Dealing with the Effects of Cold

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This leaflet is created from first aid advice provided by St John Ambulance, the nation's leading first aid charity. This advice is no substitute for first aid training - find a training course near you.

Frostbite happens when parts of the skin and other tissues freeze due to low temperatures. Frostbite usually affects the fingers and toes as they are the parts of the body furthest from the heart.

If someone has severe frostbite then they might permanently lose all feeling in that part of their body. Frostbite can also lead to gangrene, when the blood vessels and soft tissues become permanently damaged leading to death of the tissue.

Frostbite usually happens in freezing or cold and windy weather. People who cannot move around are more likely to get it. Someone with frostbite will probably have hypothermia, so be prepared to treat them for that too.

What to look for

If you think someone has frostbite, there are four key things to look for:

  1. 'Pins and needles' to begin with.
  2. Paleness, followed by numbness.
  3. Hardening and stiffening of the skin.
  4. Change in skin colour: first white, then blotchy and blue. On recovery, the skin may be red, hot, painful and blistered. If they get gangrene, the tissue may become black due to the loss of blood supply and death of the tissue.

What you need to do

  • First, encourage them to put their hands in their armpits. Then help move them indoors or to somewhere warm.
  • Once inside, gently remove anything constricting like rings, gloves or boots.
  • Next, warm the body part with your hands on your lap, or under their armpits. Don't rub it though because this could damage their skin tissue. (If there is a danger of it refreezing then don't warm it up yet as this can cause more damage).
  • Place the body part in warm (not hot) water at around 40°C (104°F) and be careful not to put it near direct heat as this can cause more damage. Dry it carefully and put on a light dressing, ideally a gauze bandage from your first aid kit.
  • Once you've done that, help them to raise their limb to reduce swelling, with cushions or a sling for instance.
  • Advise them to take some painkillers if they have some (paracetamol for example).
  • Then take or send them to hospital, keeping their limb raised.

Hypothermia happens when someone's body temperature drops below 35°C (95°F). Normal body temperature is around 37°C (98.6°F).

Hypothermia can become life-threatening quickly, so it's important to treat someone with hypothermia straight away. Severe hypothermia, when the body temperature falls below 30°C (86°F), is often fatal.

Hypothermia is usually caused by being in a cold environment for a long time. This could be from staying outdoors in cold conditions, falling into cold water, or from living in a poorly heated house. Elderly people, babies, homeless people and anyone who is thin and frail or not able to move around easily are particularly vulnerable.

What to look for

These are the four key things to look for:

  1. Shivering, cold, pale, and dry skin.
  2. Tiredness, confusion, and irrational behaviour.
  3. Slow and shallow breathing.
  4. Slow and weakening pulse.

What you need to do

  • If you notice any of these symptoms, you need to warm them up.
  • If they are outside, if possible get them indoors. Cover them with layers of blankets and warm the room to about 25°C (77°F). Give them something warm to drink, like soup, and high energy food, like chocolate.
    • Once they have warmed up, tell them to see a doctor as soon as possible.
    • If they lose responsiveness at any point, open their airway, check their breathing and prepare to treat someone who's become unresponsive.
  • If they are outdoors and you can't move them indoors:
  1. Find something for them to lie on to protect them from the cold ground, like heather or pine branches.
  2. If their clothes are wet, change them into dry clothes, if possible. Put them in a sleeping bag and cover them with blankets, if available. Make sure their head is covered too.
  3. Then call 999/112 for an ambulance. If possible, don't leave them by themselves but stay with them until help arrives.
  4. While you wait for help to arrive, keep checking their breathing, pulse and level of response.

Note: these hints are no substitute for thorough knowledge of first aid. St John Ambulance holds first aid courses throughout the country.

Adapted from the St John Ambulance leaflets: frostbite and hypothermia. Copyright for this leaflet is with St John Ambulance.

Original Author:
St John Ambulance
Current Version:
Peer Reviewer:
St John Ambulance
Document ID:
28658 (v2)
Last Checked:
21/11/2016
Next Review:
21/11/2019
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