AKU6 90002 C3AND OTHERCOLD INJURIESALASKA SEA GRANTCOLLEGE PROGRAMP - PDF document

AKU-6- 90-002 C3AND OTHERCOLD INJURIESALASKA SEA GRANTCOLLEGE PROGRAMPUBLICATION NO. 7 AND OTHERCOLD INJURIESDEBORAH MERCYAlaska Sea Grant Marine Advisory ProgramAnchorage, AlaskaPrice $400Aaska Sea Grant College ProgramUniversity Of Aaska Pa radar ks, 138 rving IIi a.radar ks, Aaska 99775-hOWO;9O7j A7d-7ORAFISHERIES SAFETY AND SURVIVAL SERIES Elmer E. Rasmuson Library Cataloging-in-Publication Data.Mercy, DeborahFrostbite and other cold injuries, Fisheries safety and survival series! SG-ED-07!1. Frostbite  Study and teaching. I. Alaska Sea Grant College Program. II, Title.III. Series; Sea grant education publication; no. 7.RC88.5.M47 1990Deborah Mercy has been instructional media specialist for the Alaska Sea Grant MarineAdvisory Program in Anchorage since 1986. She has produced several videotapes for the MarineAdvisory Program, and serves as managing editor for the Resource Quarterly.Mercy's experience also includes broadcast journalism and commercial fishing,This book and the video that accompanies it would not have been possible without the time,effort, and comments provided by the following people. Content Specialists: Scott Sullivan,R.N., Providence Hospital, Anchorage; Jerry Dzugan, Alaska Marine Safety EducationAssociation; and Todd Miner, Alaska Wilderness Studies, University of Alaska Anchorage.Instructional Designer: Barry Willis, University o

f Alaska Anchorage. Thanks also to theAlaska Wilderness Studies program for their generous contribution of video footage used in theEditing of the booklet is by Kurt Byers, cover art is by Karen Lundquist, and text formatting isby Ruth Olson. This project was funded by Saltonstall-Kennedy Fishery Development Fundsadministered by the National Marine Fisheries Service under cooperative agreement numberThis booklet was produced by the Alaska Sea Grant College Program, which is cooperativelysupported by
! the U.S. Department of Commerce, NOAA Office of Sea Grant and ExtramuralPrograms, grant no, NA90AA-D-SG066, project no. A/75-01 and A/71-01, and ! the Universityof Alaska with funds appropriated by the state. Table of ContentsWhat This Workbook Is AboutSection I. The Danger of Cold InjuriesSection II. Types and Characteristics of Cold InjuriesSuperficial FrostbiteDeep FrostbiteImmersion FootSection III. Causes and Prevention of Localized Cold InjuriesFrostnip, Superficial Frostbite, Deep Frostbite, Immersion FootSection IV. Treatment of Cold InjuriesSuperficial FrostbiteDeep FrostbiteAfter Re-WarmingImmersion FootSome Do's and Don'ts of Cold Injury TreatmentQuiz YourselfQuiz AnswersFor More InformationWe Need Your Comments Other Cold Injuries What This Workbook Is AboutThis workbook provides general information on four types of cold injuries. Thegoal is to

help increase awareness of the causes, characteristics, treatments, andprevention of cold injuries, and thus reduce the number of injuries suffered bypeople due to exposure to cold, wet, and hostile environments. This workbook,Frostbite and Other Cold Injuries, may be used alone or with the 16-minutevideo program of the same name, The workbook is part of the Fisheries Safetyand Survival Series. Others in the series are A-2-033!, and Mari ne Survival Equipment and Maintenance 06!. For help with using workbooks and the related videotapes in a classroom, aFacilitator's Notebook A-2-034! has also been prepared. The booklets and videosby the same titles are available the Marine Advisory Program, Universityof 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 coldinjuries. 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. Ifyou 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 futureIf you have any comments or suggestions after re

