is followed by a feeling of listlessness, indifference,
and drowsiness. Unconsciousness can follow quickly.
Shock becomes evident as the casualtys eyes assume a
glassy stare, respiration becomes slow and shallow,
and the pulse is weak or absent. As body temperature
drops even lower, peripheral circulation decreases,
and the extremities become susceptible to freezing.
Finally, death results as the core temperature of the
body approaches 80°F.
To treat hypothermia, take the following steps:
1. Carefully observe respiratory effort and
heartbeat; you may have to give CPR during the
2. Rewarm the casualty as soon as possible. Severe
bleeding must be controlled and fractures splinted over
clothing before the casualty is moved.
3. Replace wet or frozen clothing and remove
anything that constricts the casualtys arms, legs, or
fingers, interfering with blood circulation.
4. If the casualty is inside a warm place and is
conscious, the most effective method of warming is
immersion in a tub of warm water (100°F to 105°F or
38°C to 41°C). The water should be warm to the elbow
and never hot. Observe closely for signs of respiratory
failure and cardiac arrest (rewarming shock).
5. If a tub is not available, apply external heat to
both sides of the casualty. Natural body heat (skin to
skin) from two rescuers is the best method. This is called
buddy warming. If this is not practical, use hot water
bottles or an electric rewarming blanket, but do not
place them next to bare skin. Be careful to monitor the
temperature of the artificial heat source; the casualty is
very susceptible to burn injury. Because casualties are
unable to generate adequate body heat, placing them
under a blanket or in a sleeping bag is not sufficient
6. If the casualty is conscious, give warm liquids to
drink. Never give alcoholic beverages, or allow the
casualty to smoke.
7. Dry the casualty thoroughly if water is used for
8. As soon as possible, transfer the casualty to a
definitive care facility. Be alert for the signs of
respiratory and cardiac arrest during transfer, and keep
the casualty warm.
CHILBLAINS.Chilblains are a mild cold
injury caused by prolonged and repeated exposure to
air temperatures from just above freezing (32°F or
0°C) to as high as 60°F or 16°C. Chilblains are
characterized by redness, swelling, tingling, and pain
of the skin area. Injuries of this nature require no
specific treatment except warming of the affected part,
keeping it dry, and preventing further exposure.
IMMERSION FOOT.Immersion foot, which
also may occur in the hands, results from prolonged
exposure to wet cold at temperatures ranging from just
above freezing to 50°F or 10°C. It is usually in
connection with limited motion of the extremities and
water-soaked protective clothing.
Signs and symptoms of immersion foot are
tingling and numbness of the affected areas; swelling
of the legs, feet, or hands; bluish discoloration of the
skin; and painful blisters. Gangrene may occur.
To treat immersion foot, follow these steps:
Get the casualty off his/her feet as soon as
Remove wet shoes, socks, and gloves to
Expose the affected area to warm dry air.
Keep the casualty warm.
Do not rupture blisters or apply salves and
If the skin is not broken or loose, the injured part
may be left exposed; however, if you must
transport the casualty, cover the injured area
with loosely wrapped fluff bandages of sterile
If the skin is broken, place a sterile sheet under
the extremity and gently wrap it to protect the
sensitive tissue from pressure and additional
Transport the casualty as soon as possible to a
medical facility as a litter patient.
FROSTBITE.Frostbite occurs when ice
crystals form in the skin or deeper tissues after
exposure to a cold temperature, high altitude, and
high-wind speed. The exposure time necessary to
produce frostbite varies from a few minutes to several
hours. The areas commonly affected are the face and
The symptoms of frostbite are progressive.
Casualties generally incur this injury without being
acutely aware of it.. Initially, the affected skin reddens
and there is an uncomfortable coldness. With
continued heat loss, there is a numbness of the affected