Frostbite

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NIOSH Fast Facts ## Protecting Yourself from Cold Stress Workers who are exposed to extreme cold or work in cold environments may be at risk of cold stress. Extremely cold or wet weather is a dangerous situation that can cause occupational illness and injuries such as hypothermia, frostbite, trench foot, and chilblains. ## Hypothermia A condition in which the body uses up its stored energy and can no longer produce heat. Often occurs after prolonged exposure to cold temperature. ## Early symptoms ■ Shivering ■ Fatigue ■Loss of coordination ■ Confusion and disorientation ## First Aid ## Late symptoms ■ No shivering ■ Blue skin ■ Dilated pupils - Slowed pulse and breathing - Loss of consciousness - Request immediate medical assistance. ■ Move the victim into a warm room or shelter. ■Remove wet clothing. ■ Warm the center of their body first chest, neck, head, and groin-using an electric blanket; or use skin-to-skin contact under loose, dry layers of blankets, clothing, or towels. ■ If conscious, warm beverages may help increase the body temperature. Do not give alcohol. ■ Once temperature has increased keep them dry and wrapped in a warm blanket, including the head and neck. ■ If no pulse, begin CPR. ## Frostbite An injury to the body that is caused by freezing, which most often affects the nose, ears, cheeks, chin, fingers, or toes. ## Symptoms ■ Reduced blood flow to hands and feet ■ Numbness ## First Aid ■ Aching - Tingling or stinging ■Bluish or pale, waxy skin ■ Get into a warm room as soon as possible. ■ Unless necessary, do not walk on frostbitten feet or toes. ■ Immerse the affected area in warm (not hot) water, or warm the affected area using body heat. Do not use a heating pad, fireplace, or radiator for warming. ■ Do not massage the frostbitten area; doing so may cause more damage.

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# What are some health concerns of working in cold temperatures? (cont.) <table><tr><th colspan="4">Wind Chill Hazards and What To Do</th></tr><tr><td>Wind Chill</td><td>Exposure Risk</td><td>Health Concerns</td><td>What to Do</td></tr><tr><td>0 to -9</td><td>Low risk</td><td>Slight increase in discomfort</td><td>Dress warmly Stay dry</td></tr><tr><td>-10 to -27</td><td>Moderate risk</td><td>Uncomfortable Risk of hypothermia and frostbite if outside for long periods without adequate protection.</td><td>Dress in layers of warm clothing, with an outer layer that is wind-resistant. Wear a hat, mittens or insulated gloves, a scarf and insulated, waterproof footwear. Stay dry. Keep active</td></tr><tr><td>-28 to -39</td><td>High Risk: exposed skin can freeze in 10 to 30 minutes</td><td>High risk of frostnip or frostbite: Check face and extremities for numbness or whiteness. High risk of hypothermia if outside for long periods without adequate clothing or shelter from wind and cold.</td><td>Dress in layers of warm clothing, with an outer layer that is wind-resistant Cover exposed skin Wear a hat, mittens or insulated gloves, a scarf, neck tube or face mask and insulated, waterproof footwear Stay dry Keep active</td></tr><tr><td>-40 to -47</td><td>Very high risk: exposed skin can freeze in 5 to 10 minutes (In sustained</td><td>Very high risk of frostbite: Check face and extremities for numbness or whiteness.</td><td>Dress in layers of warm clothing, with an outer layer that is wind-resistant.</td></tr></table> Cold Environments Control Measures CCOHS

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# What first aid is appropriate for frostbite or immersion foot? First aid for frostbite, as well as immersion or trench foot, includes: - Never ignore numbness. If the area feels numb or tingly, take steps to warm the area immediately. (e.g., put hands under armpits, or pull arms into the inside of a jacket for more direct contact with the body) - If possible, move the victim to a warm area. - Remove wet clothing, and gently loosen or remove constricting clothing or jewellery that may restrict circulation. - Warm the person by wrapping them in blankets or by putting them in dry clothing. Cover the head and neck. Warm the person slowly. Avoid direct heat which can burn the skin. - Loosely cover the affected area with a sterile dressing. Place some gauze between fingers and toes to absorb moisture and prevent them from sticking together. - If the person is alert, give them warm liquids to drink to rehydrate. - Check for signs of hypothermia and seek medical attention. If necessary, quickly transport the victim to an emergency care facility. - Treat the person gently and monitor breathing - DO NOT attempt to rewarm a frostbitten area on site (but do try to stop the area from becoming any colder). Without the proper medical care, the tissue that has been warmed may refreeze and cause more damage. - DO NOT thaw the area if it may freeze again. - DO NOT rub the area or apply snow. - DO NOT allow the victim to drink alcohol or smoke. ## What are the signs of hypothermia? The levels of cold stress and hypothermia include: Cold stress (not hypothermic) - Shivering - Normal mental status - Able to care for self Mild hypothermia Cold Environments - Health Effects and First Aid CCOHS

