Cold-related Injuries and Illnesses

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Cold-related Injuries and Illnesses

• Hypothermia, Frostbite, and Other Health Problems

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What this presentation covers

• Summary of factors increasing risk of
  cold-related injuries and illnesses
• Summary of preventive measures against
  cold-related injuries and illnesses
• Causes, signs and symptoms, and treatment of

• Hypothermia
• Frostbite
• Frostnip

• Chilblains
• Immersion Foot (Trench foot)

See Working in Cold Environments for more
information on the causes and risk factors of
cold-related illnesses and injuries, and
preventive measures to minimize the hazards from
cold exposure.
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Factors Increasing Risk of Cold Injuries/Illnesses

• Previous cold-related injury
• Predisposing health conditions
• Fatigue, poor physical condition
• Poor nutrition
• Dehydration
• Medication
• Alcohol
• Caffeine

• Nicotine (Smoking)
• Age
• Improper clothing and equipment
• Under-activity
• Over-activity
• Cold conditions
• Temperature
• Wind
• Wetness
• Length of exposure

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Preventing Cold-related Injuries and Illnesses

• Wear appropriate clothing.
• Avoid wetness or excessive sweating.
• Stay dry. Change into dry clothes and shoes if
  they become wet.
• Keep active. Avoid sitting or standing still for
  prolonged periods.
• Take frequent breaks in warm, shielded areas.
• Work in pairs to keep an eye on each other.
• Consume warm, high calorie food often.
• Drink plenty of warm non-caffeinated,
  non-alcoholic liquids.
• Dont smoke.

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Hypothermia

• Hypothermia ("low heat) is a potentially serious
  and fatal health condition resulting from the
  bodys failure to maintain its normal core
  temperature of 98.6F.
• When exposed to cold conditions, your body begins
  to lose heat faster than it can be produced.
  Prolonged exposure to cold eventually uses up
  your bodys stored energy and your core body
  temperature drops to 95F or below. The
  result is hypothermia.

Hypothermia is a medical emergency!
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Hypothermia

• Body temperature that is too low affects the
  brain, making the affected person unable to think
  clearly or move well.

This makes hypothermia particularly dangerous
because a person may not realize it is happening
and may deny being in any trouble. Recognition
of symptoms depends on co-workers' ability to
identify symptoms and to seek medical help.
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Hypothermia
Most cases of hypothermia occur in air
temperatures from 30F to 40F.
However, it can occur at warmer temperatures as
high as 65F, or more, if a person becomes
chilled from prolonged exposures to wetness
(rain, snow, submersion in cold water, or sweat)
and accompanying winds. Generally, in cold dry
environ- ments, hypothermia occurs over a period
of hours. In cold water, core temperature can
drop to dangerous levels in a matter of minutes.
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Immersion Hypothermia
Water transfers heat away from the human body 25
times faster than air, so even moderate water
temperatures can be dangerous in a relatively
short time.
Water Temperature inDegrees F (Degrees C) Exhaustion or Unconsciousness Expected Time of Survival
32.5 (0.3) Under 15 min. Under 15 to 45 min.
32.5 to 40 (0.3 to 4.5) 15 to 30 min. 30 to 90 min.
40 to 50 (4.5 to 10) 30 to 60 min. to 3 hrs.
50 to 60 (10 to 15.5) to 2 hrs. to 6 hrs.
60 to 70 (15.5 to 21) 2 to 7 hrs. 2 to 40 hrs.
70 to 80 (2 to 26.5) 2 to 12 hrs. 3 hrs. to indefinite
Over 80 (Over 26.5) Indefinite Indefinite
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Stages of Hypothermia

• Hypothermia progresses through three indistinct
  but sequential stages as core body temperature
  continues to decline

Approximate Core Body Temperature Approximate Core Body Temperature
Mild hypothermia 98F - 95F
Moderate hypothermia 95F - 90F
Severe hypothermia lt90F
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Mild Hypothermia
Signs/Symptoms
Physical











