What is included in the field management of frostbite?

Updated: Jul 29, 2019
  • Author: Bobak Zonnoor , MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

The first step in the management of frostbite is prevention. The US Army decreased the incidence of cold injury of all types in soldiers from 1985-1999. This was accomplished through training, education, and improved clothing. [25] When suspected frostbite does occur, transport to a trauma or burn center becomes a priority. Field rewarming should be started only if the time to arrival at a definitive care center exceeds 2 hours.

As a general principle, always address the ABCs and treat any life-threatening conditions (eg, hypothermia) first. Correct any systemic hypothermia to a core temperature of 34°C before treating the frostbite.

Remove the patient from cold. Replace wet and constrictive clothing with dry loose clothing. Remove jewelry from the affected area.  Dress the extremity in a manner that minimizes mechanical trauma.

Rewarm the frostbitten area if no danger of refreezing is present. However, rewarming should be avoided if it cannot be maintained (freeze-thaw-freeze cycle). Walking on frozen frostbitten areas and risking tissue chipping and fracture is considered better than thawing and refreezing. Reports from Canada show that forced-air rewarming with portable units can be used effectively to warm victims of hypothermia and frostbite in the field and during transport to a regional medical center. [41]


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