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CCOHS CCHST Canadian Centre for Occupational Health and Safety Centre canadien d'hygiène et de sécurité au travail # Cold Environments # Cold Environments - Health Effects and First Aid ## On this page What are the health effects of exposure to cold? How do we produce and retain heat within the body? How do we maintain thermal balance? What are examples of cold-related injuries and illnesses? What first aid can I do for frostnip? What first aid is appropriate for frostbite or immersion foot? What are the signs of hypothermia? What first aid is appropriate for hypothermia? What is meant by a hypothermia wrap? Can you become acclimatized to cold? Are there any factors that determine an individual's response to the cold? ## What are the health effects of exposure to cold? Exposure to cold working conditions may result in a variety of cold injuries and illnesses - with hypothermia and frostbite being the most serious. Other types of cold stress injuries include chilblain, immersion foot or trench foot, windburn, frostnip, and frostbite. Generally, toes, fingers, ears, and nose are at greatest risk because these areas do not have major muscles to produce heat. The body preserves heat by keeping the internal organs warm, reducing the flow of blood to the extremities under cold conditions. In addition, hands and feet tend to get cold more quickly than the body (torso) because: they lose heat more rapidly since they have a higher surface area-to-volume ratio, and - they are more likely to be in contact with colder surfaces than other parts of the body. If the eyes are not protected with goggles in high wind chill conditions, the corneas of the eyes may freeze. Cold Environments - Health Effects and First Aid CCOHS

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# What Is Heat Stroke? Heat stroke can cause hallucinations, death. (cont.) BEGIN Working Outdoors INSTRUCTION ZONE ROADWAY SAFETY 6 # What Are the Hazards of Cold Weather? Cold stress can lead to hypothermia, frostbite. Cold stress is caused by a combination of • Cold/cool temperatures (50° F and less) Wet weather and/or conditions • High winds (40+ MPH) • Inadequate clothing Cold stress is prevented by Warm layers of correct clothing, head cover, warm gloves, wool socks • Keeping dry Breaks in warm areas, drinking hot liquids Keep in good physical shape

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# What are some health concerns of working in cold temperatures? (cont.) <table><tr><th colspan="4">Wind Chill Hazards and What To Do</th></tr><tr><td>Wind Chill</td><td>Exposure Risk</td><td>Health Concerns</td><td>What to Do</td></tr><tr><td></td><td>winds over 50 km/h, frostbite can occur faster than indicated.)</td><td>Very high risk of hypothermia if outside for long periods without adequate clothing or shelter from wind and cold.</td><td>Cover all exposed skin. Wear a hat, mittens or insulated gloves, a scarf, neck tube or face mask and insulated, waterproof footwear. Stay dry Keep active.</td></tr><tr><td>-48 to -54</td><td>Severe risk: exposed skin can freeze in 2 to 5 minutes (In sustained winds over 50 km/h, frostbite can occur faster than indicated.)</td><td>Severe risk of frostbite: Check face and extremities frequently for numbness or whiteness. Severe risk of hypothermia if outside for long periods without adequate clothing or shelter from wind and cold.</td><td>Be careful. Dress very warmly in layers of clothing, with an outer layer that is wind-resistant. Cover all exposed skin Wear a hat, mittens or insulated gloves, a scarf, neck tube or face mask and insulated, waterproof footwear. Be ready to cut short or cancel outdoor activities. Stay dry. Keep active.</td></tr><tr><td>-55 and colder</td><td>Extreme risk: exposed skin can freeze in less than 2 minutes</td><td>DANGER! Outdoor conditions are hazardous.</td><td>Stay indoors.</td></tr></table> Cold Environments - Control Measures CCOHS