Mental

• shivering, mild to severe
• sensation of cold, then pain in extremities
• pale, waxy, cold skin
• numbness of hands
• unable to perform complex tasks (fumbling with
  items in the hand)
• able to walk and talk

• irritability

If shivering can be stopped voluntarily ? mild
hypothermia
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Moderate Hypothermia
Signs/Symptoms
Physical











Mental

• intense shivering becomes persistent and violent
• sluggish labored movements
• stumbling
• loss of fine motor coordination in hands
  (fumbling)

• confused, may appear alert
• irrational behavior Paradoxical Undressing
  (person starts to undress, unaware s/he is cold)
• apathetic/flattened affect "I don't care
  attitude"
• withdrawn behavior
• slurred speech, difficulty speaking
• sluggish thinking
• signs of depression

• Watch for the -umbles
• stumbles
• mumbles
• fumbles
• grumbles

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Severe Hypothermia
Signs/Symptoms
Physical











Mental

• shivering stops
• exposed skin blue or puffy
• muscle coordination very poor, muscle rigidity
• stupor
• cant walk falls to ground and curls up into
  fetal position to conserve heat
• decreased pulse and respiration rate
• irregular heart rhythm

• incoherent, irrational behavior
• may be able to maintain posture and appearance of
  awareness
• semi-conscious, drowsy
• loss of awareness of others
• amnesia, memory lapses

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Possible Death from Hypothermia
No one is dead until warm and dead
Core body temperature below 82F - 78F
Physical











Mental

• erratic, shallow breathing
• may not be able to feel pulse
• pupils dilated and fixed
• cold, blue skin
• unresponsive to any stimuli
• pulmonary edema, cardiac and respiratory failure
• death possible below 78F

• Brain activity seriously slowed
• unconscious, appears comatose or dead

Worker may appear dead and show all the accepted
clinical signs of death, but many of these people
have made complete recoveries when re-warmed.
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Treatment of Hypothermia
Treatment depends on the severity of the
hypothermia.
Mild Hypothermia

• Remove wet clothes from victim and replace with
  dry clothes and/or wrap in warm blankets cover
  the head.
• Move to a warm environment.
• Do not exercise to warm up.
• Do not re-warm person in a warm bath or by
  massaging or rubbing.
• Drink a warm (not hot) sugary drink Avoid drinks
  with caffeine (coffee, tea, or hot chocolate) or
  alcohol.
• Transport victim to an emergency medical facility
  for evaluation.

Handle the victim gently and minimize his or her
exertion.
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Treatment of Hypothermia
Moderate Hypothermia

• Call for emergency help.
• Follow the procedures on the preceding slide.
• In addition
• Cover all extremities completely, place very warm
  objects, such as hot packs or water bottles on
  the victim's head, neck, chest and groin. Arms
  and legs should be warmed last.

Handle the victim gently. Rough handling can
cause heartbeat irregularities and death.
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Treatment of Hypothermia
Severe Hypothermia

• Call for emergency help.
• Give CPR if necessary.
• Follow the procedures for treating mild
  hypothermia.
• Do not apply external heat (hot water bath, heat
  lamp, electric blanket, electric heater, etc.) to
  re-warm.
• Transport the victim to an emergency medical
  facility as soon as possible.

Handle the victim very gently. Transport to
hospital for treatment as soon as possible.
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Frostbite

• In cold conditions, your body reduces heat loss
  and increases heat production in order to
  maintain an internal (core) body temperature of
  98.6F.

• Body Core
• Heart
• Brain
• Lungs
• Liver
• Kidneys

Over time, your body will decrease blood flow to
your extremities and outer skin and shift it to
the body core to keep the internal organs warm.
However, this allows exposed skin and the
extremities to cool rapidly and increases the
risk of cold-related injuries, such as frostbite.

