Cold Weather InjuriesCold Weather Injuries

Knowledge Nuggets Knowledge Nuggets For Prevention For Prevention

And ManagementAnd Management

DisclaimerDisclaimer

This is an overview of injuries associated This is an overview of injuries associated with various outdoor winter activities, not with various outdoor winter activities, not

First Aid instruction.First Aid instruction.

For more information on Wilderness First For more information on Wilderness First Aid, contact Deb AjangoAid, contact Deb Ajango

info@info@safetyedsafetyed.net.net

http://www.http://www.safetyedsafetyed.net/.net/

Andrea AndraschkoAndrea Andraschko

Credentials: Wilderness EMT-2, Credentials: Wilderness EMT-2, volunteer medic with Alaska volunteer medic with Alaska Mountain Rescue GroupMountain Rescue Group

Work: Alaska Regional LifeFlight Work: Alaska Regional LifeFlight (Dispatch), located in the ER(Dispatch), located in the ER

Outdoor winter activities: skiing, Outdoor winter activities: skiing, snowshoeing, hiking, climbingsnowshoeing, hiking, climbing

ActivitiesActivities

CampingCamping HikingHiking SnowshoeingSnowshoeing Skiing – Alpine and NordicSkiing – Alpine and Nordic SnowmachiningSnowmachining

CampingCamping

HypothermiaHypothermia FrostbiteFrostbite Immersion footImmersion foot BurnsBurns CO poisoningCO poisoning

Hiking & SnowshoeingHiking & Snowshoeing

ChilblainChilblain HypothermiaHypothermia Frostbite: Face, Ears, Feet, HandsFrostbite: Face, Ears, Feet, Hands Immersion footImmersion foot DehydrationDehydration Snow BlindnessSnow Blindness Musculoskeletal injuriesMusculoskeletal injuries

SkiingSkiing

HypothermiaHypothermia Frostbite: Face, EarsFrostbite: Face, Ears DehydrationDehydration Snow BlindnessSnow Blindness Musculoskeletal injuries: KneesMusculoskeletal injuries: Knees Skeletal injuries: SpineSkeletal injuries: Spine Traumatic injuries: HeadTraumatic injuries: Head

SnowmachiningSnowmachining

HypothermiaHypothermia Frostbite: Face, Ears, handsFrostbite: Face, Ears, hands DehydrationDehydration Snow BlindnessSnow Blindness Skeletal injuries: SpineSkeletal injuries: Spine Traumatic injuries: Head, internalTraumatic injuries: Head, internal

Cold Injury GuidelinesCold Injury Guidelines Most current guidelines (rev. Most current guidelines (rev.

2005), applicable to all levels 2005), applicable to all levels of first aid trainingof first aid training

Covers hypothermia, cold Covers hypothermia, cold water near drowning, frostbite water near drowning, frostbite and avalanche rescueand avalanche rescue

Prepared by world-renown Prepared by world-renown experts in cold weather experts in cold weather injuriesinjuries

Available by download from:Available by download from:

www.chems.alaska.gov/EMS/ www.chems.alaska.gov/EMS/ documents/AKColdInj2005.pdfdocuments/AKColdInj2005.pdf

Hypothermia SymptomsHypothermia Symptoms MildMild

– Core Temp: 95º to 90ºFCore Temp: 95º to 90ºF– Ability to rewarm self: GoodAbility to rewarm self: Good– Symptoms: intense shivering, “umbles”, denialSymptoms: intense shivering, “umbles”, denial

ModerateModerate– Core Temp: 90º to 82ºFCore Temp: 90º to 82ºF– Ability to rewarm self: LimitedAbility to rewarm self: Limited– Symptoms: gradual loss of shivering, decreasing level of Symptoms: gradual loss of shivering, decreasing level of

consciousness, total loss of consciousness <86ºFconsciousness, total loss of consciousness <86ºF SevereSevere

– Core Temp: <82ºFCore Temp: <82ºF– Ability to rewarm self: UnableAbility to rewarm self: Unable– Symptoms: Rigid, HR and breathing may be unnoticeable, Symptoms: Rigid, HR and breathing may be unnoticeable,

may appear dead. Move with extreme caution!may appear dead. Move with extreme caution!

