One of the risks of participating in winter activities is the danger of developing frostbite which can occur when body tissues are exposed to temperatures below the freezing point of skin. 
Thousands of people experience frostbite each year. Frostbite is a medical emergency.
According to the emedicine article “Frostbite” (www.emedicinehealth.com/ frostbite/article_em.htm), Napoleon’s surgeon general, Baron Dominique Larrey, recorded one of the earliest descriptions of frostbite in 1812 when his army retreated from Moscow. He also described the harmful effects experienced by soldiers when they warmed their frozen hands over a campfire at night and then refroze those same body parts the next day.
Dr. Melissa Conrad Stoppler explained in the article that when a person is exposed to extreme temperatures for a prolonged period of time, the body sends signals to blood vessels in the arms and legs causing the blood vessels to constrict to slow blood flow to the skin so that more blood can be sent to the vital organs. If the process continues, she said that the extremities farthest from the heart become colder and colder. Then she said a process known as “hunter’s response” is initiated, in which the blood vessels go through cycles of dilatation and constriction to try to preserve as much function of the body extremities as possible. 
Stoppler added that if the body temperature drops significantly below 98.6 degrees Fahrenheit (37 Celcius), the body permanently constricts these blood vessels to prevent the return of cold blood to internal organs. It is at that point, she said, that frostbite has begun. 
Symptoms of frostbite may include a feeling like pins and needles followed by numbness; aching or throbbing; red, white, bluish-white, or grayish-yellow skin; hard, pale, or waxy looking skin; or red painful skin when it thaws out. Very severe frostbite may cause blisters or gangrene which would appear as black, deadened tissue.
Dr. Paul Hyman, who practices internal medicine and pediatrics at Mid Coast Hospital in Brunswick, said that, “Frostbite occurs when extreme cold causes permanent damage to a part of the body.” 
He said that it can occur not only from exposure to cold air, but also from wind and cold water which can cause the body temperature to drop rapidly. He advised that once frostbite occurs, it should be treated immediately because of the serious complications that it can cause.  
“If you are concerned you have frostbite, you should seek medical care as soon as you can,” said Hyman. “If not treated correctly, a minor frostbite injury can progress to a much more significant injury and lead to a major infection or loss of a body part. … Long-term sequelae include permanent nerve damage, arthritis and chronic pain.”
Hyman said that it’s important to remove wet clothing and to try to limit movement of the area which might have frostbite.
“Often this means padding or splinting that body part,” said Hyman. “Do not shake the body part or try to warm it up as this can cause more damage. The body part of concern should not be rewarmed if it might be re-exposed to cold, as thawing and freezing can cause more damage.”
In addition, he said that whenever possible, a person should avoid walking on frostbitten feet. If the person must walk, he said that it’s better not to warm the feet before walking.
“If the body part will be rewarmed prior to medical attention, it is best to warm the body part in warm (not hot) water,” he said.

Wanda Curtis is a Master’s-prepared nurse and journalist.

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