ading this please fillout and return the last page.This information was compiled by the University of Alaska Sea Grant MarineAdvisory Program, and was collected a variety of sources, includingProvidence Hospital, and outdoor health and safety specialists. 2 Frostbite and Other Cold InjuriesCold 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, andimmersion foot, also known as trench foot, The first three injuries characterized by localized frozen tissue. Immersion foot is characterized by cold,wet, non-frozen tissues. Victims of cold injuries often recover completely, but inmore severe cases, victims can lose one or more extremities or die.Anyone who goes outdoors must adopt the attitude that the only sure bet forpreventing injury is to be prepared. You never know how your day is going toend, Understanding the causes of cold injuries is the best way to prevent them.The purpose of this workbook is to help you identify, prevent, and treat coldinjuries. 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 cold injuries.In addition to knowing the principles, techniques, and procedures in thisworkbook, it is also importa

nt to practice them. Frostbite and Other Cold Injuries Section I: The Danger of Cold InjuriesIt's January, and after days of tanner crab fishing you have the day off, The boatis anchored in a quiet bay, it's morning, and everyone has finished breakfast andis anxious to get off the boat and explore the shoreline, The skipper asks you tostart the skiff's engine. It's cold and windy outside. But you' re accustomed tothat, and since you will only be outside for a few minutes, you don't bother toput on your gloves.The engine doesn't start so you adjust the choke. Now the cold is making yourfingers hurt, especially when you touch metal. All of a sudden you can't feel theengine metal and your hand feels like ice when you touch it with your warmerhand. You have developed a cold injury.Cold injuries can happen in just a few minutes, or they can creep up slowly, overseveral hours or even days. Onset of cold injuries may or may not be sensed bythe victim, but in either case the injury can result in severe tissue damagerequiring amputation, or in the worst case, death.The tragedy about localized cold injuries is that they can almost always beIt was November and Zee Hyden had asked Lori to accompany him on a picnicand 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 th

eirway, their boat got caught between two rocks, flipped over, and drifted away.They managed to grab some food and make it to shore, wet and chilly, butuninjured. Seeing no alternative, they began walking home.Zee and Lori had both drunk some wine with their picnic. The alcohol combinedwith the urgent feeling to return home clouded their ability to make a safedecision about what they should do. They ended up walking for twenty-fivemiles, through boggy terrain with only a small amount of food  all in tightfitting boots. Their soaking wet feet were tired, and began to swell, hurt, and gonumb, Eventually Lori began to hallucinate and Zee lost his ability to thinkclearly. They were suffering from hypothermia and immersion foot.Finally they made it back to their car. Slowly they drove home and on to ahospital where they were treated for their injuries, It took six months beforeeach regained all feeling in their toes. Had Zee and Lori been familiar with the warning signs of hypothermia andimmersion foot, and had they been able to make clear decisions, they could haveacted to prevent these problems.Knowing that cold water drains body heat twenty-five times faster than air, theywould have tried to find a drier route home or sought help elsewhere. Theywould have known that avoiding wetness would also have helped preventimmersion foot, since it doesn't take freezi

ng temperatures to cause this malady.They also would have known that when body temperature drops, hypothermiaoccurs, which can lead to further cold injuries, and that their restrictive clothingwould obstruct blood supply to their extremities, which also would speed theonset of a cold injury.Section II: Types and Characteristics of Cold InjuriesThere are two broad types of cold injuries: freezing injuries frostnip, superficialfrostbite, deep frostbite!, and non-freezing injuries immersion foot!. All four ofthese cold injuries are called localized cold injuries. Each differs in severity. Thefirst three are characterized by local frozen tissues, while the latter ischaracterized by localized, non-freezing, cold, wet tissues.Freezing injuries result from localized reduction in water to the cells due tofreezing between the cells. Non-freezing injuries result from prolonged exposureto cool, wet conditions.The least serious cold injury is frostnip. It is the freezing of surface skin. It canbe painful and disfiguring if skin tissue is actually lost. Frostnip usually occursin 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 tohave a friend along so you can both keep an eye on ea

