• What to do if you think you have frostbite

Authors:  Megan Park, Josianne Gauthier, Alex Poole, Caitlin Champion

If you suspect you may be getting frostbite, remove yourself from the cold environment immediately. If that is not possible, protect yourself from further cold exposure by finding a warm shelter or adding clothing.

 
  • Remove jewelry, such as rings, bracelets, or watches. Protect your frozen hands or feet from any trauma such as banging, rubbing, dragging, etc. If possible, elevate your hands or feet. Do not walk on frozen feet or use your frozen hands.
  • Avoid rubbing your frozen hands or feet, and do not rub with snow or immerse them in cold water. Avoid alcohol and tobacco.
  • Avoid rewarming frozen hands or feet by the fire or using a dry heat source, such as a stove or car exhaust pipe; this may cause a burn, especially if you lack sensation. 

When should I stop my activity?

You should stop your activity if you think you are getting frostbite, if you are losing sensation in  your fingers, hands, toes, or feet or if you feel tingling (“pins and needles sensation”) or pain. Often, as the skin of fingers and toes cools below its normal temperatures, it goes through two phases: (1) Pain and tingling, then (2) loss of sensation. While they may feel better when numb, it is a serious warning sign that frostbite is possible if you do not immediately warm them back up.

You should rewarm frostbite in hot water. The water should be hot but tolerable to the touch. Do not use boiling water. Use a bath or basin to immerse your frozen hands or feet and let them thaw for approximately 30 minutes, or until the fingers and toes are soft and can bend easily.

Thawing frostbite can be painful. Use medications such as ibuprofen (Advil) or ASA (Aspirin) to treat the pain if you are not at risk of bleeding. 

When should I go to the hospital?

If you have rewarmed your skin and it looks or feels abnormal for more than an hour later, you should seek medical attention to be safe.

You should rewarm or thaw frostbitten hands or feet only if you can keep them warm afterward. Re-freezing your frostbitten hands or feet after thawing can be very damaging.

If you are in a remote environment and you cannot immerse your frostbitten hands or feet in hot water, protect them from further cold exposure and seek medical attention immediately.

Signs of infection

Frostbite generally does not get infected. Infection can happen if severe frostbite causes severe blisters, bleeding, a break in the skin, and if the wounds are not properly cleaned and cared for.

Skin infection can appear red, inflamed, swollen, and can cause pus or liquid to drain. Seek medical attention if you suspect skin infection.

How do I care for my frostbite at home? 

Avoid wearing jewelry such as rings, bracelets, or watches or tight footwear on frostbitten parts. Take a hot bath daily to cleanse wounds and promote blood circulation and healing. Taking a bath with jets can act as a gentle wound cleanser and can further promote circulation. Keep your wounds clean and use aloe vera gel if possible. Protect your frostbite wounds from any trauma such as banging, rubbing, dragging, etc. Use bulky, non-adhesive bandages to create protection against banging or rubbing. Avoid using tight bandages or bandages that stick on the wounds. If possible, elevate your hands or feet. Avoid walking on frostbitten feet. Seek medical attention if you notice any worsening.

What treatments are available for frostbite?

There are promising treatments used in different parts of the world for frostbite. Treatments are used to prevent damage to the skin and tissue after rewarming. If not treated, severe frostbite can block the blood circulation in the extremities and cause the tissue to turn black (“necrosis”). Frostbite treatments are used to prevent amputation.


Rewarming

The first step is to thaw the frostbite by immersing the frozen body parts in hot water for 30 minutes. Water should be hot but tolerable to the touch. Some hospitals use a rewarming basin with moving water, such as a whirlpool, and add an antiseptic/gentle cleansing soap. The frostbitten body parts should be cleaned gently, with dirt or debris removed. Remove jewelry, rings, bracelets, or watches. Let the body parts air dry and protect from injury.


Ibuprofen or ASA

Ibuprofen or ASA can be used to treat the pain if you do not have a risk of bleeding, allergies or contraindications. Ibuprofen and ASA can also treat frostbite by preventing blood clots and improving blood circulation. Ibuprofen and ASA have been studied in animals and patients with frostbite and can help prevent amputation.


Aloe vera

The gel from the plant aloe vera has been studied in animals and patients with frostbite. It can help with healing, improving circulation, preventing infection, and preventing amputation. Use a product that does not contain alcohol or topical anesthetics, and is not sticky.


Tetanus-diphteria (Td) vaccine

If you have not received a tetanus-diphtheria vaccine in the last 10 years, you may receive a shot to prevent infection.


Iloprost

Iloprost is an injectable medication that is available in some hospitals to treat frostbite. It can help restore blood flow in the extremities and prevent blood clot. It can help prevent amputation. To find out where iloprost is available, visit the Contact page or contact your local hospital.

Iloprost was approved by the FDA in the US for use in frostbite in February 2024 (1).


Thrombolytics or “clot busters”

Thrombolytics (also called "clot busters"), such as alteplase, are used to treat frostbite. It is a medication given by injection that stops blood clots. While more commonly used for heart attacks and strokes, it can be used after frostbite to prevent death of tissue and amputation. It has been studied in small groups of patients with frostbite and appears to reduce the risk of amputation. Alteplase can cause rare but serious bleeding.​​


Anticoagulants or “blood thinners”

Anticoagulants such as enoxaparin can be used with other frostbite treatments to prevent more blood clots. They are generally not used alone to treat frostbite.


Blister management

A doctor or nurse can clean the blisters when they appear (generally 1 day after rewarming). Some doctors may use a syringe and a needle to aspirate the liquid from the blisters, if the blisters are clear. Bloody blisters should not be drained unless over a joint, or breaking down already.

Source: https://www.healogics.com/hyperbaric-oxygen-therapy-hbot


Hyperbaric Oxygen Therapy (HBOT)

Some studies suggest that breathing pure oxygen in a pressurized tank can help bring more oxygen to the frostbitten parts. It may reduce the risk for amputation.