Hypothermia ManagementHypothermia Management

Mild Mild (Person is able to ‘self rescue’)(Person is able to ‘self rescue’) Remove wet and/or restrictive clothing.Remove wet and/or restrictive clothing. Get inside shelter if possible.Get inside shelter if possible. Eat – Mix of proteins, fats and carbs is best to Eat – Mix of proteins, fats and carbs is best to

fuel the furnace.fuel the furnace. Drink – sugar is good, caffeine is bad. Should Drink – sugar is good, caffeine is bad. Should

not be cold, does not need to be warm.not be cold, does not need to be warm. Exercise – move around to increase circulation. Exercise – move around to increase circulation. It is ok to use chemical heat packs placed on It is ok to use chemical heat packs placed on

pulse-points to assist rewarming (not directly on pulse-points to assist rewarming (not directly on skin).skin).

Warm showers or baths are ok.Warm showers or baths are ok.

NuggetsNuggets

It “costs” the body 70 kcal/hr to maintain normal It “costs” the body 70 kcal/hr to maintain normal body function at rest. Breathing in 0ºF air and body function at rest. Breathing in 0ºF air and warming it to body temperature costs an warming it to body temperature costs an additional 40 kcal/hr. additional 40 kcal/hr.

Intense shivering rapidly depletes muscle Intense shivering rapidly depletes muscle glycogen stores, “costing” up to 220 kcal/hr. glycogen stores, “costing” up to 220 kcal/hr. Shivering stops when there is no glycogen left to Shivering stops when there is no glycogen left to fuel muscle contractions.fuel muscle contractions.

Lactic acid is a by-product of muscle activity. Lactic acid is a by-product of muscle activity. High levels of lactic acid in the blood interferes High levels of lactic acid in the blood interferes with further muscle activity – i.e. the heart.with further muscle activity – i.e. the heart.

NuggetsNuggets

Carbohydrates rapidly provide 7-10 kcal Carbohydrates rapidly provide 7-10 kcal heat per 100 kcal ingested; proteins slowly heat per 100 kcal ingested; proteins slowly provide 27-30 kcal heat per 100 kcal provide 27-30 kcal heat per 100 kcal ingested. ingested.

Snacks that provide both carbohydrates Snacks that provide both carbohydrates and protein should be consumed at and protein should be consumed at regular intervals.regular intervals.

Warm Jell-o provides a protein and sugar Warm Jell-o provides a protein and sugar source suitable for a quick warm-up or source suitable for a quick warm-up or bedtime snack.bedtime snack.

NuggetsNuggets During rest, 10% of the body’s heat is lost During rest, 10% of the body’s heat is lost

through the head. During exercise, up to 55% is through the head. During exercise, up to 55% is lost through the head.lost through the head.

A hooded parka can be used to help capture body A hooded parka can be used to help capture body heat generated by “warming” exercises – heat heat generated by “warming” exercises – heat lost through the head can be redirected to the lost through the head can be redirected to the trunk via the hood.trunk via the hood.

A protein and carbohydrate snack followed by A protein and carbohydrate snack followed by light exercise is a good way to manage mild light exercise is a good way to manage mild hypothermia.hypothermia.

Circulation enhancing foods such as ginger and Circulation enhancing foods such as ginger and cayenne can help stimulate warmth.cayenne can help stimulate warmth.

Hypothermia ManagementHypothermia ManagementModerateModerate (Person appears confused or disoriented)(Person appears confused or disoriented) Do not try to rapidly rewarm.Do not try to rapidly rewarm. Cut off wet clothing and place in a hypobag or Cut off wet clothing and place in a hypobag or

hypowrap.hypowrap. Do not apply heat directly to skin; warm bottles Do not apply heat directly to skin; warm bottles

or heat packs may be placed between layers in or heat packs may be placed between layers in the hypowrap.the hypowrap.

Do not allow person to exercise, sit or stand.Do not allow person to exercise, sit or stand. Do not give oral fluids or food.Do not give oral fluids or food. Do not use warm baths or showers.Do not use warm baths or showers. Transfer to a hospital ASAP.Transfer to a hospital ASAP.

