“Day had broken cold and gray, exceedingly cold and gray …” With those words, Jack London opened his classic story “To Build a Fire,” a vivid tale of the struggle between a man and bone-cracking Yukon winter cold.
I was reminded of this story by January’s near record-breaking cold, and by my perpetually chilled fingers and toes. Cold injury — specifically frostbite — was a constant lurking risk.
What is frostbite? Simply put, it is the freezing of tissue with the formation of ice crystals between and even within the cells. Our high mountain environment, continental winters and outdoor-oriented lifestyles make it an all-too-common occurrence. After all, our bodies are composed primarily of water, and we humans are not exempt from the laws of physics.
Naturally, those at highest risk include outdoor athletes and workers. However, the very young, the elderly and those with medical conditions affecting circulation or sensation also require special attention.
Frostbite can occur anywhere on the body that is exposed to cold but tends to be most common at sites “at the end of the line” of circulation — ears, nose, fingers and toes. Wind and wet increase the threat. The skin becomes pale and whitish in appearance, feels icy and waxy, and is numb and difficult to move.
At its mildest and most limited form, the injury is readily healed without lasting effect. More significant consequences can include long-term pain, numbness, altered appearance, and even loss of the frostbitten part. This makes early recognition vitally important.
Treatment of the frostbitten part hinges on gentle rewarming. After the victim is brought in from the cold environment, wet or restricting clothes must be removed. Hands and feet are best warmed in a bath of lukewarm water. Placing warm packs or warm skin on other body areas is effective.
Rubbing affected skin can worsen injury. Also never allow a part that has been rewarmed to refreeze, as that compounds the injury. As gruesome as it sounds, it is better to walk to safety on frostbitten feet than to allow them to be injured a second time.
Since the injury can continue to evolve for days after rewarming, and the ultimate outcome can be improved by proper treatment, it is prudent to have any frostbite evaluated by a medical professional.
I talked to Kristia Check-Hill, an incident commander and 12-year veteran of Routt County Search and Rescue, about her experiences with frostbitten individuals in the field. She reports that certain mistakes are committed regularly. These include allowing oneself to become thoroughly cold, wet and numb before taking action, and neglecting to bring along proper supplies when traveling into hostile environments.
She particularly recommends spare dry socks and air-activated hand warmers as easily portable items that can be invaluable in emergencies. She also notes that Search and Rescue team members keep an eye on one another for signs of cold injury while on missions.
Awareness and prevention always are the best strategy. If avoiding frigid, wet and windy environments is not possible, use a hat, coat, gloves and proper footwear to trap a layer of warm dry air next to the skin.
A final point is the danger posed by alcohol. The warm glow that follows consumption of one’s favorite adult beverage is a ruse. Alcohol creates a nasty cocktail of accelerated heat loss by dilating blood vessels, blunting sensation and impairing judgment. As an emergency physician, some of the worst cases of frostbite I have seen have been in intoxicated individuals.
I hope this leaves you with an understanding of the risk of frostbite and an appreciation of the value of prevention and prompt treatment. I’ll let Jack London help drive home the point: “This time the shivering came more quickly upon the man. He was losing in his battle with the frost. It was creeping into his body from all sides.” Now that’s cold.
Dr. Nate Anderson is an emergency physician and trauma medical director at Yampa Valley Medical Center. He can be contacted at firstname.lastname@example.org.