• Extremities
• Legs, feet
• Arms, hands

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Frostbite

• Frostbite occurs when the deep layers of the skin
  and other body tissues freeze (tissue temperature
  lt28F-30F). Ice crystals form, destroying
  tissues and causing permanent damage. In severe
  cases, amputation of the frostbitten area may be
  required.

Frostbite typically affects the

• toes/feet
• fingers/ hand
• ears

• nose
• cheeks
• chin

These parts are farthest from the body core,
receive less blood flow, and are thinner so they
cool faster.
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Frostbite
Causes

• Exposure to below freezing temperatures
• Can occur in above freezing temperatures due to
  wind chill factors and wetness
• Contact with extremely cold objects (especially
  metal)
• Contact with cooled or compressed gases, at
  normal temperatures (e.g., liquid nitrogen)

Direct skin exposure to freezing metal, extreme
cold, or high winds can cause frostbite in
minutes.
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Frostbite
Frostbite can be classified into two main
divisions

• Superficial (mild)
• Deep (severe)

The extent of frostbite depends on the
extremeness of conditions and duration of
exposure.
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Superficial Frostbite

• includes all layers of the skin
• initially redness in light skin, grayish in dark
  skin
• burning, tingling, itching, or cold sensations in
  the affected areas, followed by numbness
• skin turns white, waxy some resistance when
  pressed (feels firm or wooden but underlying
  tissue is soft) cold to the touch
• may have blistering

Photo courtesy of USACHPPM
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Deep Frostbite

• involves skin, muscle, tendons, nerves, blood
  vessels may include bone
• white or yellowish waxy skin that turns purplish
  blue as it thaws
• underlying tissue hard, no resistance when
  pressed, may appear blackened and dead
• blood-filled blisters and swelling may develop
• may develop blood clots

Photos courtesy of USACHPPM
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Deep Frostbite

• significant pain as affected areas re-warm dull
  continuous ache becomes throbbing sensation in
  2-3 days and may last weeks to months
• frostbitten skin is highly susceptible to
  infection, and gangrene (death and decay of body
  tissues) may develop
• time will reveal the final amount of tissue
  damage
• many people with frostbite may also be
  experiencing hypothermia

Photos courtesy of USACHPPM
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Treatment of Frostbite

• Move the person to a warm dry area. Dont leave
  the person alone.
• Remove any wet or tight clothing that may cut off
  blood flow to the affected area.
• Treat for hypothermia if victim is also
  experiencing hypothermia. Saving their lives is
  more important than preserving a finger or foot.
  Perform CPR if necessary.
• Do not rub the affected area, because rubbing
  causes damage to the skin and tissue.
• Gently place the affected area in a warm (105F)
  water bath and monitor the water temperature to
  slowly warm the tissue. Dont pour warm water
  directly on the affected area because it will
  warm the tissue too fast causing tissue damage.
  Warming takes about 25-40 minutes.

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Treatment of Frostbite

• After the affected area has been warmed, it may
  become puffy and blister. The affected area may
  have a burning feeling or numbness. When
  normal feeling, movement, and skin color have
  returned, the affected area should be dried and
  wrapped to keep it warm.
• NOTE If there is a chance the affected area may
  get cold again, do not warm the skin. If the skin
  is warmed and then becomes cold again, it will
  cause severe tissue damage.
• Seek medical attention as soon as possible.

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Frostnip

• Frostnip is the mildest form of a freezing cold
  injury. Only the very outer layers of the skin
  freeze, usually on the cheeks, earlobes, fingers,
  and toes, and also nose and chin.

• Usually occurs at about 59F
• Generally reversible, no tissue injury or
  permanent damage
• Skin turns white, top layer of skin feels hard
  but deeper tissue still feels normal (soft)
• May feel tingling or numbness

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Frostnip
Frostnip can be prevented by wearing warm
clothing and footwear.
Treatment

• Gently rewarm affected area by blowing warm air
  on it or placing it against a warm body part
  (e.g., another persons stomach or armpit).
• Do not use very hot objects such as hot water
  bottles to rewarm the area or person.
• Do not rub the affected part - ice crystals in
  the tissue can cause damage if the skin is
  rubbed.

