National Athletic Trainers' Association position statement: environmental cold injuries

Abstract

Objective: To present recommendations for the prevention, recognition, and treatment of environmental cold injuries.

Background: Individuals engaged in sport-related or work-related physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk.

Recommendations: These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.

Keywords: chilblain; environmental physiology; frostbite; frostnip; hypothermia; immersion foot; pernio; trench foot.

Figure 1. Frostbite.

Figure 2. Chilblain. Photograph reprinted with permission: ©Christoph U. Lehmann, MD, Dermatlas; http://www.dermatlas.org.

Figure 3. Immersion (trench) foot.

Figure 4. A, United States National Weather Service Wind Chill Chart (figure reproduced from http://www.weather.gov/os/windchill/images/windchillchart3.pdf). B, Meteorological Society of Canada/EnvironmentCanada Wind-Chill Calculation Chart (figure adapted from http://www.msc.ec.gc.ca/education/windchill/windchill_chart_e.cfm). T_air  =  Actual air temperature in °C; V₁₀  =  wind speed at 10 m in km/h (as reported in weather observations). Temperatures to the left of the bold line are a low risk of frostbite for most people. Increasing indicates within 30 min, increasing risk of frostbite for most people within 30 minutes of exposure; High, 5 to 10 min, high risk for most people in 5 to 10 minutes of exposure; High, 2 to 5 min, high risk for most people in 2 to 5 minutes of exposure; and High, ≤2 min, high risk for most people in ≤2 minutes of exposure. Conversions: °F  =  (°C × 9/5) + 32; mile  =  km × 0.6214.

Figure 5. Algorithm for patient with hypothermia.

Figure 6. Physiologic responses to cold exposure.