ch other. If you are alone,periodically check your face with a mirror. Frostnip appears white, but the skinremains soft. A long-term effect of frostnip can be an increased sensitivity to Injuries 5Superficial FrostbiteSuperficial frostbite is the freezing of superficial tissues. If frostnip goesuntreated it will develop into superficial frostbite, a more serious cold injury. Itcan occur on exposed facial areas as well as the hands and feet. Often an earlysymptom is pain, but as tissues continue to freeze the pain will give way tonumbness. However, symptoms vary with the individual  most people never feelpain; others never lose it. The injury appears white, waxy, and firm on thesurface but soft when pushed. Blisters will generally form after thawing and re-warming, but long-term tissue damage can often be minimized with propertreatment. Future sensitivity to cold can be a long-term effect.Deep Frostbi teIf superficial frostbite goes untreated it will develop into deep frostbite, the mostdangerous of the cold injuries. Freezing will continue to spread over skin tissuesand move deeper into muscle, bones, blood vessels, nerves, and even the organs.As with superficial frostbite, an early warning sign of deep frostbite may bepain. However, sometimes no pain is felt and the injured area just becomesDeep frostbite appears white, sometimes blotchy, or purple if t

he injured area islarge, such as an entire foot or hand. The surface and underlying tissues willfeel cold and hard when pushed. The damage can be extensive, resulting in amajor loss of tissue or even entire extremities. If not treated, the injury canbecome infected, which can lead to amputation or cause death. As with othercold injuries, there is increased sensitivity to cold.Immersion foot, also known as trench foot, is unlike other types of cold injuriesbecause rather than being caused by freezing temperatures, it usually occurswhen wet feet are exposed for many hours to above-freezing, cold, wet weather.Prolonged cooling damages tissues and nerves. Immersion foot has traditionallybeen associated with infantry soldiers, cannery workers, and fishermen whowear boots and waders.Immersion foot makes the foot appear mottled, red, waxy, and swollen. Long-term damage is minimal, although the area could remain more sensitive to cold. Other Cold InjuriesSection III: Causes and Prevention ofLocalized Cold InjuriesFrostnip, Superficial Frostbi te, Deep Frostbite, Immersion FootMost of us are familiar with the most obvious causes of cold injuries and how toprevent them. Following is a summary of what causes freezing and non-freezingcold injuries and tips on how to prevent them.This is the process whereby heat moves from a warmbody to a colder surrounding environmen

t, such as to snow, cold water, coldair, or cold objects, All of these can freeze skin and will steal your body heat,leaving you vulnerable to cold injury. Conductive heat loss can be reduced ifuncovered parts of the body are not exposed to cold materials.Wet clothing. Dry clothes are necessary to keep the body warm. Wool whenwet insulates better than cotton and most synthetic fabrics, Dry socks areespecially important, so always have an extra pair available.with "supercooled" liquids such gasoline or solvents. These liquidswill remain fluid at temperatures well below freezing, but your skin willfreeze when exposed to them, Contact with a "supercooled" liquid can causeinstant freezing.Cooling of extremities. When the body cools, blood flow slows in theextremities, This helps keep interior organs warm and reduces overall heatloss, but it also makes the extremities more susceptible to cold injury. Thesolution is to have enough warm, dry clothes to keep the body and out.Hypothermia is the total cooling of the body. Although it doesnot always cause a cold injury, it is usually present when an injury occurs.Hypothermia can be avoided by wearing warm, dry, layered clothing to keepbody heat close to the body and protected from outside temperatures. Headand neck protection is particularly important.Obstruction of blood supply to Constrictive clothing, such astigh

t fitting boots or plastic boots which do not expand, can hasten onset ofcold injury. This can be avoided by wearing loose fitting garments, dry socks,and proper fitting boots. Injuries 7Nicotine and alcohol. Both should be avoided in cold environments. Cigarettesmoke, or nicotine from any constricts blood vessels and willaggravate localized cold injuries. Alcohol may open up blood vessels, whichcould fight off frostbite, but that possible benefit is far outweighed by the lossin mental capacity suffered when drinking. When judgment is impaired byalcohol, a person may increase their chances of hypothermia and furtherendanger themselves.Dehydration and lack of food. Fluids and food are the body's fuel. Withoutthem the body will not stay warm and thus will leave the body susceptible tocold injuries.Words about Immersion foot trench foot! is the most notable non-freezing cold injury. Manyof the mechanisms listed above will cause immersion foot. Immersion footusually occurs when wet feet are continuously exposed to a near-freezingenvironment for days or weeks. Actual immersion of feet in cold water is notWhen cold water steals heat from feet, blood vessels constrict, causing furthercooling. Take precautions to avoid wet feet for prolonged periods of time in a coldenvironment, and take the time to dry the feet and put on dry socks. During theFalkland War, imme

