Frostbite (local cold injury)
Frostbite mainly affects the fingers, toes, nose, ears and cheeks: the skin turns white or greyish-yellow, hard and numb. Do not rub, do not rub with snow, no direct heat. Rewarm slowly with body heat – but only if there is no risk of refreezing. Always have it treated by a doctor, and first check for hypothermia of the whole body. This text does not replace a first-aid course.
- Start immediately; medical treatment needed
Explained simply
In great cold and wind, fingers, toes, the nose, ears or cheeks can freeze. The skin then turns white or greyish-yellow, feels hard and you can no longer feel it.
Very important: do not rub and do not rub with snow – that makes it worse. Do not hold it to a stove, fire or in hot water either, because numb skin burns easily. Instead, rewarm slowly with body heat, for example by putting the hands in the armpits. But only if the spot cannot freeze again afterwards.
A doctor must always look at frostbite. And because often the whole body is cold, you first check whether the person is hypothermic. This text does not replace a first-aid course.
How it works
When it gets very cold, the body protects its core first: it lets less blood flow into the hands, feet and face. These parts therefore cool down quickly, and in frost the tissue can freeze. Wind, wet and tight shoes speed this up.
Frozen tissue is as fragile as glass. Rubbing destroys it further, snow cools it even more, and heat burns it because the person feels nothing. Worst of all is when a thawed spot freezes again. How severe frostbite is often only shows after days.
What really matters
First think of the whole body: if the person is shivering hard, confused or drowsy, they are hypothermic – that takes priority. Call the emergency number, shelter from wind and wet, insulate from the ground and wrap them up.
Then gently rewarm the frozen area with body heat, carefully remove wet and tight things and rings, cover it loosely and keep it dry, and do not open blisters. Avoid putting weight on thawed feet if possible.
Safety and limits
Outdoors, only rewarm if you are sure the area will stay warm. If you still have to go on through the cold, it is often better to get help. No hot-water bottle, no fire, no hot water, no alcohol.
Deliberate rewarming in a warm water bath belongs in the hands of doctors or trained helpers; this text deliberately gives no temperatures for it. Any frostbite that does not quickly look and feel normal again needs a doctor.
Prevention
Several dry layers, spare gloves and socks, shoes that are not too tight and face and ear protection in wind. Eat and drink regularly, change wet clothing early.
In a group, check each other's faces: you often do not notice white patches on your own nose, ears or cheeks. Turning back in time is not failure.
Step by step
- 1
Recognise the signs
Look for white, greyish-yellow or blotchy skin that feels hard or waxy and is numb, especially on the fingers, toes, nose, ears and cheeks. In a group, check each other's faces.
- 2
Consider the whole body
Check whether the person is hypothermic (heavy shivering, confusion, drowsiness). If so, hypothermia comes first: emergency call, shelter, insulation, warmth to the trunk.
- 3
Into the warm
Move to a sheltered, warm place. Carefully remove wet and tight clothing, rings and watches.
- 4
Rewarm with body heat
Only if there is no risk of refreezing: put affected hands in your own armpits, place feet against a helper's stomach or cover the area with warm hands. Do not rub.
- 5
Protect and do not load
Cover the area loosely and keep it dry, do not open blisters. Avoid putting weight on thawed feet if possible.
- 6
Medical help
Have any frostbite that does not fully return to normal colour and sensation after a short time treated by a doctor. With extensive frostbite call the emergency number.
Common mistakes
- Rubbing with snow
- Rubbing or massaging
- Thawing at a stove, fire or with hot water
- Thawing on the way and then going back out into the cold
- Overlooking hypothermia of the whole body
- Alcohol "to warm up"
Quick view
Materials
Dry spare clothing
Dry gloves and socks
Carry it in waterproof packaging – wet clothing barely insulates.
Emergency blanket
Tears easily once punctured; short-term shelter only.
Conductive – keep away from power lines.
Sterile dressings and bandages
Cover loosely, no pressure
Open sterile packaging only immediately before use; observe the expiry date.
