"Well, the ole Wind/Chill factor...."

Cold Emergencies can be grouped into three categories:

• Frostnip

• Frost bite

• Hypothermia

Frostnip is a group of cold injuries (including chilblains and trench foot ["cold immersion foot"]) which occur without freezing of body tissue.  It is the beginning of a process that, left uncorrected, will lead to greater injury.  To treat the victim of frostnip, protect the patient from further cold exposure, remove wet clothing and gently dry and re-warm the affected part.  Taking warm fluids by mouth may help the re-warming process.

Frost bite is a move (from frostnip) toward greater damage, in-as-much-as some freezing has occurred.  To treat this victim, the provider should make available a warm environment and the frozen parts should be allowed to warm naturally.  Do not manipulate the frozen parts, this will only lead to cellular damage and muscle tearing.  If there is any possibility that the frozen part will re-freeze, DO NOT thaw.  The re-freezing will cause larger crystals to form and the resulting damage will be greater than if the part had been left frozen a little while longer.

Hypothermia presents with a patient that is initially alert and shivering.  As the process progresses, the patient's level of consciousness deteriorates and the shivering stops.  At the later stages of hypothermia the patient is in a state of extreme medical emergency.  Most patients encountered by the first aid provider will be in a mild state of hypothermia (characterized by shivering) and should be provided with a warm environment and given warm fluids by mouth.  If possible wet warm cloths should be placed under the patient's armpits and in the patient's groin (near the top of the legs.)  Once the patient has begun to feel some relief, then start warming the extremities (arms & legs.)  If the patient is in a state of profound hypothermia (characterized by altered consciousness and lack of shivering,) the patient needs to transported immediately to a critical care facility where "core warming" can be initiated with warm IV fluids, warm oxygen, peritoneal lavage, and warm saline insufflations.  None of these therapies are available outside the critical care facility and the only thing that a first aider can do for this patient would be to offer an environment that is just slightly warmer than the outside environment.  It is essential that this patient's core be warmed first and to place this patient is a "comfortably warm" environment would tend to warm the extremities first.

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