NuggetsNuggets A hypowrap is also known as “the human A hypowrap is also known as “the human

burrito.”burrito.” A hypowrap consists of dry clothing, 1-2 dry A hypowrap consists of dry clothing, 1-2 dry

sleeping bags, an insulating pad, and a wind sleeping bags, an insulating pad, and a wind barrier such as a sheet of plastic, tarp or tent-fly.barrier such as a sheet of plastic, tarp or tent-fly.

Lay the tarp out first, then the pad, the sleeping Lay the tarp out first, then the pad, the sleeping bag(s) and then the patient. bag(s) and then the patient.

Cover the head with a hat, and the face loosely Cover the head with a hat, and the face loosely with a scarf or face mask. Ensure breathing is not with a scarf or face mask. Ensure breathing is not compromised.compromised.

Warm water bottles or hand-warmers may be Warm water bottles or hand-warmers may be placed between layers, but not directly on the placed between layers, but not directly on the skin.skin.

Hypothermia ManagementHypothermia Management

Severe, Severe, with signs of life (pulse, respirations)with signs of life (pulse, respirations) Handle very very gently.Handle very very gently. Do not rub or massage patient.Do not rub or massage patient. Cut off wet clothing and place in a hypobag or Cut off wet clothing and place in a hypobag or

hypowrap.hypowrap. Do not add any external heat.Do not add any external heat. May assist respirations with mouth to mask May assist respirations with mouth to mask

rescue breathing if within scope of training.rescue breathing if within scope of training.

Hypothermia ManagementHypothermia Management

Severe Severe (no signs of life, but death not obvious)(no signs of life, but death not obvious) Handle very carefully; avoid bumping or jarring Handle very carefully; avoid bumping or jarring

patient.patient. May provide mouth to mask breathing.May provide mouth to mask breathing. CPR only if patient is greater than 3 hours from CPR only if patient is greater than 3 hours from

definitive care and properly trained providers are definitive care and properly trained providers are present.present.

Best treatment is careful and gentle evacuation.Best treatment is careful and gentle evacuation.

FrostbiteFrostbite

Early stage (frostnip) is characterized by a soft Early stage (frostnip) is characterized by a soft waxy appearance, with numbness and decreased waxy appearance, with numbness and decreased local motor skills.local motor skills.– It is safe to rewarm in the field by increasing peripheral It is safe to rewarm in the field by increasing peripheral

circulation, skin-to-skin warming, or warm water circulation, skin-to-skin warming, or warm water immersion. Take care not to refreeze.immersion. Take care not to refreeze.

Late stage is characterized by complete loss of Late stage is characterized by complete loss of sensation and movement, skin feels hard and ice sensation and movement, skin feels hard and ice crystals may be visible.crystals may be visible.– Do not attempt to thaw in the field unless thawing and Do not attempt to thaw in the field unless thawing and

refreezing can not be avoided.refreezing can not be avoided.

NuggetsNuggets

Avoid hypothermiaAvoid hypothermia Avoid vasoconstricting gloves and socks, and use Avoid vasoconstricting gloves and socks, and use

wicking liners.wicking liners. Keep dry socks and gloves handy, and change Keep dry socks and gloves handy, and change

frequently.frequently. Do not use water-based lotions or sunscreen on Do not use water-based lotions or sunscreen on

the face.the face. Cover as much exposed skin as possible, Cover as much exposed skin as possible,

especially when wind is a factor.especially when wind is a factor. Use “buddy checks” to monitor for S/Sx of Use “buddy checks” to monitor for S/Sx of

freezing injuries.freezing injuries.

ChilblainsChilblains A recurring condition related to pre-existing A recurring condition related to pre-existing

peripheral circulatory issues.peripheral circulatory issues. Aggravated by exposure to wet windy conditions Aggravated by exposure to wet windy conditions

between 32º and 60ºF.between 32º and 60ºF. Causes decreased perfusion to the skin tissues Causes decreased perfusion to the skin tissues

which does not readily return with warming.which does not readily return with warming. Affected areas may swell and blister.Affected areas may swell and blister. Symptoms may persist up to 2 weeks.Symptoms may persist up to 2 weeks.

