4.2 Cold first aid, and what not to do

1 Hypothermia: the sequence

OSHA's guide gives the steps for a person suffering from hypothermia:

1. 1
   Call 911 immediately in an emergency; otherwise seek medical assistance as soon as possible.
2. 2
   Move the person to a warm room or vehicle.
3. 3
   Remove wet clothes and replace with dry clothes; cover the body — including the head and neck — with layers of blankets, and add a vapor barrier such as a tarp or garbage bag. Do NOT cover the face.
4. 4
   If medical help is more than 30 minutes away: give warm sweetened drinks if the person is alert (no alcohol) to help increase body temperature. Never try to give a drink to an unconscious person.
5. 5
   If medical help is more than 30 minutes away: place warm bottles or hot packs in the armpits, sides of the chest and groin, and call 911 for additional rewarming instructions.
6. 6
   If the person is not breathing or has no pulse: call 911 immediately and perform CPR until they respond or medical aid arrives.

Three details are easy to get wrong. Wet clothes come off — leaving them on and piling blankets over the top keeps the cooling engine running. The head and neck get covered, because that is where a large share of heat escapes; the face does not. And the aggressive rewarming steps, hot packs and warm drinks, are framed as what you do when help is more than 30 minutes away; when EMS is close, warmth, dry cover and monitoring are the job.

2 Frostbite: the "do not" list

For frostbite, OSHA's guide says to follow the hypothermia recommendations above, and then adds a list of prohibitions that is the heart of cold first aid:

• Do not rub the affected area to warm it — this action can cause more damage.
• Do not apply snow or water.
• Do not break blisters.
• Loosely cover and protect the area from contact.
• Do not try to rewarm the frostbitten area before getting medical help — for example, do not place it in warm water. If a frostbitten area is rewarmed and then gets frozen again, more tissue damage occurs. It is safer for the area to be rewarmed by medical professionals.
• Do not massage the frostbitten area; doing so may cause more damage.
• Give warm sweetened drinks if the person is alert. Avoid drinks with alcohol.

The rule that comes out of that list: if the person is going to a hospital, protect and transport. Rewarming in the field is for the case where medical care is genuinely far away, and even then it is done under instruction from 911, not from memory.

3 Trench foot and chilblains

Trench foot (immersion foot). Call 911 immediately in an emergency; otherwise seek medical assistance as soon as possible. Remove the shoes or boots and the wet socks. Dry the feet. Avoid walking on the feet, as this may cause tissue damage.

That last instruction is the one crews ignore, because a person with trench foot can usually walk — the feet are numb. Walking on damaged tissue is exactly how a recoverable injury becomes a serious one.

Chilblains. Avoid scratching. Warm the skin slowly. Corticosteroid creams may be used to relieve itching and swelling, and blisters and ulcers should be kept clean and covered. Chilblains are also a signal to fix the exposure that caused them — repeated cold on unprotected skin.

4 The decision table

5 Getting the person to help

Cold emergencies happen where cold work happens — remote sites, rural roads, rooftops, night shifts — so the logistics matter more than they do in a warehouse.

Three questions belong on the pre-task plan before a cold shift: where is the nearest warm space (a heated trailer, a running vehicle, a nearby building); how far away is EMS, in minutes, because that number decides whether field rewarming is even a question; and what is the address for the ambulance, in a form a dispatcher can use. A crew that cannot say the site address out loud has a gap that costs minutes at the worst possible time.

Keep the vehicle in the plan too. A running truck with the heater on is a legitimate warm space, and on many sites it is the only one.

6 After the incident

A cold injury is a signal about the program, and the debrief is short.

Was the person wet, and why — rain, snow, sweat under insulation, a boot that took water on early? Wetness is the leading risk factor in OSHA's list and it is usually fixable with dry spares. Were they new or returning, and were they being ramped up as the guide advises? Was there a warm area close enough to use during breaks? Did the person feel able to stop — was the right to interrupt work when extremely uncomfortable something they had been told about, or something they would have had to ask for? And did the injury get reported the same day, or a day later at home?

Every one of those questions maps back to a control in Chapter 3.3. That is what makes the debrief worth holding: it does not produce blame, it produces the next revision of the plan — which is the subject of the last chapter of this course.