Exposure to COLD Weather


Cold and wind exposure can lead to frost-nip and frostbite, and may not be immediately apparent if the skin turns numb. Other common cold-induced conditions include hypothermia, Raynaud’s phenomenon, cold-induced urticaria, and chilblains.  

  • Most cold-related injuries result from insufficient protection against the elements. As the body cools, the body’s outer shell, i.e. the skin, shifts blood flow to the internal organs to protect the core.
  • Hypothermia is the lowering of the body’s core temperature and is characterized by shivering, altered mental status, slurred speech, and coordination difficulty. Cold temperatures alone can lead to all these conditions, but when wind-chill is added to the mix, heat loss is accelerated, with the greatest effect seen in the first 20 mph of wind speed.
  • The most common skin injury caused by cold exposure is frostbite.  Frost-nip is less severe and results from superficial skin freezing. Frostbite involves deeper freezing, and affects the hands and feet in 90% of the cases. About 17% occur on the face and ears.


Because frost damage occurs in stages, warming at any stage can stop the progression. The stages of frostbite are:

  1. Prefreeze stage occurs at temperatures of 37 to 50 F and causes decreased sensation with slight edema of the skin.
  2. Freeze-thaw stage occurs from 5 to 21 F and produces intra- and extra-cellular ice crystal formation and slight tingling sensation in the skin.
  3. Vascular stasis results from continued cooling producing more ice crystal formation, plasma leakage, vasospasm, and stasis coagulation, and pain in the skin.
  4. Late ischemia is the final phase resulting in thrombus formation, autonomic dysfunction, tissue breakdown, and numbness.

In most cases of frostbite seen in schools, even among outdoor athletes, severe frostbite is rare unless there has been substance use, alcohol, or simply plain poor judgment not to get out of the cold when they notice a problem. 


The classification of frostbite is based on the depth of injury. The ultimate severity of the frostbite, based on clinical exam, is usually not gauged until several days after the injury. The classification of frostbite into a diagnosis is:

§ FROST NIP:  since only the superficial layers of skin are involved, typically this causes just numbness and blue-white discoloration of the affected areas that quickly reverses on warming.

§ MILD FROSTBITE: the skin is usually grayish and pale but the deeper tissue is soft and pliable. The child may complain of burning and/or numbness.<!--[endif]-->

§ DEEP FROSTBITE:  the skin is cold, firm, rigid, and pale. The child may report that it was painful at first and then stopped hurting and became numb. Clear blisters may develop after thawing. There are four degrees of deep frostbite:

  1. First-degree involves mild numbness, erythema, and edema
  2. Second-degree involves clear blisters, erythema and edema
  3. Third-degree involves hemorrhagic blisters
  4. Fourth-degree involves injury to bone and muscle with necrosis and tissue loss 


The mainstay of therapy is warming the skin, but this should not be done until the risk of cold exposure is over, since thawing and refreezing causes more damage than waiting to re-warm.  For hypothermia, wet clothing must be removed and blankets provided. A frostbitten extremity should be elevated. Warming may be by putting the frostbitten extremity next to the skin of a warmer part of the body, as the axillae (arm-pits), or warming in a water bath that is 102-108 F for 15 – 30 minutes. With severe frostbite, re-warming causes pain, and pain medicine may be useful during the process.

Care for blisters is similar to that of burns. The blisters should be left intact and covered with a clean, dry sterile dressing. Deep tissue can be so severe as to warrant IV antibiotics and even surgery.  Tetanus status should be determined and updated if longer than ten years.  All deep frostbite warrants a referral and following by a private physician.  ALWAYS CALL YOUR HEALTH CARE PROVIDER FOR MEDICAL ATTENTION IF YOU SUSPECT ANY OF THESE PROBLEMS!


To make sure you don’t get frostbite, follow these simple tips:

  • Dress warmly. Clothes help keep warm air close to your body. Long underwear is a good start. Then put on a shirt, a sweatshirt, heavy pants and a warm coat that keeps you from getting cold and wet.
  • Wear gloves or mittens and a hat and winter boots to keep your feet warm and dry.
  • Go inside if you get wet or cold.
  • When inside, take off your wet clothes and put on something dry and warm.
  • If you can’t feel any part of your body or skin or if something tingles, do not rub it. Go inside and tell an adult right away.

File Cold Weather.pdf