rsion foot was reduced dramatically by soldiers simplystopping for a moment to dry off their feet and put on Be PreparedSimply put, the best prevention against localized cold injury is protection.Always be prepared for rapid weather changes. When going anywhere outdoors,even if it is just a drive, take sufficient clothing and check weather conditionsbefore leaving. Ask yourself, "If I don't make it to my destination, can I staywarm and dry, or will I be susceptible to a cold injury?"Section IV: Treatment of The treatment for all localized cold injuries is rapid re-warming. Thisminimizes blood circulation damage that follows thawing. If the injury is Other Cold Injuriessuperficial, the warming may usually be done in the field, However, if the injuryis serious, frozen tissues should not be thawed if there is any chance of re-freezing. Ideally, the victim should be rushed to a hospital or clinic where theycan be kept warm and the injury protected after it has been thawed.Frostnip is not considered a serious injury, and treatment can be carried out inthe field. Immediately re-warm the injured area to prevent development of moreserious injury. Frostnip responds to body heat, so simply cover the affected areawith your hands. If frostnip is on your hands, place them in your armpits or anyother place that is warm,Super fieia/ FrostbiteSuperficial frostbite is a s

urface injury that is a bit more serious than frostnip.The treatment is the same. Re-warm the affected area, keep it covered, and getout of the cold as soon as possible.Deep FrostbiteThe ideal environment for rapid re-warming of deep frostbite injuries rarelyexists unless you are in an urban area with hospitals nearby. In remotesituations, you may have to walk or ride in a cold helicopter or plane. Do notthaw the frozen part if you cannot keep it thawed. Let it stay frozen. Walking ona frozen foot will produce less damage than if it is thawed and re-frozen. If thefrozen part is a foot, you will need to be to transportation once thawingoccurs. Unfortunately, walking on a frozen foot may be the only choice forsurvival. In this case there may be no way to avoid further damage.Re- WarmingThe proper method for re-warming a deep frostbite injury is to
! removeclothing or other items that may impair circulation, ! place the injured area ina warm water bath between 95 and 105 degrees Fahrenheit. Be careful. If thewater is hotter, it will cause further damage to the tissues with a burn. If thewater is too cold, re-warming will be too slow. The water must not feeluncomfortable to an uninjured person's hand. Do not allow the damaged area totouch the sides of the tub, Frostbite and Other The frostbitten hand or foot, like a block of ice, will cool the warm water.Ma

intain the correct temperature by adding warm water. When warmwater is added, the injured part should be removed until the water is thoroughlymixed. Re-warming of the damaged tissue will take about twenty to fortyminutes. The water bath should continue until there does not appear to befurther improvement in skin color and tissues have completely thawed.Most but not all people experience some pain during the warming process. Thepain usually stops shortly after thawing has occurred.After Re-WarmingAfter re-warming, the patient must be kept warm and the injured tissues shouldbe elevated and carefully protected, Water baths should be repeated at leastonce a day. Length of treatment will differ with the severity of the injury.Unless frostbitten tissues are damaged beyond repair, blisters will form. Theblisters are a normal part of the healing process. To avoid infection, every effortmust be made to protect the blisters from rupturing. Sterile gauze or cottonshould be placed between frostbitten fingers or toes to absorb moisture.Healing can take as long as several weeks or months, and it is vital to keep theaffected areas clean. Cigarette smoking other use of tobacco should beavoided, since nicotine will further reduce deficient blood supply to theinjured tissues.Immersion FootTreatment is to get the victim off their feet, out of the cold, warmed up, and dry.Af

