First Aid for Frostbite

Frostbite occurs when skin and underlying tissues freeze after exposure to very cold temperatures. It often begins with a cold feeling and numbness, progressing to hard or waxy-looking skin in areas such as fingers, toes, cheeks, ears, chin, or the tip of the nose.

Signs and Symptoms

• A cold, prickling sensation followed by numbness
• Skin that appears white, grayish-yellow, or waxy in the affected area
• Hard or frozen feeling when touched
• Blisters or swelling during the rewarming phase

When to Seek Emergency Help

• Intense pain that persists even after rewarming
• Severe shivering, confusion, or drowsiness (signs of hypothermia)
• Slurred speech or difficulty walking
• Large areas of deep frostbite or involvement of the face and hands

First Aid Steps

1. Move the person indoors to a warm environment and remove any wet clothing.
2. Wrap the individual in dry, warm blankets protecting frostbitten areas from refreezing.
3. Gently rewarm affected areas by soaking them in warm water (37 °C–42 °C) for about 30 minutes.
4. For frostbite on nose, ears, or cheeks, apply warm, wet cloths for 30 minutes.
5. Encourage sipping warm, nonalcoholic fluids to help raise core temperature.
6. Offer an over-the-counter pain reliever to manage discomfort.
7. Remove rings, watches, or tight clothing before swelling begins.

What to Avoid

• Rubbing or massaging frostbitten skin with snow or objects
• Applying direct heat sources (stoves, heat lamps, heating pads)
• Walking on frostbitten feet or toes if avoidable
• Consuming alcohol, which can exacerbate heat loss

Stages of Frostbite

Frostbite occurs in four stages:

No frostbite. At this stage, you don’t have any frostbite symptoms or signs of skin or tissue damage. Your skin still looks the same as it usually is.

Frostnip. This stage is when you start having symptoms such as pain, cold, numbness, tingling, and skin color changes, causing your skin to look red or purple. However, your skin has not been injured or damaged yet. Experts describe this stage as the warning stage. You can treat your symptoms immediately by thawing your skin in warm water. Small red bumps may appear on your skin after. See your doctor even after managing it at home so they can check for any damage.

Superficial (mild to moderate) frostbite. Your skin feels warm and patchy and looks pale and frozen at this stage. When you warm up to treat the frostbite, your skin might also sting, burn, and swell. Blisters could appear 12 to 36 hours after you warm up. You can’t manage this stage at home. See your doctor immediately for treatment.

Deep frostbite. This is the final stage of frostbite. Your skin turns entirely blue or black and freezes. Your joints and muscles may stop working. Big blisters show up about a day or two after you warm up. The frozen skin areas may start to fall off, but if they don’t, your doctor will use surgery to remove them.

Home Remedies

• Move to a warmer location.
• Gently remove any jewelry or items of clothing from around the affected region.
• Get rid of your wet clothes and put on dry and soft clothes to prevent further heat loss.
• Don’t apply direct heat on the affected area or rub it.
• Don’t smoke if you develop frostbite, as it can impact your blood circulation.
• Wrap your body with blankets and keep the frostbitten area protected.
• Slightly elevate the affected area.
• Don’t walk if you have frostbitten feet or toes.

Complications of Frostbite

The complications of frostbite include:

• Changes in the color of the skin
• Increased sensitivity to cold
• Issues with growth in children
• Infection
• Excessive sweating
• Prolonged numbness in the affected region
• Loss of nails or damaged nails
• Tetanus
• Hypothermia
• Amplified risk of being affected by frostbite again
• Stiff joints or frostbite arthritis
• Gangrene (death of body tissue due to lack of blood flow or infection. 

Prevention

Here are some of the ways in which frostbite can be prevented:

•  Don’t spend a lot of time outdoors when the weather is windy, wet, or cold.
• Choose several layers of warm and loose clothing when the temperatures are low.
• Pick a hat that covers your ears and head completely.
• Put on insulating gloves or mittens when you go out in the cold.
• Don’t forget to wear warm shoes and socks.
• Don’t drink alcoholic beverages when you’re outside in cold temperatures, as alcohol causes quicker loss of body heat.
• Stay hydrated and eat meals that are well-balanced.
• Change out of your wet clothes immediately.

REFERENCES

1. Thompson DA. Frostbite. In: Adult Telephone Protocols: Office Version. 4th ed. American Academy of Pediatrics; 2019.
2. Walls RM, et al., eds. Hypothermia, frostbite and nonfreezing cold injuries. In: Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Elsevier; 2023. https://www.clinicalkey.com
3. Schmitt BD. Frostbite and cold exposure. In: Pediatric Telephone Protocols: Office Version. 17th ed. American Academy of Pediatrics; 2021.
4. Buttaravoli P, et al., eds. Frostnip, frostbite, and mild hypothermia. In: Minor Emergencies. 4th ed. Elsevier; 2022. https://www.clinicalkey.com.

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