Hypothermia and other life threatening conditions may be present in the patient with frostbite and must be evaluated and treated immediately.
When caring for a person in extremely cold temperatures, take great care to prevent hypothermia, tissues from becoming frostbitten, and already frostbitten tissues from becoming worse.
If transporting a person with frostbite that will not be re-warmed in the field, you should protect the frostbitten parts from additional injury and temperature changes.
Superficial frostbite affects the skin surface and shallow subcutaneous layers of the skin and is recognized by white or gray colored patches. The affected skin feels firm, but not hard. The skin initially turns red and, once frostbitten, is not painful. No tissue loss will occur when treated properly.
Deep frostbite affects the dermal and sub-dermal layers and may involve an entire digit or body part. The skin feels hard and cold and the affected tissue is white or gray. A pulse cannot be felt in the deeply frostbitten tissue and skin will not rebound when pressed.
Large blisters on the frostbitten area indicate that deep frostbite has partially thawed.
Treatment of deep frostbite is usually extremely painful and best accomplished in a medical facility. If you can get the person to a medical facility within a reasonable amount of time, or do not have the capability to re-warm the tissues properly or cannot prevent re-freezing, you should transport the person rather than attempt to re-warm the tissue in the field. Advice should be sought from a physician by radio or telephone before electing to re-warm frostbitten tissue in the field, whenever possible.
In most circumstances, the risks posed by improper re-warming or re-freezing outweighs the risks of delaying treatment for deep frostbite.
Tissue that is thawed and then re-frozen almost always dies. Consequently, the decision to thaw the frostbitten tissue in the field commits the provider to a course of action that may involve pain control, maintaining warm water baths at a constant temperature, and protecting the tissue from further injury during re-warming and eventual transport. If re-warmed in the field, frostbitten extremities cannot be used for ambulation.
It is reasonable to consider re-warming the frostbitten tissue in a controlled manner if uncontrolled, spontaneous, re-warming is likely to occur during prolonged evacuation or transport.
Make plans for transporting the person as early as circumstances allow. In some circumstances, when frostbite is not severe and is not complicated by other injuries, and there are resources available to monitor the person's progress, a physician should be consulted. He or she may decide the person should not be transported.
Do not:
Frostbitten tissues should be handled extremely gently before, during, and after re-warming.
Anticipate, assess and treat the person for hypothermia, if present.
Assess the frostbitten area carefully since the loss of sensation may cause the person to be unaware of soft tissue injuries in that area.
If the decision is made to re-warm frostbitten tissue in the field, you should prepare a warm water bath (approximately 100° - 106° F) in a container large enough to accommodate the frostbitten tissues without them touching the sides or bottom of the container.
Remove jewelry and clothing, if present, from the affected area.
If possible, consult a physician regarding the administration of oral analgesics, such as acetaminophen, ibuprofen or aspirin.
Water should be maintained at approximately 100° - 106° F and gently circulated around the frostbitten tissue until the tip of the frostbitten part becomes flushed.
Pain after re-warming usually indicates that tissue has been successfully re-warmed.
After re-warming, let the frostbitten tissues dry in the warm air. Do not towel dry.
After thawing, tissue that was deeply frostbitten may develop blisters or appear cyanotic (bluish). Blisters should not be broken and must be protected from injury.
Pad between affected digits and bandage affected tissues loosely with a soft, sterile dressing.
Re-warmed extremities should be kept at a level above the heart, if possible.
Protect the re-warmed area from refreezing and other trauma during transport.
Do not allow an individual who has frostbitten feet to walk except when the life of the person or rescuer is in danger. Once frostbitten feet are re-warmed, the person becomes non-ambulatory.