AKU-6- 90-002 C3 FROSTBITE AND OTHER COLD INJURIES ALASKA SEA GRANT COLLEGE PROGRAM EOUCATION PUBLICATION NO. 7 1990 FROSTBITE AND OTHER COLD INJURIES DEBORAH MERCY Alaska Sea Grant Marine AdvisoryProgram Anchorage, Alaska SG-ED-07 1990 Price $400 Aaska Sea Grant College Program UniversityOf Aaska Pa radarks, 138 rving II i a.radar ks, Aaska 99775-hOWO ;9O7j A7d-7ORA FISHERIESSAFETY AND SURVIVAL SERIES Elmer E. RasmusonLibrary Cataloging-in-PublicationData. Mercy, Deborah Frostbite and other cold injuries, Fisheries safety and survival series! SG-ED-07! 1. Frostbite Study andteaching. I. AlaskaSea Grant CollegeProgram. II, Title. III. Series; Sea grant education publication; no. 7. RC88.5.M47 1990 About the Author DeborahMercy has been instructional media specialist for the Alaska SeaGrant Marine AdvisoryProgram in Anchoragesince 1986. She has produced several videotapes for the Marine AdvisoryProgram, and servesas managingeditor for theALaska Marine Resource Quarterly. Mercy'sexperience also includes broadcast journalism and commercial fishing, Acknovvledgments This bookand the videothat accompaniesit would not havebeen possible without the time, effort, andcomments provided by the followingpeople. Content Specialists: Scott Sullivan, R.N.,Providence Hospital, Anchorage; Jerry Dzugan,Alaska Marine Safety Education Association;and Todd Miner, Alaska Wilderness Studies, University of AlaskaAnchorage. InstructionalDesigner: Barry Willis, Universityof AlaskaAnchorage. Thanks also to the AlaskaWilderness Studies program for their generouscontribution of videofootage used in the program, Editing of the bookletis by Kurt Byers,cover art is by KarenLundquist, and text formattingis by Ruth Olson.This projectwas funded by Saltonstall-KennedyFishery Development Funds administeredby the NationalMarine Fisheries Service under cooperative agreement number 86-ABH-00031. This bookletwas produced by the AlaskaSea Grant CollegeProgram, which is cooperatively supportedby ! the U.S. Department of Commerce,NOAA Office of SeaGrant and Extramural Programs,grant no,NA90AA-D-SG066, project no. A/75-01 and A/71-01, and ! the University of Alaska with funds appropriated by the state. Table of Contents What This Workbook Is About Overview SectionI. The Dangerof ColdInjuries SectionII. Typesand Characteristicsof ColdInjuries Frostnip Superficial Frostbite Deep Frostbite Immersion Foot SectionIII. Causesand Preventionof LocalizedCold Injuries Frostnip,Superficial Frostbite, Deep Frostbite, Immersion Foot Section IV. Treatment of Cold Injuries Frostnip Superficial Frostbite Deep Frostbite Re-Warming After Re-Warming Immersion Foot Some Do's and Don'ts of Cold Injury Treatment Summary Quiz Yourself Quiz Answers For More Information We Need Your Comments Frostbite and Other Cold Injuries 1 What This Workbook Is About This workbook provides general information on four types of cold injuries. The goal is to help increase awareness of the causes, characteristics, treatments, and prevention of cold injuries, and thus reduce the number of injuries suffered by people due to exposure to cold, wet, and hostile environments. This workbook, Frostbite and Other Cold Injuries, may be used alone or with the 16-minute video program of the same name, The workbook is part of the Fisheries Safety and Survival Series. Others in the series are Hypothermia A-2-031!, Shore Survival A-2-033!, and Mari ne Survival Equipment and Maintenance SG-ED- 06!. For help with using workbooks and the related videotapes in a classroom, a Facilitator's Notebook A-2-034! has also been prepared. The booklets and videos by the same titles are available from the Marine Advisory Program, University of Alaska, Carlton Trust Building, 2221 E. Northern Lights Blvd., Suite 110, Anchorage, AK 99508-4140, 907! 274-9691. This booklet does not include everything there is to know about localized cold injuries. For sources of further information, see the "For More Information" section at the end of this book. If you are studying the workbook and viewing the videotape as part of a group, your group facilitator will suggest ways to most effectively cover the material. If you are studying the material alone, we suggest you read through the workbook, and answer questions at the end as a revie~. Keep this workbook for future reference. If you have any comments or suggestions after reading this workbook, please fill out and return the last page. This information was compiled by the University of Alaska Sea Grant Marine Advisory Program, and was collected from a variety of sources, including Providence Hospital, Anchorage, and outdoor health and safety specialists. 