Overexposed: a look at cold weather injuries and how to avoid them

Photo By Staci-Jill Burnley | The Centers for Disease Control and Prevention developed an easy and comprehensive checklist to make sure proper care is given when dressing for outdoor cold weather activities. (Illustration courtesy of the CDC)  

ROCK ISLAND ARSENAL, IL, UNITED STATES

12.15.2021

Story by Staci-Jill Burnley 

U.S. Army Sustainment Command

ROCK ISLAND ARSENAL, Ill. – When people think of exercise and activity safety tips, monitoring the heat is often the first concern.

While many recreational and job-related injuries and illnesses occur due to excessive heat, frigid temperatures have their own risks which must be considered to conduct outdoor hobbies and jobs in a safety-minded manner.

If you are thinking cold weather injuries only happen to the elderly or children, you may want to consider the statistics shared by the U.S. Army Combat Readiness Center’s Risk Management Magazine. In an article by Col. (Ret.) Joseph McKeon, M.D., he shared the case study profile of the typical service member most at risk, and it may surprise you.

“So what does the typical cold injury patient look like? He is young, from a warm climate, has less than 18 months in the service and doesn’t yet know how important it is to take care of his feet,” he said.

“Just so you know, I’m not using your usual sexist male pronoun in that profile; the typical cold injury victim is male, usually about 20 years old and, because he is from a warm climate, hasn’t learned you don’t walk to your mailbox in February with no shoes on. In addition, he is likely to use alcohol, tobacco and, possibly, medications.”

If you are asking yourself what feet have to do with this situation, a look back to World War II and trench foot (also called “immersion foot”) might a be good starting point.

“During World War II and Korea, the number of Soldiers incapacitated due to cold weather injuries was staggering,” McKeon said. “Lt. Col. (Dr.) Kenneth Orr reported in 1954 that the number of hospitalization days due to cold injuries in those two conflicts was more than 3 million! Imagine our entire Army being hospitalized for more than a week.”

Maj. Brian Shiowaza, M.D., is the Occupational and Environmental Medicine Command surgeon at the U.S. Joint Munitions Command on Rock Island Arsenal, Illinois, and agrees that proper care of feet, and other extremities, is critical to beat cold weather injuries. He explained the science behind immersion foot, frostbite and frostnip, as well as why these are high risk areas to protect.

“Cold temperatures increase the risk of exposure with prolonged exposure to both time and moisture,” he said. “Our bodies physiologically respond to cold by preserving core body temperature through mechanisms that reduce heat loss. Immersion foot can emerge after prolonged exposure to wet, cold conditions. The long-term complications of immersion foot are similar to and as debilitating as those produced by frostbite.”

Other extremities become susceptible in cold weather in what is known as “accidental.” According to Shiozawa, this happens when you experience convective heat loss (due to cold air exposure) and conductive heat loss to water (including being wet either from immersion in water and from sweat). It’s a combination with potentially serious consequences, he said.

“In response to cold temperatures or heat loss, peripheral blood vessels constrict to divert blood away from our arms and legs and toward internal vital organs,” said Shiozawa. “The result is an increased risk of frostnip and frostbite. Frostbite causes ice crystal formation within the cells of the exposed extremities or skin that may be irreversible. Areas of the body most frequently affected by frostbite include the ears, nose, cheeks, chin, fingers, and toes.”

All bodies are not created equal when it comes to susceptibility to cold weather injuries, and certain health factors and personal choices increases vulnerability. Shiozawa listed several things which increase the risk for people. They include older age, exhaustion, dehydration, inadequate caloric intake, alcohol use, smoking, previous cold injury, certain chronic diseases (such as diabetes), as well as some medications.

For those in the Quad Cities, winters can be incredibly wet with wind chill factors of -50 degrees Fahrenheit. While some of the local outdoor activities – such as fat-tire biking, fishing, sledding and cross-country skiing – are amazing ways to social distance and enjoy the beauty of winter, if you are going to play outside, you need to bundle up, Shiozawa said.

“Ensure you have proper clothing and gear (hats, gloves, and boots), as well as a plan in the event of severe conditions or injury,” he said. “Individuals who engage in outdoor recreation should be cautious to stay warm and dry by monitoring exertion levels, temperature and wind conditions, and water exposure risk. And stay dry next to your skin – what many people may fail to remember is how accumulated sweat in undergarments (underwear, boxer shorts, brassieres, etc.,) from exercise can contribute to cold weather injury, despite outer clothing being dry.”

Shiozawa says the one take away he wants people to remember is to never underestimate the risk of cold weather and exposure.

“Quad Cities residents should not underestimate the risk of a cold weather injury,” he said. “Everyone who spends considerable time performing activities outdoors needs to take proper precautions to minimize their risk of exposure.”

Special care and considerations should be given to children, according to Shiozawa. Children often get distracted with outdoor play and may not be able to realize, or verbalize, how cold they are or that their feet or hands are wet. It is critical for caregivers to vigilantly monitor their time in the cold and their exposure status.

“Children tend to be at higher risk than older adults for numerous reasons,” he said. “They often cannot recognize or verbalize when they are experiencing a cold weather injury. They also may not appreciate the importance of wearing appropriate clothing and gear to protect themselves.

“Also, because of their smaller size, they may be at a higher risk to cold weather injury due to smaller extremities and greater surface area. Parents and responsible adults will need to monitor children’s activity as they play, to bring them back into warm environments when they show any signs of cold weather injury.”

Shiozawa said that cold weather isn’t the only risk winter poses for people, and urges everyone to continue to take preventive steps to avoid illness and dangers inside, as well.

“It is important to be aware of other hazards during the winter months,” he said. “The pandemic is not over and COVID-19 is circulating at increasing levels throughout the country and causing reinfections and breakthrough infections. Influenza is also circulating at higher levels than it was last year, and carbon monoxide poisoning is frequently reported during colder months, as people use gas or fuel-powered heaters in rooms.”

Here is a quick guide to help you recognize the most common cold weather injuries which require immediate medical attention:

• Hypothermia: Shivering, an altered sense of consciousness and uncoordinated movements. Hypothermia can be fatal if treatment is not given immediately.

• Frostbite: Loss of feeling or a tingling sensation in the affected area along with white, gray, red, yellow or waxy-looking skin. The frozen tissue will feel solid to the touch.

• Trench foot: Numbness in the feet accompanied by burning sensations and shooting pain. Severely affected tissue will appear pale and slightly blue. Trench foot can lead to gangrene.

• Chilblain: Reddened, slightly swollen skin accompanied by a prickly or burning sensation. Left untreated, chilblain can lead to more severe cold injuries.

For more tips on cold weather safety, visit the Army Public Health Center website at:
https://phc.amedd.army.mil/topics/discond/cip/Pages/Cold-Weather-Casualties-and-Injuries.aspx

• Date Taken: 12.15.2021
• Date Posted: 12.15.2021 16:29
• Story ID: 411221
• Location: ROCK ISLAND ARSENAL, IL, US