Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter IV: Cold Injury

First Aid

United States Department of Defense

The emergency treatment of cold injury is as follows:

1. All casualties with involvement of the lower extremities should be treated as litter cases if feasible.

2. Carefully assess concomitant injury or complicating systemic problems.

3. All constricting items of clothing, such as boots, gloves, and socks, should be removed, but only when adequate protection from further cold exposure is available. Boots and clothing frozen on the body should be thawed by immersion in warm water before removal. Vigorous manipulation of frozen parts or attempts at range of motion or massage should be avoided. If the hands are affected, rings should be removed from the fingers early after presentation.

4. If the injured parts are still frozen when first seen, they should be rewarmed rapidly by immersion in water at 100° to 104°F (375° to 40°C) with added antiseptic soap, such as pHisoHex, and with agitation of the bath water to hasten the warming. A whirlpool apparatus is most satisfactory for this.

5. General body warmth must be maintained. Sleep and rest should be encouraged.

6. A booster dose of tetanus toxoid should be given to those previously immunized. No evidence exists that prophylactic use of antibiotics is valuable either in promoting healing or in preventing superficial or deep infection. In fact, the use of prophylactic antibiotics may result in the emergence of a resistant strain of organisms.

7. Large vesicles or bullae should be protected and kept intact if possible. Once ruptured, it is usually desirable to debride the vesicle. Ointment dressings have no place in the usual management of cold injury. Protective dry dressings are desirable during transportation, and sterile cotton should be used between the toes to prevent maceration.

8. Smoking is prohibited.

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Operational Medicine 2001

Health Care in Military Settings

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