FROSTBITE: SERIOUS COLDWEATHER RISK
When temperatures drop below 30 degrees (Fahrenheit), farmers, ranchers and anyone working outside are at risk to incur frostbite, trench foot and/or chilblains. This is especially true when cold is combined with wind.
Cold weather conditions are the most common cause of frostbite, although direct contact with ice, frozen metal or very cold liquids can also lead to frostbite.
Trench foot is a type of tissue damage brought on by prolonged exposure to cold and wet conditions. It leads to swelling, pain and sensory disturbances in the feet.
Chilblains are the painful inflammation of small blood vessels in the skin that occur in response to repeated exposure to cold but not freezing air. Also referred to as pernio, chilblains can cause itching, red patches, swelling and blistering on hands and feet.
Aaron Yoder, Environmental, Associate Professor for Agricultural and Occupational Health at the University of Nebraska Medical Center, says farmers and ranchers can avoid these serious cold weather illnesses by recognizing their symptoms and understanding how to respond if either frostbite, trench foot or chilblains occur.
“Fingers, toes, cheeks, nose and ears are the areas where frostbite typically occurs,” Yoder says. “Once skin has been frostbitten, it may look white or grayish yellow. It may feel cold, hard, and maybe waxy to the touch.”
Persons with frostbitten skin will experience numbness of the area, aching, tingling and stinging. Appropriate first aid response includes finding a warm room or shelter (i.e. a vehicle) as soon as possible. If your feet or toes are frostbitten, avoid walking, which can lead to further tissue damage.
“Soak the affected area(s) in warm but not hot water,” Yoder says. “Avoid rubbing the affected area because that could cause tissue damage. Use a soft cloth the wrap the affected area, but don’t use a heating pad, fireplace or radiator for warming the frostbitten area. If there’s a chance the area could be refrozen, don’t warm it.”
Minor frostbite can be treated at home. Serious frostbite may involve rewarming, medications, wound care, surgery and other various therapies.
If frostbite is severe enough to warrant a physician’s care, provide the doctor with the following information to assist in developing a treatment plan:
1. List all signs and symptoms you’re experiencing.
2. Document the length of time you have experienced the symptoms.
3. List key medical information, including all other medical conditions, prescribed medications, OTC medications and supplements.
4. Document the date of your last tetanus shot. Frostbite increases the risk of tetanus. If it’s been more than 10 years since your last tetanus vaccination, your doctor may recommend a tetanus vaccination.
5. List all the questions you have for your doctor about what to expect, such as:
a. Are tests need to confirm a diagnosis of frostbite?
b. What are my treatment options; what are the pros and cons of each option?
c. What results can I expect?
d. What skin care routines do you recommend during my healing process?
e. What kind of follow-up should I expect?
f. What changes should I look for in my skin?
In addition to rewarming, a physician may use oral pain medicine to ease the pain of rewarming a frostbitten area. Once the skin thaws, the doctor may loosely wrap the area with sterile sheets, towels or dressings to protect the skin while it heals. The affected area may need to be elevated to reduce swelling.
To properly heal, a frostbitten are must be free of damaged, dead or infected tissue. It’s possible that damaged tissue cannot be removed for one to three months.
Whirlpool (hydrotherapy) or physical therapy may be included in frostbite treatment. Hydrotherapy aids healing by keeping skin clean and by naturally removing dead tissue. If the skin or blisters appear infected, infection fighting drugs may be prescribed.
In the most serious frostbite cases, within the first 24 hours, clot-busting drugs may be used to help restore blood flow to the area. Severe frostbite treatment may also require surgery or amputation to remove dead or decaying tissue. Hyperbaric oxygen therapy may also be used, although the value of this treatment for frostbite is still be studied.
Following frostbite, both prescribed and over-the-counter (OTC) drugs should be used to help combat pain. Some people may find it helpful to apply aloe vera gel or lotion several times per day to the affected area. All exposure to cold and wind should be avoided. No rings should be worn on frostbitten fingers and no other kinds of tight items should be worn. In the case of frostbitten feet, don’t walk on them, don’t apply direct heat or rub the area. If blisters develop, don’t break them as they act as a bandage. They will break on their own.
In trench foot, which is typically less severe than frostbite, victims may experience reddening of the skin, numbness, leg cramps and swelling. They may also have tingling pain, blisters or ulcers, bleeding under the skin and gangrene.
To treat trench foot, remove shoes or boots and wet socks. Dry the feet. Avoid walking to reduce the risk of damage to foot tissue.
Areas most susceptible to chilblains are the toes, fingers, ears, and nose. When chilblains occur, symptoms include redness, blistering, itching, inflammation and (in severe cases) ulceration.
To treat chilblains, avoid scratching the affected area. Slowly warm the skin and use corticosteroid creams to relieve itching and swelling. If blisters and ulcers are present, they should be kept clean and covered.
The most effective treatment for these cold-related illnesses is prevention, beginning with appropriate dress.
“When you’re working outdoors, wear a minimum of three layers of clothing,” Yoder says. “An outer layer to break the wind, a middle layer to retain insulation and an inner layer that allows for ventilation. Have a change of clothes available in case your garments become wet.”
Since 40% of body heat can be lost through the head, protecting the head and face in cold weather conditions is critical. Feet should be protected from cold and dampness by wearing layered socks inside comfortable, insulated footwear. Insulated gloves protect hands and dexterity, which is affected by temperatures below 59 degrees (Fahrenheit).
On-site sources of heat, such as radiant heaters and air jets, can help provide protective warmth. Anyone experiencing prolonged exposure to wind chill temperatures below 20 degrees (Fahrenheit) should have access to a heater shelter or vehicle.
Reducing drafty or windy areas within buildings will help shield work areas. When temperatures drop below 30 degrees (Fahrenheit), thermal insulating material on equipment handles will help protect your hands from excessive cold. Avoid sitting or kneeling on cold, unprotected surfaces.
“Anyone suffering with ongoing medical conditions may need to take special precautions when working in the cold,” Yoder says. “Check with your physician to determine if any of your prescription medications might affect you when you work in cold conditions.”
Since alcohol and drugs can increase heat loss and impair judgment, never use these substances when working in a cold environment. Know the signs and symptoms of cold-induced conditions and know the appropriate first-aid response to them.
“Anytime you experience heavy shivering, severe fatigue, drowsiness, or signs of cold-induced illness, seek warm shelter immediately,” Yoder says. “Avoid tasks that cause you to sweat, as that will quickly rob your body of heat.”
Warm, caffeine and alcohol-free beverages can be used to help maintain energy and body heat. Staying in good physical condition also helps prevent cold-related illness.
“Farm and ranch managers need to take precautions to keep workers safe during cold and/or wet weather, too,” Yoder says. “Allow them to complete their work at a comfortable pace, taking extra breaks if necessary. Always have workers doing jobs in teams during cold weather to help keep an eye on one another.”
When possible, farm managers should schedule outdoor work during the warmest part of the day, or move a job to an enclose area. Workers should be discouraged from sitting or standing in prolonged periods during cold weather.
“If your employees aren’t accustomed to cold weather conditions, allow them to acclimate themselves to it before they begin a task,” Yoder adds.