“Old Man Winter” is just around the corner with his usual assortment of cold temperatures, fierce winds and frozen precipitation. Now is the time to review with your personnel cold-related injuries, the signs and symptoms, prevention strategies and rehab strategies.
There are two specific cold-related vascular (skin and blood vessels) conditions that may result from cold exposure: chilblains and frostbite.
Chilblains are a common type of cold weather-related injury that can develop in predisposed individuals — those with underlying medical conditions or medications — after exposure to non-freezing temperatures and humid conditions. Chilblains typically develop because of an abnormal vascular response several hours after the area exposed to cold is warmed.
Chilblains are itchy, painful, reddish or purplish areas of swelling that usually affect the fingers, toes, nose or ears. In some individuals, blisters or small open sores may also form, increasing the risk for developing an infection.
Chilblains typically last for several days, and the affected area usually heals after several weeks. Although the affected area may remain sensitive to the cold in the future, there is usually no permanent damage.
Frostbite
Frostbite happens when fluid in the cells freeze; there are various degrees of frostbite. Frost nip refers to a milder form of frostbite in which only the surface cells of the skin freeze, usually on the nose, ears, cheeks, fingers and toes.
The affected skin may at first turn become flushed or reddened. Burning and tingling sensations are also common.
If exposure continues, the skin may turn white and become numb. Frost nip is the most common type of frostbite affecting firefighters and, if identified early, can be reversed without any tissue damage.
Superficial frostbite involves the skin and subcutaneous tissue and the deeper freezing of tissue stops oxygenated blood from reaching the cells putting the tissue at risk. The skin becomes firm, white and waxy although the tissue underneath remains soft. Deep frostbite denotes full thickness skin and deeper tissue damage, including muscle and bone.
Hypothermia
Hypothermia is a condition in which the body’s core temperature falls below 95ºF (35ºC). Firefighting activities, particularly when firefighters get wet, presents opportunities for firefighters’ bodies to cool to dangerous levels. Another scenario is when firefighters must conduct emergency operations when low ambient air temperatures are combined with strong winds — creating dangerous wind-chill conditions.
In most cases of firefighting-related hypothermia, exhaustion is a predisposing factor. As exhaustion sets in and the intensity of a firefighter’s efforts slow down, the firefighter’s core temperature starts to fall. Shivering will set in, which is one way the body tries to generate heat.
As their temperatures start to fall, the skin will become cold and pale, their respiration will be depressed and a slow irregular pulse will be present. Continued exposure will cause the firefighter to show signs of irritability, incoordination, weakness, clumsiness and difficulty speaking — this happens at temperatures below 90ºF.
If temperature depression continues, the firefighter will collapse into a coma and failure of the respiratory and cardiovascular systems will ensue.
Treating cold-related injuries
The initial treatment for any cold weather-related injury involves removing the affected person from the precipitating cold environment, if possible, to prevent further heat loss. Move the patient indoors, and remove all wet and constricting clothing, such as socks, boots and gloves, and replace with dry clothing. Uncontrolled shivering is a positive sign of hypothermia that requires aggressive re-warming.
Avoid massaging or rubbing areas with chilblains or frostbite as this could cause additional tissue damage. If a firefighter experiences frost nip, the affected part may be warmed by blowing through cupped hands onto the skin, covering the area, or holding the extremity against the body and using body heat for re-warming.
For superficial or deep frostbite, conduct the initial treatment as described above and then get the affected firefighter to a medical facility for definitive treatment under controlled conditions. Such care will help to reduce or eliminate nerve and tissue damage that can occur when normal perfusion, oxygenated blood flow, is returned to frozen tissue too quickly.
Prevention
Staying warm when the air temperature is frigid and the wind is howling is not difficult when firefighters are actively engaged in tasks on the emergency scene. The exposure comes when the activity slows down or ceases and firefighters are standing around in the elements with sweat-soaked clothing under their turnout gear, especially if the turnout gear is wet as well.
As officers, we need to recognize this exposure risk for what it is and limit the exposure of our people. If personnel are not needed for tasks, say you’re waiting for a fire investigator to arrive, get them out of the cold until needed.
If possible, call for relief personnel to come to the scene to complete operations while your cold and wet firefighters return to their stations for clothing change, warming, food, etc.
As an old Boy Scout (Eagle Scout, 1973) I still recall our scout leader’s admonitions when we would go camping during cold weather, “Ears, nose, fingers and toes.” Protecting these body parts from exposure to wind and cold temperatures and keeping them warm is good preventative medicine for preventing cold-related injuries.
Encourage your personnel to carry a duffle bag containing a minimum of: a change of clothes, several pairs of socks, extra pairs of gloves, a lightweight jacket, knit cap, and energy bars. This will ensure that your people have dry clothing to change into on scene to prevent cold-related injuries, particularly hypothermia.
Consider it their “self-rehab” kit.
Rehab: best practices
Firefighter rehab is an intervention designed to mitigate against the physical, physiological, and emotional stress of fire fighting in order to sustain a member’s energy, improve performance, and decrease the likelihood of on-scene injury or death (NFPA 1584: Recommended Practices on the Rehabilitation of Members Operating at an Incident Scene Operations and Training Exercises).
Cold firefighters (just cold, not those suffering from a cold-related injury) cannot be properly rehabbed outdoors. If they are expected to return to active tasks in the cold, they must have the ability to:
- Get out of the cold and into a warm area that can add external heat to the body (I’ve seen cold weather rehab set up in a neighbor’s garage across the street from the fire).
- Change the wet clothing beneath their turnout gear.
- Consume useful calories, not fats or sugars. The cold body needs fuel and the best fuels for a cold firefighter are proteins and carbohydrates.
