Frequently Asked Questions About Cold Injuries

Q: Can you get hypothermia in 50°F weather?

A: Yes, especially if wet or windy. Wind and water dramatically increase heat loss. Elderly people can develop hypothermia indoors at temperatures as high as 65°F over time.

Q: Why shouldn't I warm frostbitten areas if I might refreeze?

A: Refreezing causes catastrophic tissue damage—much worse than leaving frozen. Only thaw if you can keep the area thawed and protected. Walking on frozen feet causes less damage than thaw-refreeze cycles.

Q: How long should I continue CPR on a hypothermic patient?

A: Much longer than normal. Cold protects the brain, and many "miraculous" recoveries occur. Continue until medical professionals arrive. The saying is "No one is dead until warm and dead."

Q: What's afterdrop?

A: When rewarming, cold blood from extremities returns to heart, causing core temperature to drop further. This can trigger cardiac arrest. It's why gentle handling and core-first rewarming are crucial.

Q: Can I use a hot tub to rewarm someone?

A: No. Rapid rewarming can trigger cardiac arrest through afterdrop. Peripheral vasodilation drops blood pressure. Gradual rewarming is safer. Maximum safe water temperature is 102°F for extremities only.

Q: Why do hypothermic people take their clothes off?

A: "Paradoxical undressing" occurs in moderate to severe hypothermia. The person feels hot due to blood vessel dilation and confused brain function. It's a sign of life-threatening hypothermia.

Q: Should I give hot drinks to someone with hypothermia?

A: Only if they're alert, shivering, and can swallow safely. Use warm (not hot) sweet drinks. No alcohol or caffeine. If confused or severely hypothermic, giving fluids risks aspiration.

Q: How can I tell if frostbite will result in amputation?

A: You can't determine this in the field. Even severe-looking frostbite sometimes heals completely. Only time and medical evaluation reveal final outcomes. Proper field care improves chances.

Q: Is shivering good or bad?

A: Shivering is good—it means the body is still fighting hypothermia. When shivering stops without rewarming, it signals moderate to severe hypothermia and exhausted energy reserves.

Q: What's the best clothing for cold weather?

A: Layers of synthetic or wool (not cotton), windproof/waterproof outer layer, insulated boots, mittens (warmer than gloves), and head covering. Cotton kills in cold—it loses all insulation when wet.

> Final Quick Reference Box: > Remember: C.O.L.D. > - Cover to prevent heat loss > - Observe for shivering cessation > - Lay flat and handle gently > - Delivery to medical care > > For Frostbite: D.O.N.T. > - Don't rub or massage > - Only thaw if can keep thawed > - No direct heat > - Treat pain aggressively

Final Critical Reminders:

Cold injuries are deceptive—they often look less serious than they are, and victims may not recognize their own danger due to impaired judgment. The key to treatment is preventing further heat loss while avoiding the pitfalls of too-rapid rewarming. Remember that hypothermic hearts are extremely irritable, requiring gentle handling. For frostbite, the field decision often comes down to whether you can prevent refreezing. When in doubt, evacuate for professional medical care. Most importantly, prevention through proper clothing, nutrition, hydration, and recognizing early warning signs remains your best defense against cold injuries. In cold emergencies, patience and gentle care save lives—there are no shortcuts to safe rewarming.# Chapter 14: When to Call 911: Medical Emergencies That Require Professional Help

The decision took only seconds but haunted Jennifer for months. Her father had complained of mild chest discomfort after dinner, describing it as "probably just heartburn." He insisted he didn't want to bother anyone and refused to let her call 911. Not wanting to upset him, Jennifer agreed to wait and see if it improved. Two hours later, when the pain became unbearable and he finally agreed to go to the hospital, it was too late—he suffered a massive heart attack in the car. The emergency room doctor later told her that if they had called 911 immediately, her father would likely have survived. "Time is muscle," he explained gently, "and every minute of delay meant more permanent damage to his heart." This heartbreaking scenario plays out thousands of times each year across America. People delay calling 911 for various reasons—fear of overreacting, concerns about cost, not wanting to bother anyone, or simply not recognizing the severity of symptoms. Yet studies show that the average person waits 2-3 hours before seeking help for heart attack symptoms, and this delay is often the difference between full recovery and death. Understanding when to call 911 versus seeking other medical care is literally a life-or-death skill that everyone needs to master.