Perform First Aid for Cold Injuries

Conditions: You see a casualty who has signs and symptoms of a cold injury. Necessary equipment and materials: canteen of potable water, blanket or similar item to use for warmth, and dry clothing.

Standards: Identified the type of cold injury and gave the correct first aid.

Performance Steps

Note. When performing first aid on a casualty, seek medical aid as soon as possible. Do not stop the first aid; but, if the situation allows, send another person to find medical aid.

1. Identify the type of cold injury.

   a. Chilblain/frostnip.  If the signs and symptoms are as follows, go to step 2a.

       (1)  Prolonged exposure of bare skin at temperatures of 60 degrees Fahrenheit to 32 degrees Fahrenheit.

       (2)  Redness or pallor of affected areas.

       (3)  Absence of pain (numb).

       (4)  May have ulcerated bleeding skin lesions.

Note. Freezing of superficial skin tissue may occur with frostnip; however, there is no freezing of the deeper tissues.

   b. Frostbite.  If the signs and symptoms are as follows, go to step 2b.

       (1)  Superficial.

           (a)   Loss of sensation or numb feeling in any part of the body.

           (b)   Sudden whitening of the skin in the affected area followed by a momentary tingling feeling.

           (c)   Redness of skin in light-skinned soldiers, grayish coloring in dark-skinned soldiers.

       (2)  Deep.

           (a)   Blisters.

           (b)   Swelling or tender areas.

           (c)   Loss of previous feeling of pain in the affected area.

           (d)   Pale, yellowish, waxy-looking skin.

           (e)   Frozen area feels solid or wooden to the touch.

   c. Immersion foot/trench foot.  If the signs and symptoms are as follows, go to step 2c.

       (1)  Long exposure of feet to wet conditions at temperatures from 50 degrees Fahrenheit to 32 degrees Fahrenheit.

       (2)  Early stage/first phase.

           (a)   Affected area feels cold.

           (b)   Numb and painless.

       (3)  Later stage/advanced phase.

           (a)   Limbs feel hot and burning.

           (b)   Shooting pains.

           (c)   Affected area is pale with bluish cast.

           (d)   Pulse strength decreased.

           (e)   Other signs that may follow include  blisters, swelling, redness, heat, hemorrhages, or gangrene.

   d. Snow blindness.  If the signs and symptoms are as follows, go to step 2d.

       (1)  Scratchy feeling in eyes, as if from sand or dirt.

       (2)  Watery eyes.

       (3)  Redness.

       (4)  Headache.

       (5)  Increased pain with exposure to light.

   e. Hypothermia.  If the signs and symptoms are as follows, go to step 2e.

       (1)  Mild hypothermia (body temperature 90 to 95 degrees Fahrenheit).

Note. This condition should be suspected in any chronically ill person who is found in an environment of less than 50 degrees Fahrenheit

CAUTION: With generalized hypothermia, the entire body has cooled with the core temperature below 95 degrees Fahrenheit. (Temperature is provided as a guide; the common soldier probably would not have a thermometer to use.) This is a medical emergency

           (a)   Conscious, but usually apathetic or lethargic.

           (b)   Shivering.

           (c)   Pale cold skin.

           (d)   Slurred speech.

           (e)   Poor muscle coordination.

           (f)    Faint pulse.

       (2)  Severe hypothermia (body temperature 90 degrees Fahrenheit or lower).

           (a)   Breathing slow and shallow.

           (b)   Irregular heart action.

           (c)   Pulse weaker or absent.

           (d)   Stupor or unconsciousness.

           (e)   Ice cold skin.

           (f)    Rigid muscles.

           (g)   Glassy eyed.

CAUTION: Hypothermia is a medical emergency. Prompt medical treatment is necessary. Casualty should be evacuated to medical treatment facility immediately

   f.  Dehydration (cold weather).  If the signs and symptoms are as follows, go to step 2f.

       (1)  Mouth, tongue, and throat are parched and dry.