ter re-warming, keep injured feet clean, dry, and elevated to help relieveswelling. Keep the victim warm so his or her injuries receive ample blood supply,Additional treatment may be necessary, but it should be administered by aSome Do's and Don'ts of Cold Injury TreatmentDo not re-warm a severely frozen part if there is a chance the part will be re-frozen. Freezing causes a set of sharp ice crystals to form in the tissue. If Other Cold Injuriesmelting and re-freezing occurs, the sharp ice crystals become larger and causeeven more damage to the already injured tissues. If re-warmed tissue freezesagain, the damage may be irreversible,Do not rub the frozen part with your hands or with snow because both areabrasive to the skin,Do not use open fires, ear heaters, stoves, or similar sources of dry heat to thawfrozen tissue. These heat sources cannot be closely regulated and they causedehydration. Because the frozen part is numb, the victim also could suffer aburn without knowing it.Do not bump a frozen body part against anything because the injury couldbecome worse. A bump may open brittle skin or send toxins created by theinjury through the body.Generally, cold injuries are caused by a reduction in blood supply to a localizedarea. The results varied. Cold injuries can have little no effect, they eancause serious disability or death.Points To RememberCold inju

ries are a threat when you are exposed to below freezing temperatures,or when you are exposed to above freezing temperatures for prolonged periods ofThe four types of localized cold injuries are: frostnip, superficial frostbite, deepfrostbite, and immersion foot.Cold injuries can develop in minutes, hours, or take several days, depending onthe type of exposure.Usually the first sign of frostbite is pain. Take care to notice when an extremityhurts, or to notice if a friend is getting a white patch on his or her face or otherexposed extremity.Depending on severity or treatment, cold injuries can leave no or few scars, orthey can cause permanent disability and death, Other Cold Injuries To prevent Use common sense. Keep warm, Wear proper layered clothing that does notconstrict circulation,Eat high-energy foods and drink plenty of water or juice.Avoid overexertion.Do not expose skin directly to cold air, water, metal, wind, or "supercooled"Do not smoke cigarettes or anything else containing nicotine.Do not drink alcohol because it will impair your ability to make good decisions,If clothing is wet, change into dry clothes.For frostnip and superficial frostbite, re-warming can be done in the field.For deep frostbite, re-warming should not be done until the injury is out ofdanger of being re-frozen.For immersion foot, feet should re-warmed and rested.The best pr

otection against a cold injury is not allowing it to happen. Beprepared for rapid weather changes. Whether you are going outdoors to work,play, or travel, take extra clothing, food, and water to protect yourself in casesomething happens.Remember that practicing these techniques and procedures is very important topreventing frostbite and other cold injuries, But this is not all there is to knowabout frostbite and other cold injuries. For sources of more information, see the"For More Information" section at the end of this book. Other Cold InjuriesQuiz YourselfPart ICircle "T" if the statement is true and "F" if the statement is false.Refer to the workbook if necessary.], T F8. T F Loose fitting clothing can cause a cold injury.Part IIFill in the spaces with the correct word or words. Refer to theworkbook if necessary.1. The best way to prevent a cold injury is to:2. What are the three causes of cold injuries?4. TF5. TF6, TF7, T FFor immersion foot to occur the temperature must be belowFreezing injuries are the result of a localized reduction in water tothe cells due to freezing between the cells.Superficial frostbite is the least dangerous localized cold injury.The earliest symptom of frostbite is pain.The re-warming water temperature should range between 95 and105 degrees Fahrenheit.Do not thaw frozen tissues if you cannot keep the tissue thawed.Bumping a

frozen body part will not harm the injured tissue. I'rostbite and Other 3. What is conductive heat loss?4, Why should nicotine be avoided in cold environments?5. Why should drinking alcoholic beverages be avoided in cold environments?6, What the differences between the most common types of cold7. What is a "supercooled" liquid? Why should "supercooled" liquids be8. What are the long-term effects of localized cold injuries?9. Why would you walk on a frozen foot?10. Why is dry heat dangerous for a localized cold injury?11. How long does it take for a localized cold injury to develop? Other Cold InjuriesPart IIIRead the following story and choose one of the three courses ofaction listed at the end of the story.It is late November, the temperature is a crisp minus 25 degrees Fahrenheit andthe wind is a steady 20 mph with gusts to 45 mph. Wind has tom siding fromyour shed exposing dry goods stored there.Dressed warmly, tools in hand, you head out into a wall of swirling snow.nails through heavy gloves is a frustrating chore, but you need torepair the siding now. So you take off your gloves to finish hanging the plywood,until you feel intense cold and numbness in your hands.Which of the following three courses of action would you take? Circle your1. Ignore the cold and leave your gloves off, because the work will becomplete in just a few more minutes.2. Get ou

