Frostbite - prehospital care

Frostbite is the extreme degree of hypothermia resulting from exposure to low temperatures, usually below the freezing point of tissues: -0.55 degrees Celsius (31.01 F). The impact of low temperatures is exacerbated by high humidity and wind speed. The process of frostbite begins from the periphery of the body to the center: first, the tips of the fingers and toes, the protruding areas of the facial part of the skull - the tip of the nose, earlobes, lips. The rate of frostbite increases in the presence of factors such as hunger, overwork, uncomfortable clothing, tight shoes, and alcohol intoxication.

For many hospitals, frostbite is a less frequent injury, more often associated with extremely cold seasons or extreme sports. But the prevalence of frostbite of varying degrees increases significantly during natural disasters and wars. Often patients with frostbite are homeless people or people with mental disorders.

Let’s consider standards for prehospital care for frostbite

This pathology is most thoroughly studied and documented in military medicine. A pre-Columbian mummy found in the Andes more than 5 thousand years ago may be considered the first documented evidence of frostbite. The first mention of mass frostbite is documented by Larrey, a surgeon in Napoleon's army during the invasion of Russia in 1812–1813.

Since the nature of injuries during frostbite can be quite diverse both in terms of the depth of exposure to cold on the body and in terms of anatomical localization, a multidisciplinary approach to the treatment of such patients is often required, namely the involvement of a number of specialized doctors.

Here is the first and basic rule: a patient with frostbite should be taken to the hospital as soon as possible.

The following factors influence the severity of injuries:

  •  air temperature;
  •  time spent in cold conditions;
  •  wind speed;
  •  air humidity;
  •  immersion in water;
  •  quality of clothes;
  •  concomitant pathology of the victim, especially related to the state of the peripheral vascular system;
  •  mental status, degree of dementia;
  •  abuse of psychoactive and narcotic substances;
  •  alcoholism: peripheral vasodilation accelerates heat loss, makes the victim take longer to seek refuge, which aggravates the injury.

The authors of the article "Frostbite: a practical approach to hospital management", Charles Handford et al. give the following data:

  •  frequency of amputation is more closely correlated with the duration of exposure to cold than with air temperature;
  •  90% of injuries occur in the upper and lower extremities;
  •  a high incidence of glutes and perineum damage is noted with prolonged sitting on cold surfaces;
  •  damage to the penis is observed in runners and skiers;
  •  elderly patients are at higher risk due to inactivity;
  •  children are more vulnerable due to the larger ratio of body surface area to mass;
  •  frostbite occurs most frequently in the 30-49 age group due to a combination of cold and risky behavior.

What can be done in the prehospital stage for a patient with frostbite?

It depends on many factors: the condition of the victim, the pre-hospital arsenal of care, the timing of delivery to the medical facility.

Nevertheless, the general recommendations for the prehospital phase remain as follows:

  •  the victim should be protected from wind and external influences, given a possible shelter, provided with warm drinks;
  •  replace shoes, socks, gloves with dry ones, pre-warming the limb (hands, feet) for 10 minutes in the armpit or in the groin of the one who provides assistance;
  •  rubbing the affected limbs is not recommended due to the threat of direct damage to frostbitten tissues;
  •  if sensitivity returns, the victim is advised to walk;
  •  aspirin 75 mg for the purpose of rheological effect;
  •  ibuprofen 12 mg/kg/day for prostaglandin effect (no more than 2400 mg/day).

One of the basic rules for pre-hospital care: rewarming should be carried out only if there is no risk of re-freezing; repeated freezing of thawed tissues leads to deeper and irreversible consequences.

The next mandatory and final stage is the delivery of the victim to a medical facility for the provision of professional medical care.