2 Frostbite and Other Cold Injuries Overview Cold wind, rain, water, snow, and ice can be dangerous for the unprepared, causing minor to fatal cold injuries. Localized cold injuries are frostnip, superficial frostbite, deep frostbite, and immersion foot, also known as trench foot, The first three injuries are characterizedby localized frozen tissue. Immersion foot is characterizedby cold, wet, non-frozentissues. Victims of cold injuries often recover completely,but in more severe cases, victims can lose one or more extremities or die. Anyone who goesoutdoors must adopt the attitude that the only sure bet for preventing injury is to be prepared. You never know how your day is going to end, Understanding the causesof cold injuries is the best way to prevent them. The purpose of this workbook is to help you identify, prevent, and treat cold injuries. The book describes: ~ The danger of cold injuries. ~ What causes cold injuries. ~ How to prevent cold injuries. ~ How to identify different cold injuries. ~ How to treat and care for cold injuries. In addition to knowing the principles, techniques, and procedures in this workbook, it is also important to practice them. Frostbite and Other Cold Injuries 8 Section I: The Danger of Cold Injuries It's January, and after days of tanner crab fishing you have the day off, The boat is anchored in a quiet bay, it's morning, and everyone has finished breakfast and is anxious to get off the boat and explore the shoreline, The skipper asks you to start the skiff's engine. It's cold and windy outside. But you' re accustomed to that, and since you will only be outside for a few minutes, you don't bother to put on your gloves. The enginedoesn't start soyou adjust the choke.Now the coldis makingyour fingers hurt, especiallywhen you touch metal. All of a suddenyou can't feel the engine metal and your hand feels like ice when you touch it with your warmer hand. You have developed a cold injury. Cold injuries can happen in just a few minutes, or they can creep up slowly, over several hours or even days. Onset of cold injuries may or may not be sensedby the victim, but in either casethe injury can result in severetissue damage requiring amputation, or in the worst case, death. The tragedy about localized cold injuries is that they can almost always be prevented, It was November and Zee Hyden had asked Lori to accompany him on a picnic and river boat ride. It was a mild day and they were enjoying their first date, About 3:00 pm it started cooling off, so they decided to head home. But on their way, their boat got caught betweentwo rocks, flipped over, and drifted away. They managed to grab some food and make it to shore, wet and chilly, but uninjured. Seeing no alternative, they began walking home. Zee and Lori had both drunk some wine with their picnic. The alcohol combined with the urgent feeling to return home cloudedtheir ability to make a safe decisionabout what they should do. They ended up walking for twenty-five miles, through boggy terrain with only a small amount of food all in tight fitting boots. Their soaking wet feet were tired, and beganto swell, hurt, and go numb, Eventually Lori began to hallucinate and Zeelost his ability to think clearly. They were suffering from hypothermia and immersion foot. Finally they made it back to their car. Slowly they drove home and on to a hospital where they were treated for their injuries, It took six months before each regained all feeling in their toes. 4 Frostbite and Other Cold Injuries Had Zee and Lori been familiar with the warning signs of hypothermia and immersion foot, and had they been able to make clear decisions, they could have acted to prevent these problems. Knowing that cold water drains body heat twenty-five times faster than air, they would have tried to find a drier route home or sought help elsewhere. They would have known that avoiding wetness would also have helped prevent immersion foot, since it doesn't take freezing temperatures to causethis malady. They also would have known that when body temperature drops, hypothermia occurs,which can lead to further cold injuries, and that their restrictive clothing would obstruct blood supply to their extremities, which also would speed the onset of a cold injury. Section II: Types and Characteristics of Cold Injuries There are two broad types of cold injuries: freezing injuries frostnip, superficial frostbite, deep frostbite!, and non-freezing injuries immersion foot!. All four of these cold injuries are called localized cold injuries. Each differs in severity. The first three are characterized by local frozen tissues, while the latter is characterized by localized, non-freezing, cold, wet tissues. Freezing injuries result from localized reduction in water to the cells due to freezing between the cells. Non-freezing injuries result from prolonged exposure to cool, wet conditions. Frostnip The least serious cold injury is frostnip. It is the freezing of surface skin. It can be painful and disfiguring if skin tissue is actually lost. Frostnip usually occurs in body areas that are thin, easily chilled, and often exposed directly to wind, moisture, or both, such as ear lobes, cheeks, the tip of the nose, and finger tips. Because it generally appears on the face, it can go unnoticed. It is helpful to have a friend along so you can both keep an eye on each other.