Suitable for
- White, numb fingers, toes, ears or nose after cold and wind
- Winter hiking, ski touring, mountaineering, outdoor work
Not suitable for
- Thawing if the area could refreeze on the way
- Treating severe frostbite without medical help
Prerequisites
- A sheltered, warm place is within reach
- No risk that the area will freeze again
Safety
- This text does not replace a first-aid course. First aid is learned through hands-on practice under instruction. In an emergency always call professional help – via the local emergency number (112 in the EU) – and follow the dispatcher's instructions.
- Do not rub or massage, do not rub with snow and no direct heat from a stove, fire, heater or hot-water bottle – numb skin burns easily and is very fragile.
How it works
In severe cold the body withdraws blood from the hands, feet and face to keep the trunk warm. The poorly perfused parts cool down, and in frost the tissue can freeze. Rubbing destroys the damaged tissue further, snow cools it more, and direct heat burns the numb skin. Gentle rewarming with body heat is the safe way for lay people; everything else belongs in medical hands. How severe frostbite is often only becomes clear days later.
Advantages
- Body heat is always available and gentle
- Acting correctly limits the damage
Disadvantages
- Rewarming is often not safely possible on the way
- The extent only shows later
Deep knowledge
Background
The Wilderness Medical Society frostbite guidelines describe out-of-hospital first care as: treat hypothermia first, do not rub, do not rub with snow, no direct heat sources and do not rewarm if refreezing is a risk. Deliberate rapid rewarming in warm water is described there as a measure for trained helpers or the hospital.
The old advice to rub frozen skin with snow persists stubbornly – it causes harm. Frostbite develops especially easily with wind, wet, tight footwear, exhaustion and smoking.
Variants
- Mild cold injury (frostnip)
- If the skin is only pale and cold and colour and sensation return quickly when rewarmed with body heat, it is usually a superficial cold injury. Still fix the cause (dry gloves, face protection) and keep an eye on the area.
- Prevention
- Several dry layers, spare gloves and socks, shoes that are not too tight, face and ear protection in wind. Eat and drink regularly, change wet clothing early.
Common mistakes
- Rubbing with snow
- Rubbing or massaging
- Thawing at a stove, fire or with hot water
- Thawing on the way and then going back out into the cold
- Overlooking hypothermia of the whole body
- Alcohol "to warm up"
Limits and risks
- Does not replace a first-aid course
- No water-bath temperatures or medication – that belongs in medical hands
- Hypothermia takes priority
Material alternatives
Derived from material properties: a substitute must have all relevant properties. Observe the notes on the substitute.
- Dry spare clothing
- Sleeping pad, Dry leaves, grass or conifer boughs (Collect only where allowed; no protected plants. Check for ticks and insects.), Backpack, Wool blanket / duvet (Keep away from candles, stoves and heaters.), Insulated cool box (Keeps cold only for a limited time; without ice packs or ice it is not a fridge.), Sleeping bag (Do not store compressed long-term; do not pack away damp.), Newspaper and cardboard (Flammable – keep away from candles, stoves, heaters and embers.), Insulated cooking box (hay box, thermal cooker) (Never put open flame or embers inside – only the hot, closed pot.), Long-stemmed thatch (reed, grass, rushes) (Extremely flammable – no open fire and no sparks nearby.)
- Sterile dressings and bandages
- Cotton cloth / T-shirt (Removes coarse particles only – no disinfection.), Mosquito net (Flammable – keep away from flames.), Fine cloth or muslin net against flies (Keep clean and dry; do not hang it over the flames.)
Results come exclusively from structured entries. No improvised instructions are generated.
Sources
Wilderness Medical Society – Wilderness & Environmental Medicine (2019): Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update
First care of frostbite: hypothermia first, no rubbing, no refreezing, no direct heat
European Resuscitation Council – Resuscitation (journal) (2021): European Resuscitation Council Guidelines 2021: First Aid
First aid for cold injuries
Österreichisches Rotes Kreuz: Erste Hilfe – Informationen und Kurse
Frostbite as a first-aid topic