area because of 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.
4. When adequate protection from further cold
exposure is available, prepare the casualty 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.
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.
To treat superficial frostbite, follow these steps:
5. Rapidly rewarm frozen areas by immersion in
water at 100°F to 105°F or 38°C to 41°C. Keep the
water warm by adding fresh 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.
1. Take the casualty indoors.
2. Rewarm hands by placing them under the
armpit, against the abdomen, or between the
3. Rewarm feet by placing them in the armpit or
against the abdomen of a buddy.
6. After rewarming has been completed, pat the
area dry with a soft towel. At first, the injured area will
feel numb and look mottled blue or purple. Later it will
swell, sting, and burn. Blisters may develop and should
be protected from breaking. Avoid pressure, rubbing, or
constriction of the injured area. Keep the skin dry with
sterile dressings and place cotton between the toes and
fingers to prevent them from sticking together.
4. Gradually rewarm the affected area by warm
7. Protect the tissue from additional injury and
water immersion, skin to skin contact, or hot
keep it as clean as possible (sterile dressings and linen
should be used).
5. Never rub a frostbite area.
Deep Frostbite.In deep frostbite, the freezing
reaches into the deep tissue layers. There are ice
crystals in the entire thickness or the extremity. The
skin will not move over bony ridges and feels hard and
8. Try to improve the general morale and comfort
of the casualty by giving hot, stimulating fluids such as
tea or coffee. Do not allow the casualty to smoke or use
alcoholic beverages while being treated.
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.
9. Transfer the casualty to a medical facility as
soon as possible. During transportation, slightly elevate
the frostbitten area and keep the casualty and the injured
area warm. Do not allow the injured area to be exposed
to the cold.
PREPARING THE CASUALTY FOR
To treat deep frostbite, follow these steps:
1. Carefully assess and treat any other injuries
first. Constantly monitor the casualtys pulse and
breathing since respiratory and heart problems can
develop rapidly. Administer CPR if necessary.
2. Make no attempt to thaw the frostbitten area if
there is a possibility of refreezing. It is better to leave the
part frozen until the casualty arrives at a medical facility
equipped for long term care. Refreezing of a thawed
extremity causes severe and disabling damage.
Before transporting the casualty, ensure that the
patient is stable enough to be moved. First, make sure
that all hemorrhaging is under control and wounds
have been dressed. Second, make sure that all fractures
have been splinted and the victim has been treated for
shock. If morphine or an IV was administered, see that
the casualty has been marked and a U.S. Field Medical
Card filled out. The casualtys vital signs should be
stable so there will be no problems in route.
TRANSPORTING THE INJURED
3. Treat all casualties with injuries to feet or legs as
litter patients. When this is not possible, the casualty
may walk on the frozen limb, since it has been proved
that walking will not lessen the chances of successful
treatment as long as the limb has not thawed out.
It is a basic principle that an injured person must be
given essential treatment before being moved.
However, it is obviously impossible to treat injuries
while the casualty is in a position of immediate danger.