Tips for Recognizing and Treating Cold Stress Conditions

The recent cold snap has forced millions of people to seek shelter indoors, however, many workers must brave the sub-zero temps and the hazards that come with them. Cumulatively referred to as cold stress, the two primary concerns to watch for when the mercury dips are hypothermia and frostbite. Workers experiencing cold stress are also at heightened risk for other injuries in the workplace due to discomfort, reduced mental alertness, reduced muscle strength, joint stiffness and distraction. Here we’ll give you some tips for recognizing and treating cold stress conditions.

When to Watch for Cold Stress

Cold stress can occur at temperatures above freezing because wind, humidity and moisture all remove body heat. Cold typically affects the body’s extremities such as hands, feet and the face as these areas are the furthest away from the body’s core and have less circulation of blood, which keeps you warm. Susceptibility to cold varies from person to person with the following conditions increasing the risk of cold-related stress:

• Age
• Diseases of the circulatory system
• Injuries resulting in blood loss or altered blood flow
• Previous cold injury
• Raynaud’s Phenomenon
• Fatigue
• Consumption of alcohol or nicotine (smoking)
• Use of certain drugs or medication

Cold Stress is most likely to occur from October through March with the most serious form of cold stress being hypothermia. Hypothermia can be fatal in absence of immediate medical attention.

What is Hypothermia?

Hypothermia is a reduction in the core body temperature in which the core temperature drops below the required temperature of (35.0°C/95.0 °F) for normal metabolism and body functions. It’s most likely to occur at very cold temperatures, but it can occur even at cool temperatures (above 40°F) if a person becomes chilled from rain, sweat or submersion in cold water.

Recognizing Hypothermia

As the body temperature drops, a person will exhibit symptoms in stages:

1. Initially the worker may have trouble with his/her dexterity, shivering, exhaustion confusion, fumbling of the hands.
2. Next, the speech may become slurred and the worker may stumble or seem confused or disoriented and my experience memory loss.
3. In very serious cases, the worker will actually stop shivering and may deny that they are even cold.

Treating Hypothermia

Get medical attention immediately! While first responders are on their way, begin warming the person as follows:

1. Get the victim into a warm room or shelter.
2. Remove any wet clothing.
3. Warm the center of the body first—chest, neck, head, and groin—using an electric blanket, if available or use skin-to-skin contact under loose, dry layers of blankets, clothing, towels or sheets.
4. Warm non-alcoholic beverages can help increase the body temperature. Do not give beverages to an unconscious person.
5. After the body temperature has increased, keep the person dry and wrapped in a warm blanket. Also, wrap the persons head making sure they can still breathe from the nose and mouth.
6. Ensure medical attention is received as soon as possible.

A person with severe hypothermia may be unconscious and may not seem to have a pulse or to be breathing. In this case, handle the victim gently and call 911 immediately!

What is Frostbite?

Frostbite is the freezing of the exposed extremities, such as the nose, ears, cheeks, chin, fingers and toes. It occurs when the fluids and tissues of the skin freeze. The condition a loss of feeling and color in the affected areas. Frostbite can permanently damage the body and severe cases can lead to amputation. The risk of frostbite increases in people with reduced blood circulation and among those who are not dressed properly for extremely cold temperatures.

Recognizing Frostbite

The first sign of frostbite is a reddening of the skin. Redness or pain in any skin area may be a sign of frostbite so get out of the cold or protect any exposed skin. Any of the following signs may indicate frostbite:

• White or grayish-yellow skin area or blotches
• Skin that feels unusually firm or waxy
• Numbness
• Completely white skin and sometimes blisters

A victim is often unaware of frostbite until someone else points it out because the frozen tissues are numb!

Treating Frostbite

Seek medical attention and get out of the cold right away. Because frostbite and hypothermia both result from exposure, first determine whether the victim also shows signs of hypothermia as described above. If there is frostbite but no signs of hypothermia, you should proceed as follows:

1. Get out of the cold and into a warm area as soon as possible.
2. Do not walk on frostbitten feet or toes unless necessary.
3. Immerse the affected area in warm, not hot, water. The temperature should be comfortable to the touch for unaffected parts of the body. Or, warm the affected area using body heat. For example, the heat of your armpit can warm frostbitten fingers.
4. Do not rub the frostbitten area with snow or massage it at all. This can lead to further tissue damage.
5. Do not use a heating pad, heat lamp or the heat of a stove, fireplace or radiator for warming the affected areas as they can be burned due to numbness.

These procedures are not substitutes for proper medical care. A health care professional should evaluate frostbite as soon as possible.

Preventing Cold Stress

Proper equipment and planning can go a long way to prevent cold stress. Here are a few tips for when you’re working outside to help you avoid hypothermia and frostbite when the temps go down and risk goes up.

• Cold weather gloves, hardhat liners, jacket and insulated boots are the most important cold weather protection as the extremities are the most at risk when working in cold conditions.
• Be cognizant of the heightened cold stress risk and recognize the hazards.
• Utilize warm-up facilities and work/rest cycles. Ensure areas are available for workers to warm up and get out of the cold
• Ensure “Ice Melt” is strategically placed around walking areas and readily available to eliminate and minimize slippery/icy conditions.
• Bring slippery/icy conditions and snow accumulation to the attention of your supervisor and other appropriate personnel.
• Implement the buddy system when working in cold or stormy weather. Use high visibility clothing that meets at least ANSI Class 2 designation.
• Take breaks as necessary to prevent over exertion during heavy manual labor (such as manual snow removal).
• Ensure equipment, including clothing and PPE, is approved for operating in low temperatures.
• Hard hats should have an LT (low temperature) identifier.
• Workers should not come within contact with cold surfaces (metal with bare hands) when temperatures below -7°C. Workers should avoid skin contact when handling evaporative liquids such as gasoline, alcohol or cleaning fluids below 4°C.
• Eat balanced meals and drink plenty of liquids to maintain normal body heat and to prevent dehydration.

For more information on preventing, recognizing and treating cold stress, visit OSHA.gov.

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