t of the cold and warm up your hands. Eat something, drink awarm fluid, and rest.3. Get out of the cold, warm up your hands, smoke a cigarette and drink acup of hot coffee, then return outside to finish the job.Quiz AnswersPart I1. False, Immersion foot occurs with prolonged exposure to cold, slightlyabove freezing temperatures,2. True. Freezing injuries are the result of a localized reduction in water tothe cells due to freezing between the cells.3, False. Frostnip is the least serious cold injury, It occurs only on the outerlayers of skin. frostbite and Other False. Although the earliest symptom of frostbite can be pain, some coldinjuries immediately become numb.True. If the water is colder, the re-warming will be too slow. If hotter, thewater may burn the injury.True, If a frozen part is thawed and re-frozen, tissue damage will be evengreater than if the area is left frozen. But sometimes, walking on a frozenfoot may be the only choice for survival. In this case, there may be no wayto avoid further serious damage.False. If an injured area is bumped against something, it will make theinjury worse, It may open brittle skin or send toxins created by the injurythrough the body.False. Loose fitting clothing will not cause a cold injury. Quite theopposite, it is necessary to wear loose clothing so that blood circulation isnot restricted in any part of the bo

dy. Restricted blood flow can cause acold injury.Part IIBe prepared. Carry extra loose fitting clothing and boots if you can. Alsohave extra water and food on hand and do not invite a problem throughunnecessary exposure to cold, smoking cigarettes, or drinking alcohol, l! Allowing unprotected skin to be exposed to a cold, wet, or windyenvironment or to "supercooled" liquids or cold objects, ! hypothermia,or the cooling of the entire body, and ! alteration of blood supply to theextremities by injury, illness, drugs, nicotine, or constricting clothing orConductive heat loss is the process whereby heat moves from a warmbody to a colder environment, as when unprotected hands are exposed tocold air. Conductive heat loss is reduced if uncovered parts of the body arenot exposed to the cold.Cigarette smoke, or nicotine from any source, constricts blood vessels andwill aggravate local cold injuries. Ii'rostbite and Other Cold InjuriesDrinking alcoholic beverages may open up blood vessels, which could fightoff frostbite. However, judgment is usually so poor when drinking that aperson may increase his or her chances for suffering hypothermia andother cold injuries.Frostnip is the freezing of surface skin. Ear lobes, cheeks, the tip of thenose, and finger tips are often affected by exposure to cold wind, water, orSuperficial frostbite is a more serious cold injury

that attacks superficialtissues. It can occur on exposed facial areas as well as the hands and feet.Pain is typically an symptom of superficial frostbite, but as tissuescontinue to freeze the pain will give way to numbness.Frostbite is the most dangerous of the cold injuries. Freezing spreads skin tissues, and it moves into deeper structures such as muscle, bones,blood vessels, nerves, and organs.Immersion foot is the most common non-freezing cold injury. It usuallyoccurs in above-freezing, cold, wet weather when wet feet are exposed tothese conditions for many hours, days, or weeks.A "supercooled" liquid remains fluid at temperatures well below freezing.An example of a "supercooled" liquid is gasoline or antifreeze.of all types of localized cold injuries can be increasedsensitivity to cold. Damage from deep frostbite can be as little asincreased sensitivity to cold or as extensive as a major loss of tissue or anentire extremity. If not treated, the injury can become infected andwithout further treatment, can cause death.You might walk on a frozen foot if your survival depends on it. However,the long-term damage to the foot will probably be extensive.Dry heat cannot be regulated, and it can cause dehydration, Because thefrozen part is numb, a burn can easily happen without the victim' sCold injuries can develop in minutes, hours, several days. Other Cold

