How best to prevent frostbite during extremely cold temperatures

Jan. 11, 2024
Tight shot of man's face. He's bundled up for the cold with snow on his hat and scarf. Photo: Getty Images.
Dangerously cold air and windchills can cause frostbite within seconds. Preventing frostbite is the key to staying safe. Photo: Getty Images.

Dangerously cold arctic air is gripping the U.S., prompting experts to warn people to prevent frostbite by bundling up, covering exposed skin, and if possible, avoid spending time outdoors.

If you need to be outside, it’s essential to dress in layers to reduce the risk of frostbite. Don’t forget your hat, gloves, scarf and boots. Medical experts at the UCHealth Burn and Frostbite Center on the Anschutz Medical Campus say frostbite can happen within seconds if skin is exposed during extremely cold temperatures.

Frostbite is an injury — almost like a burn — that occurs when the skin and tissue freeze after being exposed to extreme cold for too long. Most frostbite injuries occur on the fingers, toes, nose, cheeks, and ears. In most cases, the body part can be rewarmed to avoid long-term injury, but in severe cases, surgery or even amputation may be required.

“The big thing, obviously, is preventing frostbite in the first place,’’ said Dr. Arek Wiktor, director of the burn center at UCHealth University of Colorado Hospital. “Stay out of the cold, and if you must be outside, protect your skin.’’

Elderly people, small children, people experiencing homelessness and those who have peripheral vascular disease or diabetic neuropathy are most at risk for frostbite, said Wiktor, who is also an associate professor of surgery at the University of Colorado School of Medicine on the Anschutz Medical Campus.

Frostbite can happen very quickly.

Here are tips for preventing frostbite and staying warm during dangerously cold weather:

  • Be especially careful when wind accompanies cold weather, as windchills can dramatically reduce the time when frostbite can set in.
  • Avoid drinking alcohol since people who are intoxicated may not immediately be aware of how cold they are.
  • Keep as much of your skin covered as possible. Cover your head. Wear a hat and earmuffs, and wear heavy mittens if you have them since they work better than gloves. Wiggle your fingers frequently to keep them warm.
  • Dress in layers and, keep outerwear dry. If your clothes get wet, head indoors as quickly as possible to change into dry clothes.
  • Choose loosely-woven fabric for the inside layer (wool, silk, polypropylene). These fabrics hold more heat and help avoid excessive perspiration.
  • When outside in cold temperatures, take frequent breaks indoors and assess hands, feet, ears and your nose.
  • Wear boots with warm, dry socks, wiggle your toes and do not lace up your boots too tightly. Two pairs of thinner socks provide better insulation than a single pair of thicker socks.
  • Be prepared when traveling in cold weather. Keep a winter survival kit in the car that includes blankets, matches and extra clothes. Never rely on your car’s heater to be the only source to stay warm, since your car could run out of gas or be damaged in an accident.

Here are the signs and symptoms of frostbite:

  • Shivering is the first sign the body is losing heat, so don’t ignore it.
  • Numbness.
  • Pale color to the skin.
  • Clumsy movements.
  • Pain that persists for 45 minutes after rewarming.
  • Following rewarming, increased redness or discoloration.

In severe cases of frostbite, a person’s skin can turn black.

“The black color occurs when there is death of the tissue, called necrosis,” Wiktor said.

“You can also develop blisters from frostbite. Another sign of frostbite is significant pain as you try to warm up your fingers or toes,” he said.

How do doctors treat frostbite?

The No. 1 treatment is rapid rewarming.

If you are concerned that you have suffered severe frostbite, contact your doctor or seek help at a hospital.

If you have gotten chilled and don’t think you have severe frostbite, you can try to rewarm your body and your fingers and toes.

Use water that is between 98 and 102 degrees. It takes about 15 minutes to rewarm, and you have to be careful not to use too hot of water because then you can go in the opposite direction with a different thermal injury and have a burn.

A doctor may prescribe an analgesic to help ease the pain of frostbite. In more complicated injuries, if a blister forms or there is a non-healing wound, the person should seek help from a doctor immediately.

In severe cases, doctors at the UCHealth Burn and Frostbite Center will use tPA, a medication that breaks tiny blood clots and restores circulation.

“If frostbite sets in, we can deliver tPA within eight hours of seeing the patient and starting the warm-up process,” Wiktor said.

Why is frostbite so dangerous?

Frostbite damages the skin and other tissues from exposure to freezing temperatures and happens when exposed areas of skin get very cold, causing ice crystals to form. This eventually leads to the blood vessels in that area freezing, causing the affected areas to go without blood, nutrients and oxygen.

The body parts most commonly affected by frostbite are areas exposed to the cold air, especially the fingers and hands, the feet and toes, the nose and ears.

At what temperature does frostbite happen?

Frostbite can happen fast. It only takes 30 minutes for frostbite to set in when the temperature is 5 degrees and the wind speed is 30 mph. At minus 5 degrees and a wind speed of 30 mph, frostbite will happen in 10 minutes.

A chart about wind chill from the National Weather Service. Colorado weather can cause frostbite in matter of minutes for exposed skin.
Wind chill can dramatically increase the potential for frostbite. Courtesy: The National Weather Service.

What should you do if you suspect you have frostbite?

  • Remove wet clothing and get into a warm environment.
  • Avoid rubbing the area – rubbing frozen tissue can cause further damage.
  • If you are concerned that you may have frozen digits/ extremities, avoid rewarming them until you are sure they will not refreeze.
  • Immediately seek medical attention. Getting proper treatment within 12-24 hours of rewarming of the injury, can save the frozen areas from possible amputation.

Possible long-term effects of frostbite include:

Frostbite can be serious.

  • Change in the sensation of the injured area, including cold sensitivity, muscle weakness or joint stiffness
  • Chronic pain secondary to nerve damage
  • Damage to sweat glands, cracking skin and nail loss
  • Possible need for amputation of the damaged digits or limb.

There are good treatments for frostbite if you seek help early. The UCHealth Burn and Frostbite Center is an American Burn Association and American College of Surgeons verified burn center since 1998 and has been serving the region since 1978.

About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.