How to Treat Severe Frostbite

Frostbite is dangerous. You can lose a finger or toe, even an arm or leg, if you don't treat it properly. Do everything in your power to prevent frostbite before it occurs (see "Prevent Frostbite"). If you suspect frostbite, assess the degree of frostbite (see "Recognize and Assess Frostbite") and treat properly.

Instructions

Difficulty: Easy

Things You’ll Need:

• Hot Water
• Heat source
• Thermometers
• Ibuprofen Or Aspirin Or Tylenol
• Antibacterial Soaps
• Aloe Vera Ointment

Evacuate or Rewarm?

1. Figure out if it's possible to evacuate without the affected area being used. For instance, can the person be moved without walking on a frostbitten foot?
2. Decide if you'll be able to keep the person, including the affected area, warm throughout the eventual evacuation.
3. Determine if you have all the supplies for field rewarming: the ability to heat a lot of water for a long time, a receptacle large enough to hold the affected part without allowing it to touch the sides, and a thermometer to check the water's temperature.
4. Rewarm in the field only if the above three conditions are met: no necessity to use the affected area before reaching a hospital, ability to keep the person warm during future evacuation, and adequate supplies to rewarm properly. Otherwise evacuate before rewarming.

Rewarming

5. Administer ibuprofen to brace the frostbitten person for the inevitable pain of rewarming.
6. Heat the right amount of water - enough to cover the affected area once it's in the receptacle - to between 104 and 108 degrees F.
7. Pour the heated water into the receptacle.
8. Immerse the affected part - stripped of all clothing and covering - in the water, taking care that it doesn't touch the sides of the receptacle.
9. Heat more water, again to between 104 and 108 degrees F.
10. Replace the water in the receptacle once it has cooled to below 100 degrees.
11. Repeat the heat-and-replace cycle until all discoloration has disappeared and all tissue is once again soft and pliable. This generally takes 30 to 60 minutes.
12. Prepare a bath of water mixed with antibacterial soap. Immerse the affected area for five minutes to minimize risk of infection.
13. Air-dry the injured area and gingerly apply aloe vera ointment. Aside from small pieces of cotton to separate fingers, do not allow the affected area to come into contact with anything.
14. Evacuate, taking extreme care not to let the affected body part refreeze.

Tips & Warnings

• The biggest danger of field rewarming is that the affected area may thaw and then refreeze, resulting in far worse tissue damage than if you delay thawing so that it's done well and only once.
• Because refreezing is so undesirable, and because the affected area should remain uncovered after rewarming, in almost all cases evacuation before thawing is going to be the best option.
• Don't use an open flame to keep the bath water warm, as this risks burning the frostbitten part. Instead, periodically change the water as indicated above.
• If you decide to evacuate, first strip the affected part of all clothing (unless frozen to the skin) and wrap it in as much dry insulation as possible. As you evacuate, do what you can to keep the frozen body part from partially thawing along the way: Change how well the part is covered and adjust your pace.
• Do not try any of the following "folk remedies," which will only make the injury worse: rubbing the affected part with snow, exposing the area to an open flame, or hitting the area (supposedly to restore circulation).
• Do not rub the affected area or expose it to any external heat source other than warm water. To do so is to risk permanent tissue damage.
• The biggest danger of field rewarming is that the affected area may thaw and then refreeze, resulting in far worse tissue damage than if you delay thawing so that it's done well and only once.
• Because refreezing is so undesirable, and because the affected area should remain uncovered after rewarming, in almost all cases evacuation before thawing is going to be the best option.
• Don't use an open flame to keep the bath water warm, as this risks burning the frostbitten part. Instead, periodically change the water as indicated above.
• If you decide to evacuate, first strip the affected part of all clothing (unless frozen to the skin) and wrap it in as much dry insulation as possible. As you evacuate, do what you can to keep the frozen body part from partially thawing along the way: Change how well the part is covered and adjust your pace.
• Do not try any of the following "folk remedies," which will only make the injury worse: rubbing the affected part with snow, exposing the area to an open flame, or hitting the area (supposedly to restore circulation).
• Do not rub the affected area or expose it to any external heat source other than warm water. To do so is to risk permanent tissue damage.
• If your feet or hands feel cold, it may be the first step on a journey to frostbite: Stop and warm them before they go numb.
• Frostbite can strike in any season, especially in the high country. Keep a close eye on the weather whenever you go in the wilderness, and adjust your plans as necessary to avoid the risk of frostbite.
• Frostbite can result in loss of both digits and limbs. Prevention is the best medicine.
• Avoid tight-fitting clothing - including footwear - which might impair circulation.
• Avoid alcohol, which could contribute to dehydration and impair judgment.
• Avoid caffeine and nicotine, which constrict blood vessels and therefore reduce the blood supply to extremities.
• If hypothermia is present along with frostbite, treat hypothermia first.
• This information is not intended as a substitute for professional medical advice or treatment.