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Chilblains

• Chilblains is caused by prolonged and repeated
  exposure of bare skin to air temperatures above
  freezing (32F) to 60F, accompanied by high
  humidity or wet conditions. It can develop in
  only a few hours.

• The most commonly affected areas are the cheeks,
  ears, nose, fingers, and toes.
• Affected area appears as red, swollen skin which
  is tender, hot to the touch, and may itch
• Can worsen to aching, prickly (pins and needles)
  sensation, then numbness.
• In severe cases, open sores or bleeding lesions
  may result from continued exposure.

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Chilblains

• Treatment

• Warm affected area gently with direct body heat
• put bare hands over the affected area on the face
• put affected areas against armpits or stomach of
  another person
• Do not massage or rub affected areas.
• Do not wet the area or rub it with snow or ice.
• Do not expose affected area to open fire, stove,
  or any other intense heat source.
• Seek medical attention to evaluate for tissue
  damage. Signs and symptoms of tissue damage may
  be slow to appear.

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Immersion Injury (Trench foot)

• Immersion injury (trench foot) results from
  prolonged exposure of the feet to wet or damp
  cool conditions, such as in cold water, mud, or
  wet fields, or wearing damp socks. A similar
  condition of the hands can occur if a person
  wears wet gloves for a prolonged period under
  cold conditions.

• Usually develops slowly, over hours to days and
  at temperatures from 32F to 50F.
• Can occur at temperatures as high as 60 degrees F
  if the feet are constantly wet
• The primary injury is to nerve and muscle tissue.
  There is no formation of ice crystals in the
  tissues but immersion injury can cause permanent
  damage.

Photo courtesy of USACHPPM
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Immersion Injury (Trench foot)
Symptoms

• Initially reddened skin, then turns pale and
  mottled, finally purple, grey, or blue
• Tingling pain, itching, burning sensation, or
  numbness may occur, followed by leg cramps and
  swelling
• May cause permanent damage to the circulatory
  system so person is more sensitive and prone to
  cold-related injuries in that area
• May develop blisters, ulcers, and gangrene.
  Amputation may be necessary

Note the cyanosis (blueness of skin) around the
nail beds redness and swelling and blisters.
Photo courtesy of USACHPPM
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Immersion Injury (Trench foot)
Treatment

• Remove wet clothing and replace with dry, warm
  clothing.
• Warm affected area slowly at room temperature.
  Carefully clean, dry, and wrap loosely with
  sterile dressing, taking care not to break the
  blisters. This can lead to infection.
• Elevate feet to reduce swelling.
• Do not walk on injured feet.
• Seek prompt medical attention trench foot can
  cause severe disability.

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Immersion Injury (Trench foot)
Prevention

• Keep feet clean and dry.
• Check them regularly if they get wet from water
  or sweat, dry them and replace with dry socks.
• Change socks at least every 8 hours or whenever
  wet and apply foot powder. Foot powder with
  aluminum hydroxide can help.
• Dont wear tight socks this can further impair
  circulation.
• Dont sleep with wet socks.

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Resources for further information

• Canadian Centre for Occupational Health Safety
  Cold Environments Working in the Cold
• http//www.ccohs.ca/oshanswers/phys_agents/cold_wo
  rking.html

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WISHA Consultation Services

• Safety Health program review and worksite
  evaluation
• By employer invitation only
• Free
• Confidential
• No citations or penalties
• Letter explains findings
• Follow-up all serious hazards
• For additional assistance, you can call one of
  our consultants. Click below for local LI office
  locations
• http//www.lni.wa.gov/Safety/Basics/Assistance/Con
  sultation/consultants.asp

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• Thank you for taking the time to learn about
  safety and health and how to prevent future
  injuries and illnesses.