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# Cold Environments - Health Effects and First Aid (cont.) ## What are examples of cold-related injuries and illnesses? (cont.) Frostnip is the mildest form of a freezing cold injury. It occurs when ears, noses, cheeks, fingers, or toes are exposed to the cold and the top layers of the skin freeze. The skin of the affected area turns paler than the area around it and you may feel pain or stinging, followed by numbness. The skin may also appear shiny and rosy, as well as hardened. The top layer of skin may feel hard but the deeper tissue still feels normal (soft). It is a warning that frostbite is beginning. Frostnip can be prevented by wearing warm clothing and footwear. Frostbite is a common injury caused by exposure to cold or by contact with cold objects (especially those made of conductive metal or stone) and happens when tissue temperature is below 0°C (32°F). It may also occur in normal temperatures from contact with cooled liquids such as oil, fuel, or antifreeze. The skin may look waxy and feel colder than the area around it. It may also be harder to the touch. Blood vessels may be severely and permanently damaged, and blood circulation may stop in the affected tissue. The first symptom is usually numbness in the affected body part. In mild cases, additional symptoms include inflammation of the skin in patches accompanied by pain. In severe cases, there could be tissue damage without pain, or there could be burning or prickling sensations resulting in blisters. Frostbitten skin is highly susceptible to infection, and gangrene (local death of soft tissues due to loss of blood supply) may develop. Hypothermia - In moderately cold environments, the body's core temperature does not usually fall more than 1°C to 2°C below the normal 37°C (98.6°F) because of the body's ability to adapt. However, when a person is exposed to very cold temperatures for long periods of time without adequate clothing, the body is unable to compensate for the heat loss and the body'…

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# Module 12: Working Outdoors (cont.) ## What Is Heat Stroke? (cont.) Instruction Zone Roadway Safety - Working Outdoors [redacted street address] Construction Industry Consortium Awareness Program NOTES: ## What Are the Hazards of Cold Weather? Cold stress can lead to hypothermia and frostbite. Cold stress is caused by a combination of: • Cold/cool temperatures (50° F and less). • Wet weather and/or wet conditions. . High winds (40+ MPH). • Inadequate clothing. Cold stress is prevented by: • Warm layers of correct clothing, head cover, warm gloves, and wool socks. . Keeping dry. • Breaks in warm areas and drinking hot liquids. • Keeping in good physical shape. Early symptoms of hypothermia include: • Shivering, • Fatigue, • Loss of coordination, and - Confusion and disorientation. Late symptoms of hypothermia include: • No shivering, • Blue skin, • Dilated pupils, • Slowed pulse and breathing, Fig. WO-6. Cold weather can cause hypother- mia and frostbite. Ask trainees: How cold does it have to be for you to get frost- bite? What if it is wet outside? (See Wind Chill chart on page 49.)

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# Module 12: Working Outdoors (cont.) ## What Are the Hazards of Cold Weather? (cont.) Instruction Zone Roadway Safety - Working Outdoors A Road Construction Industry Consortium Awareness Program 49 NOTES: • Loss of consciousness, - Coma and death. Frostbite results when it is very cold out. The body reduces blood flow to the hands and feet to keep core body temperature normal. The fingers or toes can freeze. This is called frostbite. Frostbite can also happen from skin contact with very cold objects such as metal equip- ment. Symptoms of frostbite include: • Numbness, tingling, aching, and • Skin turns white then bluish. Pain occurs when the tissue thaws out. Frostbite can cause the tissue to die and force amputation. Early frost- bite can be reversed by gradual rewarming of the tissue in warm water. Fig. WO-7. Cold weather can cause hypothermia and frostbite. <table><tr><th colspan="16">Temperature (°F)</th><th></th><th></th><th></th><th></th></tr><tr><td></td><td>Calm</td><td>40</td><td>35</td><td>30</td><td>25</td><td>20</td><td>15</td><td>10</td><td>5</td><td>0</td><td>-5</td><td>-10</td><td>-15</td><td>-20</td><td>-25</td><td>-30</td><td>-35</td><td>-40</td><td>-45</td></tr><tr><td></td><td></td><td>36</td><td>31</td><td>25</td><td>19</td><td>13</td><td>7</td><td>1</td><td>-5</td><td>-11-16</td><td></td><td>-22-28</td><td></td><td>-34</td><td>-40</td><td>-46</td><td>-52</td><td>-57</td><td>-63</td></tr><tr><td></td><td></td><td>34</td><td>27</td><td>21</td><td>15 53</td><td>9</td><td>3</td><td>-4</td><td>-10</td><td>-16</td><td>-22</td><td>-28</td><td>-35</td><td>-41</td><td>-47</td><td>-53</td><td>-59</td><td>-66</td><td>-72</td></tr><tr><td></td><td></td><td>32</td><td>25</td><td>19</td><td>13</td><td>6</td><td>0</td><td>-7</td><td>-13</td><td>-19</td><td>-26</td><td>-32</td><td>-39</td><td>-45</td><td>-51</td><td>-58</td><td>-64</td><td>-71</td><td>-77</td></tr><tr><td></td><td></td><td>30</td><td>24</td><td>17</td><td>11</td><td>4</td><td>-…