³ Treating for Cold Exposure and Frostbite ³ The following material may assist you in treating a victim forexposure to the cold and also how to deal with frostbite. Thisinformation is derived from "Advanced First Aid & Emergency Care,"2nd edition, by the American Red Cross. To obtain a copy of thisbook and to take instruction in first aid, please contact the localoffice of the American Red Cross. They are listed in the whitepages of your telephone book. =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= The extent of injury caused by exposure to abnormally lowtemperature generally depends on such factors as wind velocity,type and duration of exposure, temperature and humidity. Freezing is accelerated by wind, humidity or a combination ofthe two. Injury caused by cold, dry air will be less than thatcaused by cold, moist air or exposure to cold air while wearing wetclothing. Fatigue, smoking, drinking of alcoholic beverages,emotional stress and the presence of wounds or fractures intensitythe harmful effects of cold. SIGNS AND SYMPTOMS The general manifestations of prolonged exposure to extremecold include shivering, numbness, low body temperature, drowsinessand marked muscular weakness. As time passes there is mentalconfusion and impairment of judgment. The victim staggers, hiseyesight fails, he falls and he may become unconscious. Shock isevident and the victim's heart may develop fibrillation. Death, ifit occurs, is usually due to heart failure. Frostbite results when crystals form, either superficially ordeeply in the fluids and the underlying soft tissues of the skin.The effects are more severe if the injured area is thawed and thenrefrozen. Frostbite is the most common injury caused by exposure tothe cold elements. Usually, the frozen area is small. the nose,cheeks, ears, fingers and toes are the most commonly affected. Just before frostbite occurs, the affected skin may be slight-ly flushed. The skin changes to white or grayish yellow as thefrostbite develops. Pain is sometimes felt early but subsideslater. Often there is NO pain; the part being frostbitten simplyfeels intensely cold and numb. The victim commonly is not aware offrostbite until someone tells him or until he observes his pale,glossy skin. The extent of local injury cannot be determinedaccurately on initial examination, even after rewarming. The extentof tissue damage usually corresponds to that in burns. In superfi-cial frostbite, there will be an area that looks white or grayishand the surface skin will feel hard but the underlying tissue willbe soft. With deeper involvement, large blisters appear on thesurface, as well as in underlying tissue, and the affected area ishard, cold and insensitive. Destruction of the entire thickness ofthe skin will necessitate skin grafting and will constitute amedical emergency, because gangrene may result from loss of bloodsupply to the injured part. FIRST AID The objectives of first aid are to protect the frozen areafrom further injury, to warm the affected part rapidly and tomaintain respiration. Formerly, it was recommended that victims offrostbite be treated by slow warming -- rubbing with snow andgradually increasing the temperature. But recent studies have shownconclusively that much better results are obtained if the affectedpart is WARMED RAPIDLY in running or circulating water, unless thepart has been thawed and refrozen, in which case it should bewarmed at room temperature (from 70 to 74 degrees Fahrenheit). DoNOT use excessive heat, as from a stove, hot water bottles, elec-tric blankets or other devices. FROSTBITE1. Cover the frozen part.2. Provide extra clothing and blankets.3. Bring the victim indoors as soon as possible.4. Give him a warm drink (not alcoholic!).5. Rewarm the frozen part QUICKLY by immersing it in water that is warm but not hot. Test the water by pouring some over the inner surface of your forearm or place a thermometer in the water and carefully add warm water to keep the temperature between 102 degrees and 105 degrees Fahrenheit. If warm water is not available or practical to use, wrap the affected part in a sheet and warm blankets.6. Handle the area of the frostbite GENTLY and DO NOT MASSAGE IT. Severe swelling will develop rapidly after thawing. Discon- tinue warming as soon as the part becomes flushed (turning red). Once the part is rewarmed, have the victim exercise it.7. Cleanse the affected area with water and either soap or a mild detergent (NOT laundry or dishwasher detergent, though; they can be caustic and cause a chemical burn). Rinse it thorough- ly. Carefully blot dry with sterile or clean towels. Do NOT break the blisters.8. If the victim's fingers or toes are involved, place dry, sterile gauze between them to keep them separated.9. Do NOT apply other dressings unless the victim is to be transported to medical aid.10. Elevate frostbitten parts and protect them from contact with bedclothes.11. Do NOT allow the victim to walk after the affected part thaws, if his feet are involved.12. Do not apply additional heat and do not allow the victim to sit near a radiator, stove or fire. The numbed part may be severely burned and the victim might never realize it is happening to him.13. If a person with frozen feet is alone and MUST walk to get medical assistance, he should NOT attempt thawing in advance.14. If travel after receiving first aid is necessary, cover the affected parts with a sterile or clean cloth.15. Obtain medical assistance as soon as possible. If the distance to be covered is great, apply temporary dressings to the hands if they have been affected by frostbite.16. Keep injured parts elevated during transportation.17. If medical help or trained ambulance personnel will not reach the scene for an hour or more AND if the victim is CONSCIOUS and NOT VOMITING, give him a weak solution of salt and baking soda at home or while enroute (1 level teaspoon of salt and 1/2 level teaspoon of baking soda in each quart of water, neither hot nor cold). Do not give alcoholic beverages. Allow the victim to sip S-L-O-W-L-Y. Give an adult about 4 ounces (a half glass) over a period of 15 minutes; give a child from 1 to 12 years old about 2 ounces; give an infant (under 1 year old) about 1 ounce every 15 minutes. Discontinue giving fluids if vomiting occurs. Fluid may be given by mouth ONLY if medical help will not be available for an hour or more and is not otherwise contraindicated. PROLONGED EXPOSURE1. Give the victim artificial respiration, if necessary.2. Bring the victim into a warm room as quickly as possible.3. Remove wet or frozen clothing and anything that constricts the victim's arms, legs or fingers and might interfere with circulation as the frozen part is thawed and swelling begins.4. Rewarm the victim rapidly by wrapping him in a warm blanket or by placing him in a tub of water that is warmed to 102 to 105 degrees Fahrenheit. If a thermometer is not available, make sure the water is not hot to YOUR hand and forearm.5. If the victim is conscious, give him hot liquids (but not alcohol) by mouth.6. Dry the victim thoroughly if water was used to rewarm him.7. Carry out the appropriate procedures as described under frost-bite.