2. Rewarm the victim as soon as possible. It may
be necessary to treat other injuries before the
victim can be moved to a warmer place. Severe
bleeding must be controlled and fractures
splinted over clothing before the victim is
3. Replace wet or frozen clothing and remove
anything that constricts the victims arms, legs,
or fingers, interfering with circulation.
4. If the victim is inside a warm place and is
conscious, the most effective method of
warming is immersion in a tub of warm (100 to
105F or 38 to 41C) water. The water should
be warm to the elbownever hot. Observe
closely for signs of respiratory failure and
cardiac arrest (rewarming shock). Rewarming
shock can be minimized by warming the body
trunk before the limbs to prevent vasodilation in
the extremities with subsequent shock due to
blood volume shifts.
5. If a tub is not available, apply external heat to
both sides of the victim. 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. Do not place the blanket or
bottles next to bare skin, however, and be
careful to monitor the temperature of the
artificial heat source, since the victim is very
susceptible to burn injury. Because the victim is
unable to generate adequate body heat,
placement under a blanket or in a sleeping bag is
not sufficient treatment.
6. If the victim is conscious, give warm liquids to
drink. Never give alcoholic beverages or allow
the victim to smoke.
7. Dry the victim thoroughly if water is used for
8. As soon as possible, transfer the victim to a
definitive care facility. Be alert for the signs of
respiratory and cardiac arrest during transfer,
and keep the victim warm.
Local cooling injuries, affecting individual parts
of the body, fall into two categories: freezing and
In the order of increasing
seriousness, they include chilblain, immersion foot,
superficial frostbite, and deep frostbite. The areas
most commonly affected are the face and extremities.
CHILBLAIN.Chilblain is a mild cold injury
caused by prolonged and repeated exposure for several
hours to air temperatures from above freezing 32F
(0C) to as high as 60F (16C).
characterized by redness, swelling, tingling, and pain
to the affected skin area. Injuries of this nature require
no specific treatment except warming of the affected
part (if possible use a water bath of 90F to 105F),
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 50F (10C). Immersion foot is
usually seen 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.
General treatment for immersion foot is as follows:
1. Get the victim off his feet as soon as possible.
2. Remove wet shoes, socks, and gloves to
3. Expose the affected area to warm, dry air.
4. Keep the victim warm.
5. Do not rupture blisters or apply salves and
6. If the skin is not broken or loose, the injured part
may be left exposed; however, if it is necessary
to transport the victim, cover the injured area
with loosely wrapped fluff bandages of sterile
7. 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
8. Transport the victim as soon as possible to a
medical treatment facility as a litter patient.
FROSTBITE.Frostbite occurs when ice
crystals form in the skin or deeper tissues after
exposure to a temperature of 32F (0C) or lower.
Depending upon the temperature, altitude, and wind
speed, the exposure time necessary to produce
frostbite varies from a few minutes to several hours.