The areas most commonly affected are the face and extremities. The symptoms of frostbite are progressive. Victims 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 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 follows: 1. Take the victim indoors. 2. Rewarm hands by placing them under the armpits, against the abdomen, or between the legs. 3. Rewarm feet by placing them in the armpit or against the abdomen of the buddy. 4. Gradually rewarm the affected area by warm water immersion, skin-to-skin contact, or hot water bottles. 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 of the extremity. The skin will not move over bony ridges and will feel 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. 1. Carefully assess and treat any other injuries first. Constantly monitor the victim’s pulse and breathing since respiratory and heart problems can develop rapidly. Be prepared to administer CPR if necessary. 2. 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 victim arrives at a medical treatment facility equipped for long-term care. Refreezing of a thawed extremity causes severe and disabling damage. 3. 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 thawed out. 4. When adequate protection from further cold exposure is available, prepare the victim 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. 5. Rapidly rewarm frozen areas by immersion in water at 100F to 105F (38C to 41C). Keep the water warm by adding fresh hot water, but do not pour the water 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. 6. 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 constriction of the injured area. Keep the skin dry with sterile dressings and place cotton between the toes and fingers to prevent their sticking together. 7. Protect the tissue from additional injury and keep it as clean as possible (use sterile dressings and linen). 8. 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. 9. 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. 4-64