As we consider first aid for frostbite, keep in mind that there is no other condition where it rings as true that prevention is far more important than treatment.
The Frostbite Assessment
As we discuss in Raven Medical wilderness first aid training, the frostbite assessment is completed twice. First, assess the injury while frozen. The second assessment is completed with tissue thawed.
While frozen, assess to determine depth of the frozen tissue:
- Pale or white skin
- Cold and numb
- Frozen skin feels separate from underlying tissue
- Hard, pale or blue — with no sensation
- Frozen into underlying tissue with limited movement of joints
Once the injury has been thawed, assess the area looking for signs of deep tissue damage.
Superficial injury will have white or yellow raised areas with some mild swelling. More serious superficial injury will have clear or milky blisters and obvious swelling. The area will be painful as well.
Deep frostbite will result in tissue loss and can be identified by blue or black tissue on thawing. Blisters associated deep injury will be blood tinged. Significant swelling and pain will also be present.
First aid for frostbite treatments are all the same. The tissue needs to be thawed as soon as practical. Ideally the injury is thawed in a controlled manner – warm water with good pain management.
This is not always practical. In the field some hard decisions might have to be made. This is where some treatment principles will help guide you in the best treatment plan.
- Re-warm with a strong radiant heat source – camp fire, stove etc.
- Rub frostbitten tissue
- Apply ice or snow or anything cold.
What To Do?
- Thaw with warm water or body contact – expect not to be able to use the limb once thawed.
- Immobilize and elevate(if possible) injury and apply dry dressings to blisters.
- If field re warming is not possible, then evacuate patient with frozen tissue, even walking on frozen toes, if there is no other option.
- Balance the risk – time delay to thaw the frozen tissue vs evacuating to a hospital. It might be better to evacuate patient while preventing hypothermia.
- Spontaneous re-warming is ok. Don’t do anything to prevent spontaneous thawing.
- Treat the patient for hypothermia
- Administer Ibuprofen for pain – Add stronger meds if necessary.
- Never allow thawed tissue re-freeze – this will cause extensive damage.
Evacuation decisions are based on severity of injury once re-warming has occurred. If field re-warming is not possible, then a rapid evacuation is reasonable for all deep injuries.
Generally, all frostbite injuries need evacuation. However, superficial frostbite with small clear blisters may be manageable in the field. Consideration must be given to: protecting the injury, preventing re-freezing, and pain management in the field.
Determining evacuation urgency requires balancing risk, a skill developed during Raven Medical’s hands-on scenarios. Further tissue damage, hypothermia, mobility of patient, and demands of the terrain/evacuation must all be considered.
Heeding First Aid For Frostbite Considerations
Frostbite is one of those seemingly simple injuries. However, it is complex to manage and can easily start a downward spiral with life threatening consequences.
Prevention is by far the best medicine. Monitor travel mates for signs/symptoms, stay warm and hydrated, keep covered and watch out for tight fitting clothing. Most importantly, aggressively treat any early signs of freezing injuries!
Frostbite permeates the stories of the north and high adventure. Everyone should heed these cautionary tales – death can result from a few frozen fingers.