Afflicted individuals should avoid cold, wet windy Afflicted individuals should avoid cold, wet windy conditions, and should dress appropriately.conditions, and should dress appropriately.

TrenchfootTrenchfoot Caused by prolonged exposure to very cold water Caused by prolonged exposure to very cold water

resulting in decreased perfusion to skin tissue.resulting in decreased perfusion to skin tissue. Left untreated can lead to tissue death.Left untreated can lead to tissue death. Exacerbated by constricting socks or boots.Exacerbated by constricting socks or boots. Initial appearance is similar to frostbite.Initial appearance is similar to frostbite.

Treatment is rewarming, which is very painful.Treatment is rewarming, which is very painful.

Avoid by keeping feet warm and dry.Avoid by keeping feet warm and dry. Do foot inspections (socks and shoes off) and foot Do foot inspections (socks and shoes off) and foot

massages every 3-4 hours.massages every 3-4 hours.

Snow BlindnessSnow Blindness

Sunburn to the eyes.Sunburn to the eyes. UV blocking eyewear is important when outdoors UV blocking eyewear is important when outdoors

in a snowy environment, even if it isn’t that in a snowy environment, even if it isn’t that sunny.sunny.

Treatment includes prescription opthalmic Treatment includes prescription opthalmic ointments.ointments.

Field treatment includes loosely covering the Field treatment includes loosely covering the eyes and evacuating the patient.eyes and evacuating the patient.

BurnsBurns Burn injuries can be caused by stove flare-ups Burn injuries can be caused by stove flare-ups

and campfires.and campfires. Burns to face, neck, arms and hands common.Burns to face, neck, arms and hands common. Superheated inhaled air can be life-threatening.Superheated inhaled air can be life-threatening. Swelling from burns peaks within 24 hours.Swelling from burns peaks within 24 hours. Burns to face, neck and airway can cause Burns to face, neck and airway can cause

swelling that compromises respiration.swelling that compromises respiration. Treatment includes cool compresses (not snow), Treatment includes cool compresses (not snow),

anti-inflammatories, and evacuation.anti-inflammatories, and evacuation. Prevention includes fire and stove safety Prevention includes fire and stove safety

awareness awareness

DehydrationDehydration Fluid losses can be insensible.Fluid losses can be insensible. Sweat, breathing and urination are modes of fluid Sweat, breathing and urination are modes of fluid

loss.loss. Cold causes peripheral vasoconstriction which Cold causes peripheral vasoconstriction which

increases blood pressure, and in turn triggers the increases blood pressure, and in turn triggers the kidneys to produce more urine (cold diuresis).kidneys to produce more urine (cold diuresis).

Low ambient humidity contributes to fluid lossesLow ambient humidity contributes to fluid losses Be sure to drink whenever snacking or eating. Be sure to drink whenever snacking or eating. Water or electrolyte drinks (Emergen-C) are good Water or electrolyte drinks (Emergen-C) are good

choices while exercising. choices while exercising. Soups, hot Jell-o, and hot Tang are good choices Soups, hot Jell-o, and hot Tang are good choices

in camp. in camp.

NuggetsNuggets

Wear several easily removable layers Wear several easily removable layers while exercising to avoid overheating.while exercising to avoid overheating.

Exercise increases moisture loss through Exercise increases moisture loss through respiration.respiration.

Face masks that help capture expired air Face masks that help capture expired air can help prevent dehydration.can help prevent dehydration.

NuggetsNuggets

Urination will be more frequent during Urination will be more frequent during winter activities – it may take some winter activities – it may take some encouragement to get kids to drink encouragement to get kids to drink enough fluids throughout the day.enough fluids throughout the day.

Encourage kids to urinate as needed at Encourage kids to urinate as needed at night. A full bladder triggers stretch night. A full bladder triggers stretch sensors that causes a sensation of cold.sensors that causes a sensation of cold.

Musculoskeletal InjuriesMusculoskeletal Injuries

Skiing – knees and ankles most vulnerable to Skiing – knees and ankles most vulnerable to breaks, strains, sprains, and ligament injuriesbreaks, strains, sprains, and ligament injuries

Snowshoeing – knees and hips most Snowshoeing – knees and hips most vulnerable to muscle and connective tissue vulnerable to muscle and connective tissue injuries.injuries.