       (2)  Swallowing is difficult.

       (3)  Nausea and dizziness.

       (4)  Fainting.

       (5)  Tired and weak.

       (6)  Muscle cramps especially in the legs.

       (7)  Focusing eyes may be difficult.

2. Perform first aid for the cold injury.

   a. Chilblain/frostnip.

       (1)  Apply rewarming (body heat).

           (a)   Apply warmth with casualty's bare hands.

           (b)   Blow warm air on the affected area.

           (c)   For hands and fingertips, place hands in armpits.

       (2)  Protect lesions (if present) with dry sterile dressing.

       (3)  Seek medical aid.

CAUTION: Do not rub or massage area.

Note. If the condition does not respond to simple care, begin first aid for frostbite.

   b. Frostbite.

CAUTION: DO NOT— Rub snow on the frostbitten part. Massage or rub the frostbitten part. Use dry or radiant heat to rewarm. Rupture blisters. Use ointments or other medications on the part. Handle a frostbitten extremity roughly. Allow a thawed extremity to refreeze. Allow the casualty to use alcohol or tobacco products

       (1)  Warm the area using firm, steady pressure of hands, underarm, or abdomen.

       (2)  Face, ears, nose—cover with hands (casualty's or a buddy's).

       (3)  Hands—open casualty's field jacket and place against the body (under armpits if possible), then close the jacket.

       (4)  Feet—remove boots, socks, and place feet under clothing and against the body of another soldier.

CAUTION: Do not remove clothing in a chemical environment.

WARNING: Do not attempt to thaw the casualty's feet, or other seriously frozen areas, if the soldier will be required to walk or travel to a medical center to receive medical treatment. The possibility of injury from walking is less when the feet are frozen than after they have been thawed (if possible, avoid walking). Thawing in the field increases the possibility of infection, gangrene, or injury.

       (5)  Loosen or remove constricting clothing and remove any jewelry.

       (6)  Increase insulation (cover with blanket or something similar and dry).

       (7)  Have the casualty exercise as much as possible, avoiding trauma to injured part(s).

       (8)  Seek medical aid.  (Evacuate the casualty.)

WARNING: Monitor the casualty for life-threatening conditions and apply appropriate first aid as necessary.

   c. Immersion foot/trench foot.

       (1)  Gradually rewarm by exposing to warm air.

       (2)  Protect affected parts from trauma.

       (3)  Dry feet thoroughly and avoid walking.

       (4)  Elevate the affected part.

       (5)  Seek medical treatment.  (Evacuate the casualty.)

   d. Snow blindness.

       (1)  Cover the eyes with a dark cloth.

       (2)  Seek medical treatment.  (Evacuate the casualty.)

   e. Hypothermia.

CAUTION: This is a medical emergency! Prompt medical treatment is necessary.

       (1)  Mild.

           (a)   Rewarm body evenly.  (Must provide heat source--campfire or other soldier's body.)

Note. Merely placing the casualty in a sleeping bag or covering with a blanket is not enough since the casualty is unable to generate his own body heat.

           (b)   Keep dry and protect from the elements.

           (c)   Give warm liquids gradually if the casualty is conscious.

           (d)   Seek medical treatment immediately.

       (2)  Severe.

           (a)   Stabilize the temperature.

           (b)   Attempt to avoid further heat loss.

           (c)   Evacuate to the nearest medical treatment facility as soon as possible.

Note. Rewarming a severely hypothermic casualty in the field is extremely dangerous. There is a great possibility of complications such as rewarming shock and disturbance in the rhythm of the heartbeat.

WARNING: Monitor the casualty for life-threatening conditions.

   f.  Dehydration.

       (1)  Keep warm.

       (2)  Loosen clothes to improve circulation.

       (3)  Give fluids for fluid replacement.

Note. Medical personnel will determine the need for salt replacement.

       (4)  Rest.

       (5)  Seek medical assistance.