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Give winter weather injuries the cold shoulder

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Whether hiking Mount Everest or exercising outdoors near home, cold-related injuries are always a danger. Military Health System experts encourage everyone, whether acclimated to cold weather or not, to take the right precautions to protect against these preventable injuries.

“Regardless if you’re shoveling snow or exercising, the chill factor, improper warm up, and inadequate clothing can potentially lead to musculoskeletal injuries or cold injuries,” said Maj. Jeffery Dolbeer, assistant professor and faculty for the Baylor University-Keller Army Community Hospital Sports Division 1 Fellowship in West Point, New York. Extremities, including fingers, toes, ears, and nose, are usually at most risk for cold injury.

“Cold injuries can be prevented in most cases,” said Dolbeer, adding that not paying proper attention to prevention methods can lead to an unnecessary injury. “From a military perspective, that could easily affect the readiness for the individual and the unit itself.”

Cold-related injuries do not require extreme — or even below freezing — temperatures to be an issue, said Dolbeer. Two types of milder injuries are considered nonfreezing, or able to occur in above-freezing temperatures. Chilblains, which cause the skin to become red, tender, and itchy, can happen after repeated exposure to low temperatures and high humidity for extended periods. Immersion foot, or trench foot, can happen in temperatures as high as 60 degrees. This type of injury results from prolonged exposure to cold and wet conditions, such as damp socks and boots or allowing sweat to accumulate. The affected areas can become swollen, discolored, or waxy.

When freezing does occur, frostnip — the first degree of frostbite can be a risk. This condition involves the top layers of skin tissue freezing, usually as a result of high wind, severe cold, or a combination of both. When this happens, the skin appears firm with cold, painless areas that may peel or blister in 24 to 72 hours, Dolbeer said. Treatment involves putting firm pressure on the affected area, blowing hot breath on the spot, or placing in armpits if fingertips are affected.

“Frostnip is not a medical emergency, but it’s something you track. Get warm — without rubbing — and let it return back to normal,” said Dolbeer. “If you sustain any kind of cold injury, you don’t want to go back into the cold environment prior to that tissue returning to its normal state.”

The most severe of the injuries is deep frostbite, which occurs when all layers of skin freeze. Extended exposure to extreme temperatures, high wind chill, and wet conditions can cause this condition to set in within hours, said Dolbeer. Amputation of affected extremities may be necessary in severe cases.

Cold-related injuries involve several factors, including adjustment to low temperatures, level of dampness, and wind, said Dolbeer. Numbness or pain in the extremities, as well as change in skin color, can be a good indication that an injury is setting in.

About 65 percent of the heat the body produces can be lost by radiation, and up to half of radiation heat can be lost from the head and neck, said Dolbeer. About 20 percent of heat loss can occur through evaporation, which occurs mostly through the skin. Young children and older individuals tend to have a harder time with regulating body heat and can potentially be at higher risk for cold injuries.

Minimizing risk for cold-related injuries — or preventing them altogether — typically results from taking simple precautions. Using proper clothing or equipment can be a major preventative factor when exposed to low or freezing temperatures, as well as cold or damp conditions. Fluids should also be replaced during and after exercising in the cold, said Dolbeer, adding that dehydration will lead to reduced blood volume, which means less fluid is available to warm the tissue.

“It’s completely possible to exercise outdoors through the winter and not sustain any cold injuries, provided you take preventative measures as far as clothing, gear, and respecting the amount of time you’re exposed to those types of temperatures,” said Dolbeer. “We need to take those necessary steps in order to minimize the risk of what’s usually a preventable cold injury.” n