Playing it safe in winter

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VOL 105 / NO 1 / JANUARY 1999 / POSTGRADUATE MEDICINE

Outdoor activities can be an exciting part of winter, provided you are prepared and can protect yourself from cold, windy, and wet conditions. Remember that temperatures need not be extremely low for injuries to occur, and even people living in warm climates are vulnerable to "exposure." Young age, old age, physical problems, and medications also play a role. Here is some information to help you stay safe.

The most important part of protecting yourself during winter activities is being prepared. This means, first of all, dressing appropriately. Children get cold much more quickly than adults and therefore should be bundled in warm, layered clothing, hats, warm socks, mittens (not gloves), and ski masks or fitted neckwear that will not get caught in anything. For adults engaged in fairly strenuous exercise, an inner layer of polypropylene to wick away perspiration, topped with several thin shirts or sweaters covered with a semipermeable shell or waterproof windbreaker, helps combat extreme cold. If possible, change into dry underwear and dry, warm outer clothing after being outdoors for a while. In fact, it is a good idea for everyone who is involved in winter recreation to have a complete change of clothing available. Wet clothes are especially dangerous and are as much as 20 times less warm than dry clothing.

What to watch for
Be aware that your skin can freeze and your body temperature can fall if you are out in the cold for too long. The skin and blood vessels are easily damaged by cold, often starting with the nose, ears, cheeks, fingers, and toes. The injuries usually occur in three stages: frostnip, superficial frostbite, and deep frostbite.

Frostnip causes a prickly sensation, and the skin turns bluish white but still feels soft. Permanent tissue damage is unlikely. If frostnip is caught early, it can be treated by blowing warm breath on the area, soaking the nipped area in lukewarm water, or just covering it with a warm hand.

With superficial frostbite, ice crystals form inside skin cells, but the tissue underneath remains flexible. The skin feels waxy, numb, and stiff, and blisters may develop.

The most serious type of frostbite, deep frostbite, affects the blood vessels, muscles, nerves, tendons, and even bone and may lead to permanent damage. In deep frostbite, the affected areas lose all sensation.

What to do
When frostbite is suspected, your best bet is to get prompt medical attention from the nearest doctor or emergency care clinic. Be sure not to rub the affected area, because this increases the damage. Also, if there is any risk that the area might be refrozen, do not try to warm the tissue until help is available. Refreezing greatly increases the risk of damage.

If you cannot get to a doctor immediately and if you are sure the area won't be refrozen, you can do the following:

• Get in out of the cold.
• Apply warm towels or place the affected area in lukewarm (not hot) water for 20 minutes.
• If warm water is not available, cover the area with a warm hand.
• Drink a hot beverage that supplies nourishment, such as cider, soup, or broth.
• Keep the frostbitten area elevated.

What not to do
It is important to avoid hot water, heating pads, or open flames for rewarming the skin. Sensation may be poor, and the tissue could be easily burned. Also, never rub the frostbitten area with snow or with your hand. And do not try to pop blisters, because this can cause infection.

Frostbite can also be a clue to hypothermia, which occurs when the body cannot raise its temperature above 95°F. Shivering is an early sign of mild hypothermia. Bizarre behavior, incoherence, and fumbling and stumbling are signs of more serious trouble. Hypothermia is a medical emergency, and you should get professional help immediately.

Take precautions
Lack of fluids and low blood sugar are also important causes of cold injuries. To prevent these problems, drink plenty of water and have a snack available that will boost your energy. A carbohydrate-electrolyte "sports drink" is also a good choice. If your exercise is strenuous, you might want to warm your sports drink to 75°F and drink some of it every 15 to 25 minutes during your workout.

When you plan your outdoor fun, set up a "buddy" system and keep a regular watch on each other's nose, cheeks, and ears. Carry a handkerchief or tissue and wipe moisture off your face often. Get out of wet clothing immediately. And if the winds grow stiff or the temperature suddenly drops, call it a day.

Some facts about frostbite

If you have had frostbite in the past, you are at a high risk to have it again, so be extra careful to keep previously frostbitten areas warm and dry.

Other factors that increase the risk for frostbite are:
   Alcohol and drug use
   Arthritis
   Atherosclerosis
   Diabetes
   Inability to move around
   Low body temperature
   Previous cold injuries
   Smoking
   Tight clothing
   Use of drugs that constrict blood vessels
   Wet clothing
   Wind chill

Skin that has been frostbitten is easily damaged by exposure to the sun. Therefore, be sure to use sunscreen, regardless of the season, to protect delicate skin from repeated injury.

Always play it safe in winter. Enjoy the great outdoors, but maintain a healthy respect for the power and unpredictability of Mother Nature.

This information is not a substitute for medical treatment.

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