Thumb injuries can occur when hands get Thumb injuries can occur when hands get tangled up in ski pole straps.tangled up in ski pole straps.

High velocity injuries (skiing, snowmachining High velocity injuries (skiing, snowmachining sledding) can include breaks, dislocations, sledding) can include breaks, dislocations, spinal injuries, head injuries and internal spinal injuries, head injuries and internal injuries.injuries.

High Velocity InjuriesHigh Velocity Injuries Immediately check ABCs; carefully reposition only Immediately check ABCs; carefully reposition only

if airway is compromised.if airway is compromised. Determine level of consciousness (Alert and Determine level of consciousness (Alert and

responsive, responsive to voice, responsive to responsive, responsive to voice, responsive to pain, unresponsive).pain, unresponsive).

Leave helmet on unless airway is compromised.Leave helmet on unless airway is compromised. Protect c-spine by holding stabilization.Protect c-spine by holding stabilization. Insulate from cold, including the ground.Insulate from cold, including the ground. Perform first aid assessment in position found if Perform first aid assessment in position found if

airway is not compromised. Patients with airway is not compromised. Patients with suspected spinal injuries do NOT need to be laid suspected spinal injuries do NOT need to be laid flat.flat.

High Velocity – Internal InjuriesHigh Velocity – Internal Injuries

Internal injuries are always a possibility Internal injuries are always a possibility after collisions and airborne acrobatics. after collisions and airborne acrobatics.

Suspect internal injuries if patient Suspect internal injuries if patient experiencesexperiences– pain when abdominal cavity is palpated; pain when abdominal cavity is palpated; – pain or difficulty breathing; pain or difficulty breathing; – unusual paleness, rapid heart rate that doesn’t unusual paleness, rapid heart rate that doesn’t

decrease, increased respirations, and damp or decrease, increased respirations, and damp or clammy skin.clammy skin.

High Velocity – Head InjuriesHigh Velocity – Head Injuries

Head injuries are more serious if the level Head injuries are more serious if the level of consciousness of the patient decreases of consciousness of the patient decreases over time, or they vomit more than once.over time, or they vomit more than once.

Unconsciousness followed by return to Unconsciousness followed by return to normal mentation with amnesia is normal mentation with amnesia is indicative of a concussion and is less of an indicative of a concussion and is less of an emergency.emergency.

C-spine precautions should always be C-spine precautions should always be taken when head injuries are present.taken when head injuries are present.

Other ConsiderationsOther Considerations

Cold air can induce asthmatic attacks in some Cold air can induce asthmatic attacks in some people. Breathing warm, humid air may be people. Breathing warm, humid air may be the only field treatment needed.the only field treatment needed.

Cold decreases the perception of pain. Cuts Cold decreases the perception of pain. Cuts and bruises may go unnoticed until body and bruises may go unnoticed until body parts rewarm.parts rewarm.

Cold weather significantly increases caloric Cold weather significantly increases caloric needs, while associated dehydration needs, while associated dehydration suppresses appetite. Eat and drink frequently suppresses appetite. Eat and drink frequently to maintain optimal bodily functions.to maintain optimal bodily functions.

Other Considerations (con’t)Other Considerations (con’t)

Insulated clothing and sleeping bags act like a Insulated clothing and sleeping bags act like a thermos – they hold warmth in; they don’t thermos – they hold warmth in; they don’t provide external heat. provide external heat.

Air is an excellent insulator. A tight (wicking) Air is an excellent insulator. A tight (wicking) next-to-skin layer for torso and legs is fine, next-to-skin layer for torso and legs is fine, but subsequent layers should be loose but subsequent layers should be loose enough to allow air to be trapped.enough to allow air to be trapped.

Socks and gloves that provide compression Socks and gloves that provide compression can contribute to peripheral vasoconstriction can contribute to peripheral vasoconstriction and lead to a progression of cold-related and lead to a progression of cold-related injuries.injuries.

Thank You!Thank You!

Any Questions?Any Questions?