Hypothermia, Frostbite and other Ailments in Freezing Conditions

He smokes a pipe, so heed his words.

Hypothermia

How to Avoid Hypothermia in Cold Weather

• Wear warm, waterproof and windproof clothes. If your skin is exposed to the movement of cold air, you lose heat at a greatly increased rate. If the air movement is across wet skin, the rate increases even further. Modern fleecy fibres often mean you can get away with damp clothes, but ONLY if external air movement is blocked (or greatly reduced) by a windproof outer shell.
• Don't exhaust yourself in cold weather. Only engage in activities that your level of fitness is comfortably able to cope with. If you become exhausted, your body will have less energy spare with which to generate heat.
• Carry and eat lots of energy-rich foods, to enable your body to generate heat.
• Carry and drink plenty of water - even if it is very cold water. This helps the body's circulation, which means warm blood can be pumped around easily.
• Don't remain stationary if you start to shiver - movement is the best natural way to get your body to produce heat. Even if you are injured, try any type of movement you can manage provided it seems safe.
• If you become injured and immobile in cold weather, make immediate use of any extra clothing or shelter - don't wait until you become too cold for comfort.
• Expect to become immobile. Your clothes may seem adequate when you are on the move, but are they adequate to keep you warm if you sit still or lie down for 24 hours? Will you have enough food and water?
• Avoid prolonged contact with cold objects, such as the ground. If you are sitting or lying down, ensure you have some form of insulation, such as a foam mat.
• Don't fall into water - you will lose vast amounts of heat instantly, your body will likely go into shock (preventing you from rescuing yourself), and if you do manage to make it out, your clothes will be soaked in ice-cold water, making it extremely hard for you get warm again.
• If something unexpected happens which interferes with your ability to cope with cold weather, abandon your trip and head directly back to civilisation - don't fight it. For example, if your sleeping bag or clothes become soaked with water, or your food supplies become lower than expected, or the weather becomes more than your equipment or fitness can cope with.

How to Recognise Hypothermia

1. Casualty will feel very cold (obvious, but worth mentioning!)
2. Skin feels unusually cold to the touch. Often it appears paler, though sometimes, particularly with children, this is not the case.
3. Shivering. The affected person may also exhibit abnormal disinterest or bad temper. Look out for this sign, both in yourself and others. At this stage, it is still quite possible to recover. It may be that many of us have experienced this, without realising that we have begun to suffer from hypothermia! [Ray Gears speaks: "I think that happened to me at a bus stop, once."] It is essential to take action at this point, as self-help becomes much harder as symptoms progress.
4. Uncontrollable shivering - person becomes less able to take remedial action.
5. Shivering then often decreases, followed by slow thinking and clumsiness.
6. Loss of reason, false sense of warmth. Some survivors mention giggling and feeling comfortable or child-like.
7. Muscles become stiff, loss of consciousness. At this stage, it can be hard to detect signs of life - pulse and breathing may be very feint. It is still possible to recover from this stage, however this would normally require professional medical treatment.

Emergency Treatment of Hypothermia

• Remove the person from the cold environment as much as is possible - i.e. find or create shelter if practical. A dry, wind-free environment is ideal. It is essential to also protect the casualty from the cold ground - vast amounts of heat can be lost by contact with cold objects. A sleeping mat is ideal for this. If nothing else is available, then another person can act as the insulator between the cold ground and the casualty. A sitting arrangement is likely to be best in this case - minimising the contact points between the cold ground and the healthy person. It is important not to generate another casualty in the process!
• Remove any wet clothes, and replace these with warm, dry clothes or a sleeping bag. The face (particularly nose and mouth!) should not be covered - the casualty needs plenty of oxygen to help them recover (in a hospital, they might be given up to 100% oxygen). Any tight clothes which might restrict circulation, such as boots, should be removed or loosened.
• If the hypothermia is mild, i.e. not beyond the shivering stage and the casualty is still able to communicate coherently, then they might be able to warm themselves up, provided they are known to be well fed and otherwise healthy. In this case, consider initially leaving them in a sleeping bag or very warm clothes, and monitor progress.
• For more serious cases, consider how to re-warm the casualty. The best source of warmth available is often likely to be another person. In an ideal scenario, the casualty and a healthy person would lie next to each other, both on ground mats, and both under or in the same sleeping bag (in this case, minimum or no clothes should be worn by both people). Some sources suggest that this approach can re-warm the casualty too quickly - resulting in heart failure. Other sources suggest that the speed of re-warming should be similar to the speed of onset of hypothermia - e.g. if the cause of hypothermia was sudden immersion in cold water, then consider re-warming the casualty quickly - otherwise slowly. The fear of overdoing the re-warming process by using a healthy person to supply the heat is possibly overplayed. Consider: many hospitals re-warm casualties in baths of water at 45°C - that's quite a few degrees warmer than a healthy body. The reality is, once someone suffers from severe hypothermia, their life is in the balance. They may die from being too cold, or they may die from heart problems caused by being re-warmed too quickly. They will certainly die if no action is taken, so, if rescue cannot be organised, you need to take a gamble and try to re-warm them.
• Whatever method is chosen for re-warming, remember it should be gentle so as not to induce shock. Further, there are certain areas on the casualty's body that can be targeted for best effect. The left armpit is sometimes suggested, as this is an area where heat is exchanged fairly readily with the environment, plus it is close to the heart which will carry any warmed blood around the rest of the body quickly. The rectal area is also an option.
• Whether to give a casualty fluids or food is often a source of debate. Certainly, if the casualty is in the later stages of hypothermia - this is not a safe option. However, if the casualty is fully conscious and coherent, and you are aware that they have not been well-fed (possibly contributing to the onset of hypothermia in the first place), then this is an option. Warm (not hot) fluids with a high sugar content are ideal. The intake of energy-rich foods will help the casualty's own body generate heat. Alcohol should NEVER be given. Alcohol helps the body LOSE heat, and will do nothing for a brain which is already on the road to confusion!
• Try not to let the casualty fall asleep.
• Never give up on the re-warming process - even if life signs seem to be gone. Medical professionals, for example, never declare death in a victim of hypothermia until the body is completely re-warmed. Sometimes life signs can be impossible to detect when the body is very cold.
• In all cases, try to arrange for rescue and hospital treatment at the same time as administering emergency treatment.