Injuries Part IIIAnswer ¹1WrongI Your hands are suffering from conductive heat loss because they arebeing exposed to cold air and metal nails. Both the air and the metal steal heatfrom fingers, leaving them in danger of cold injury,It only takes a few minutes to freeze your hands and you may not even feel ithappen. Sometimes the endangered area will never feel pain. It will simplybecome numb. Therefore, if you do not stop to warm your hands you will likelysuffer a cold injury.Answer ¹2This is the best of the three options. You may finish the job if you warm up yourentire body, including your hands. It may take a little longer to complete yourproject, and you may need to go indoors to warm up. But if you take a break towarm up soon enough, a cold injury should not occur.Cold injuries are not always the result of an accident. They can be avoided if youtake the time to prevent them. If you feel cold and have access to a warm area,get into the warm place. Eat something. Food is the body's fuel, it keeps thebody warm. Drink something warm. Fluids are the key to preventingdehydration. And allow your body to rest, so it can regain good blood circulationto all extremities. Before returning outdoors to finish the job, put on plenty ofwarm clothes, including a hat, gloves, and boots, and do not take them off unlessyou feel too warm until you have returned indoors.

Adequate protection fromthe cold is the key to preventing a cold injury,Answer ¹3This is both correct and incorrect. If your hands are numb, you need to get out ofthe cold immediately. Drinking hot fluids is a good idea but smoking a cigaretteis a bad idea. Cigarettes constrict the blood vessels, slowing circulation requiredto keep the cold area warm, If your hands are not completely re-warmed and youexpose them again to the cold, they may suffer a cold injury. In addition,banging them against a hammer will only further aggravate the injury. Frostbite and Other Cold InjuriesFor More InformationHypothermia, Frostbite and Other Cold Injuries. James A, Wilkerson, M.D.,Cameron C. Bangs, M.D., John S. Ph.D. 1986. TheMountaineers, Seattle, Washington,Clinical Experiences in Treatment and Rehabilitation of Frostbite in Alaska.William J. Mills, Jr., M.D. 1960. Technical Report 59-24, ArcticAeromedical Laboratory, Ladd Air Force Base, Alaska.Fisheries Safety and Survival Series, Hypothermia A-2-031!, Shore Survival A-2-033!, Facilitator's Notebook A-2-034!, and Marine Survival Equipmentand Maintenance SG-ED-06!. Available from the Marine AdvisoryProgram, University of Alaska, Carlton Trust Building, 2221 E. NorthernLights Blvd., Anchorage, AK 99508-4140, 907! 274-9691.Medicine for Mountaineering, James A. Wilkerson, M.D. 1985. TheMountaineers, Seattle, Washin

gton,Hypothermia and Frostbite in Cross-Country Skiers. Nathan J. Smith, M.D. Pp.Common Problems in Pediatric Sports Medicine. Medical Publishers, Inc., Chicago.Alaska Medicine. William J, Mills, Jr., M.D. March 1973, Vol. 15, No. 2,Videotapes  Marine Survival Series. Hypothermia MAPV-1!, Cold WaterNear-Drowning MAPV-2!, Sea Survival MAPV-3!, Shore Survival MAPV-4!, Marine Survival Equipment and Maintenance MAPV-ll!, andFrostbite and Other Cold Injuries MAPV-17!. Available at $15.00 fromthe Marine Advisory Program, University of Alaska, Carlton TrustBuilding, 2221 E, Northern Lights Blvd., Anchorage, AK 99508-4140, 907! 274-9691. Other Cold Injuries We Need Your CommentsLet us know what you think of this workbook, and the video that goes with it.We are also interested in hearing about any instance of cold injury, how itoccurred, how it was treated, and what its short- and long-term effects were.Please write your comments on this page, it out, and send it to the AlaskaSea Grant Marine Advisory Program address on the previous page. OF ALASKA The University of Alaska Fairbanks provides equal education and employment for all,regardless of race, color, religion, national origin, sex, age, disability, status as a Vietnam eraor disabled veteran, marital status, changes in marital status, pregnancy, or parenthoodpursuant to applicable state and federal laws