Thursday, February 16, 2017

The Risk of Cold Injury & How to Protect Yourself

Written by  Dr. Eva Hersh, MD

Winter will be with us for another month. In Maryland we’ve had some unseasonably warm days this winter as well as some unusually severe cold. Last week in Baltimore we had the third Code Blue alert, which occurs when temperatures, adjusted for wind chill, are expected to be 13˚F or below.

Very cold temperatures can permanently injure people and even kill. Hypothermia, the medical word for low body temperature, can be just as dangerous as extreme heat.

The first and most straightforward thing to do to keep safe in extremely cold weather is to stay inside in heated areas. Whatever errands and activities that can be deferred until later, should be put off.

We tend to think that cold injury happens in places farther north, not here. It does happen here, though. Common situations that can lead to cold injury include:

• after a fall when a person cannot get up

• while shoveling snow

• while sitting in a car for a long period with the engine off

• after a person is accidentally locked outside the house in light clothing

• and just sitting at home when the heat is not working.

In any of these situations, alcohol and many prescription medications make hypothermia more likely because they affect the body’s ability to adapt to cold.

Shivering, turning pale, numbness of the fingers, toes or ears, mild confusion, and a bluish tinge to the lips are all signs that a person is becoming dangerously cold and should be taken inside and warmed up. I say they should be taken inside because even at this early stage of hypothermia, the person’s judgement may be impaired. If this does not happen and the person becomes colder, they will stop shivering and become more confused. They may have problems with speaking or walking. They may develop abnormal heart rhythms. In these more advanced stages of hypothermia, taking the person to an emergency department is appropriate. If the person is not treated, they may become unconscious and may die. Four out of every ten people with moderate or severe hypothermia that are treated in hospitals still die, even with intensive treatment.

Frostbite is injury to skin caused by freezing. In severe cases, muscle and bone are damaged as well. Amputation is sometimes necessary to remove dead tissue. Most cases are mild and can be managed at home or in an emergency department. Frostbite occurs in the areas of the body with less blood supply: the hands, feet, ears, nose, cheeks, and chin are the commonest areas. The person notices that the area developing frostbite feels cold and numb. If hands or feet are involved, the affected area may feel clumsy or difficult to use. Mild frostbite looks like a pale or grey area of skin surrounded by swollen tissues. The person has no sensation in the central, pale area.

Staying healthy in cold weather:

When you’e outdoors:

• Limit time outdoors, especially for children, elderly people and people with chronic illness. These groups of people are most vulnerable both to cold and to heat injury.

• Wear several layers of loose-fitting clothing.

• Always wear a hat or scarf when outdoors, making sure to cover your ears. The head accounts for 30% of heat loss from the body, and ears, like fingertips, are especially likely to be injured by cold. Wearing a face mask protects the face best.

• For the hands, mittens are better protection than gloves. The heat of fingers keeps the other fingers warm better than the extra layer of fabric in gloves does.

• Drink plenty of fluids, but avoid alcoholic beverages. Alcohol interferes with the body’s ability to adapt to cold.

• Protect yourself against falls in icy or snowy conditions. Use a cane if you need one. Use salt or an eco-friendly ice melt, especially on stairs and sloping pavement.


• Keep space heaters and candles at least 18 inches (a foot and a half) away from furniture and flammable materials, such as books and papers and fabrics like curtains and clothes.

Managing mild hypothermia at home: A person with mild hypothermia will be shivering, and may be slightly confused. They should be taken to a warm room, the heat up to 80 degrees if possible. All wet clothing should be removed and the skin dried before covering the person with towels and blankets. Heating pads should not be used because there is a high likelihood of burns. This is because the hypothermic person may be unable to judge temperature sensation in the skin of the injured areas.

Managing mild frostbite at home: On the way home, if a foot is affected, the person should not walk to avoid further injury. If a hand is involved, the person should begin rewarming it by holding it in the opposite underarm area. Before treating the frostbite, remove all wet clothes and dry the skin. Help the person dress in warm dry clothes or wrap up in towels or blankets. Then warm the possibly frost bitten areas by soaking in warm (not hot) water. Frost bitten skin looks pale and waxy. After rewarming, it may become red or blue.

Baltimore City residents can call 311 for help if they or someone they know does not have heat or power when it is very cold.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


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