Page 209 - ATP-P 11th Ed

COLD INJURY PROTOCOL

SPECIAL CONSIDERATIONS
1. Refreezing after thawing results in a high probability of amputation.
2. Check for 60 seconds for pulse and respirations due to bradycardia.

Signs and Symptoms
1. Hypothermia (Decreased core temperature)
a. Mild – Shivering, poor coordination SECTION 2
b. Moderate – Cessation of shivering, disorientation, slurred speech, confusion
c. Severe – Unconscious
2. Freezing Cold Injury (Frostbite)
a. Superficial – Skin is firm, but not hard; painful, red skin.
b. Deep – Painless, gray-appearing skin. Skin is hard, white, gray, ashen, waxy in
appearance.
3. Non freezing cold injury
a. Itching; pale, cool, blotchy wet skin; mild ulcerations may be present; numbness and
tingling sensations
Management
1. Non freezing cold injury (NFCI);
a. Gently dry and massage involved area. Elevate feet, warm torso, hydrate orally, dry
socks. NSAIDs may help. Evacuation depends on ambulatory ability.
b. Active rewarming is contraindicated in the treatment of pernio or chilblains, how-
ever mixed frostbite and NFCI injuries require rapid rewarming for the frostbite
injury, if it has not already thawed.
2. Freezing Cold Injury
a. Do not walk on frozen feet/toes unless necessary for preservation of life.
b. Do not rub with snow/ice.
c. Do not vigorously massage tissue.
d. Do not use space heaters or dry heat sources (fire, MRE heaters, hand-warmers, etc.)
®
®
e. Ibuprofen (Motrin ), 800mg PO tid (consider other NSAIDs if ibuprofen (Motrin )
is not available)
f. If thawed, refreezing will most likely result in amputation.
g. Once thawing has occurred, expect intense pain requiring narcotic use. Follow Pain
Management Protocol.

198 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 199