Frostbite

How to Avoid Frostbite in Cold Weather

• Do not ignore any numbness. If you lose feeling in any extremities, take action.
• Take, and use when necessary, warm gloves or mitts.
• Take, and use when necessary, a spare pair of warm socks.
• Take, and use when necessary, a balaclava.
• Wind and water make it harder to keep the extremities warm in cold weather. Ensure your gloves or mitts are at least windproof. Ensure your boots are waterproof, and consider also wearing waterproof leggings and gaiters, to help prevent any water getting into your boots from above. Consider using a hood over your balaclava.
• Ensure good circulation, particularly for the feet. Boots that are too tight can restrict circulation, and prevent an adequate supply of warm blood to the feet. If wearing two pairs of socks in an effort to keep warm, but your feet are still going numb, consider temporarily removing one pair to see if this improves circulation.
• If the numbness only sets in when you stop moving, then limit your stopping time. Movement is the best way to warm up your body.
• If you have used all the equipment at your disposal to try to prevent numbness, but this is not enough, then try moving the affected parts around, such as wiggling your toes and fingers, and pulling funny faces. Place your hands over any areas that are suffering, such as your ears.
• In an emergency, ask someone for help, e.g. if they wouldn't mind you sticking your feet under their armpits!

Emergency Treatment of Frostbite

• Re-warming is always extremely painful - pain is not an indication that something is going wrong with the re-warming process!
• For minor frostbite, such as the fingertips, consider placing the affected parts somewhere warm, such as under an armpit.
• If the feet are severely frostbitten but the casualty can still walk - it is often the best option to walk to safety before dealing with the frostbite. Once the frostbite has been thawed, the pain, and the further damage that can be caused, by walking on the affected parts can be immense.
• The recommended way to treat all frostbite is by placing the affected area in warm water, if possible. The ideal temperature of the water is usually quoted at around 40°C. If you cannot measure the temperature accurately, try sticking a bare elbow in it - if it's borderline too-hot-for-comfort, then this is probably about right. In practice, re-warming will probably involve immersing the affected part for 10-20 minutes or so, then removing it while the water is re-heated. Always check the temperature of the water before re-immersing the affected part. Take care not to subject the frozen tissue to nasty knocks, and do not rub it. The casualty should, however, try to move the affected parts very gently, if at all possible.
• The casualty should not smoke, even if it makes them feel better. Nicotine causes blood vessels to contract, and this will hinder the supply of warm blood to the area that is being thawed.
• Curiously, it is thought that a moderate amount of alcohol might actually help *PROVIDED THE CASUALTY IS NOT ALSO SUFFERING FROM HYPOTHERMIA*. Alcohol dilates the blood vessels.
• Continue the thawing process until it seems that all tissue is no longer frozen.
• Wrap the thawed parts in bandages or the cleanest material available. In the case of hands or feet, take care to keep the fingers or toes separate by wrapping them individually. It is essential to keep the damaged parts clean, as they will be particularly vulnerable to infection.
• The affected parts, once thawed, must rest. The tissue has been damaged, and any further use of the tissue is likely to cause more problems. That means if the feet were frostbitten, then the casualty should not walk. If the hands were frostbitten, the casualty should not use their hands. In both these cases, the casualty will need a lot of assistance in performing basic tasks. If the ears or nose were frostbitten, casualty should take extra care not to put pressure on these when sleeping.
• If the frostbite is serious, particularly if it affects mobility, then rescue should, whenever possible, be arranged at the same time as emergency treatment is administered.
• If no rescue is possible, then it is important to know what to expect next. Recovery seems to vary dramatically from individual to individual, but here are the typical consequences of frostbite:
  • Within a few hours of re-warming, the affected tissue is likely to swell dramatically.
  • Within a few days, huge blisters are likely to form. These should be left alone - it is part of the healing process. If they are punctured either deliberately or accidentally, this can increase the risk of infection.
  • Within about a week, the blisters will have reduced in size and form a mass of tissue which will separate away eventually - usually within a few more weeks. The blisters may appear black, indicating dead tissue. If the frostbite was severe, the tip of a finger or toe might be included in the mass that separates away. The tissue that separates away will be dead already, and the process is often reported as being painless.

Trench Foot

Dehydration

UV Exposure

Skin Damage

Snow Blindness and Eye Damage

Common Breakages

1. Crampons. A pair of crampons, even if they are only "in-step" crampons, should be considered a bare minimum in order to aid safe mobility in freezing weather. If you encounter ice or snow (snow can sometimes seem safe to walk in without crampons - but there is no way of telling if there are icy patches underneath), use the crampons, even if the terrain is flat.
2. Goggles. The combination of strong wind and snow or hail (whether it falls from the sky or has been lifted from the ground by the wind) can virtually put a stop to safe mobility. A pair of goggles goes a long way to countering this problem.
3. Ice axe. An ice axe can be very helpful if negotiating difficult terrain. It can also be very helpful in arresting an accidental slide down a snowy or icy slope. However, if you are negotiating such difficult terrain, you should either be with someone who is experienced, or have gained a lot of experience yourself. An ice axe needs to be practised with in order to use it safely and effectively.