Depending upon the temperature, altitude, and
wind speed, the exposure time necessary to pro-
duce frostbite varies from a few minutes to several
hours. The areas commonly affected are the face
The symptoms of frostbite are progressive.
Victims generally incur this injury without being
acutely aware of it. Initially, the affected skin red-
dens and there is an uncomfortable coldness. With
continued heat loss, there is a numbness of the
affected area due to reduced circulation. As ice
crystals form, the frozen extremity appears white,
yellow-white, or mottled blue-white, and is cold,
hard, and insensitive to touch or pressure.
Frostbite is classified as superficial or deep,
depending on the extent of tissue involvement.
Superficial Frostbite. In superficial frostbite
the surface of the skin will feel hard, but the
underlying tissue will be soft, allowing it to move
over bony ridges. This is evidence that only the
skin and the region just below it are involved.
General treatment for superficial frostbite is as
Take the victim indoors.
Rewarm hands by placing them under the
armpits, against the abdomen, or between
Rewarm feet by placing them in the arm-
pit or against the abdomen of the buddy.
Gradually rewarm the affected area by
warm water immersion, skin to skin con-
tact, or hot water bottles.
Never rub a frostbite area.
Deep Frostbite. In deep frostbite the freez-
ing reaches into the deep tissue layers. There are
ice crystals in the entire thickness of the extremity.
The skin will not move over bony ridges and feels
hard and solid.
The objectives of treatment are to protect the
frozen areas from further injury, to rapidly thaw
the affected area, and to be prepared to respond
to circulatory or respiratory difficulties.
Carefully assess and treat any other injuries
first. Constantly monitor the victims pulse
and breathing since respiratory and heart
problems can develop rapidly. Be prepared
to administer CPR if necessary.
Do not attempt to thaw the frostbitten area
if there is a possibility of refreezing. It is
better to leave the part frozen until the vic-
tim arrives at a medical treatment facility
equipped for long term care. Refreezing of
a thawed extremity causes severe and
Treat all victims with injuries to the feet
or legs as litter patients. When this is not
possible, the victim may walk on the frozen
limb, since it has been proven that walking
will not lessen the chances of successful
treatment as long as the limb has not
When adequate protection from further
cold exposure is available, prepare the vic-
tim for rewarming by removing all
constricting clothing such as gloves, boots,
and socks. Boots and clothing frozen on
the body should be thawed by warm water
immersion before removal.
Rapidly rewarm frozen areas by immersion
in water at 100° to 105°F (38° to 41°C).
Keep the water warm by adding fresh hot
water, but do not pour it directly on the
injured area. Ensure that the frozen area
is completely surrounded by water; do not
let it rest on the side or bottom of the tub.
After rewarming has been completed, pat
the area dry with a soft towel. Later it will
swell, sting, and burn. Blisters may
develop. These should be protected from
breaking. Avoid pressure, rubbing, or con-
striction of the injured area. Keep the skin
dry with sterile dressings and place cotton
between the toes and fingers to prevent
their sticking together.
Protect the tissue from additional injury
and keep it as clean as possible (use sterile
dressings and linen).
Try to improve the general morale and
comfort of the victim by giving hot,
stimulating fluids such as tea or coffee. Do
not allow the victim to smoke or use
alcoholic beverages while being treated.
Transfer to a medical treatment facility as
soon as possible. During transportation,
slightly elevate the frostbitten area and
keep the victim and the injured area warm.
Do not allow the injured area to be exposed
to the cold.
Later Management of Cold Injury
When the patient reaches a hospital or a facil-
ity for definitive care, the following treatment
should be employed:
1. Maintain continued vigilance to avoid fur-
ther damage to the injured tissue. In