of your headlamp. Even the tip of your nose as you ride the chairlift in a biting wind.

“Any significant frostbite injury means it’s time to head home and get warm.”

Once frostbite has occurred, how you respond can make a big difference. Back in 1962, legendary American mountaineer Bradford Washburn published a paper in the American Alpine Journal (eventually reprinted in the New England Journal of Medicine) advocating warm water immersion rather than the long-touted method of slowly warming frozen tissue by rubbing with snow, or plunging frostbitten parts into cold water. Washburn’s influence helped to usher in the modern era of frostbite treatment. The warm water strategy revitalizes tissue swiftly and still makes sense as long as re-freezing is unlikely (never rewarm frostbite if there’s a chance that your patient will again be exposed to a freezing environment, as that can compound the damage.)

Since Washburn’s game-changing guidelines, we’ve discovered that the freezing process leads to the formation of tiny blood clots in the smallest blood vessels in the skin. Timely administration of medications like the clot-busting drug TPA can salvage frostbitten parts that would otherwise have been lost. Additional drugs that dilate constricted blood vessels improve circulation and even prevent amputation weeks or months later. 

Any significant frostbite injury means it’s time to head home and get warm. Seeking urgent first aid as well as advice about advanced treatments could mean the difference between chronic pain and amputation, and heading back outside next season with all your digits intact.

Christopher Tedeschi teaches and writes about wilderness and disaster medicine. He is associate professor of emergency medicine at Columbia University and an editorial board member for the journal Wilderness and Environmental Medicine. He enjoys hiking and biking near his home in the lower Hudson Valley.