Staying warm, staying safe: Remain active this winter and avoid environmental cold injuries

Staying warm, staying safe: Remain active this winter and avoid environmental cold injuries


Staying warm, staying safe: Remain active this winter and avoid environmental cold injuries


USA TODAY High School Sports and the National Athletic Trainers’ Association have partnered on a monthly column to address injuries, prevention and related issues to help schools, coaches and student-athletes. Here is the first column from Scott Sailor, the president of NATA.

The weather outside might be frightful, but that shouldn’t deter you from staying active and participating in your favorite outdoor sport. With knowledge and proper preparation, you can help minimize your risk of environmental cold injuries.

snowCold injuries fall into three categories: decreased core temperature (hypothermia), freezing injuries of the extremities (frostbite) and nonfreezing injuries of the extremities (conditions such as chilblain and immersion foot). Whether you downhill ski, play football or run track, if you’re in a cold environment for an extended period of time, you’re at risk. Those who are young, old, diabetic, female or African-American are at an even greater risk. To minimize these risks, you need to know what you’re dealing with.


This occurs when the core body temperature reaches less than 95 degrees. When this happens, you’ll experience vigorous shivering, increased blood pressure, fine motor skills impairment, lethargy, apathy and mild amnesia. If the hypothermia becomes severe, the shivering will stop, skin will be very cold, vital signs will weaken and mental functions and gross motor skills will be impaired. Other signs of severe hypothermia are slurred speech and unconsciousness.

To treat hypothermia, move into a warm shelter that protects against the wind and rain. Remove wet or damp clothing and insulate the body, including the head, with warm, dry clothing or blankets. Heat should only be applied to areas above the waist and below the neck, as well as heat transfer areas of the body, such as armpits, chest wall and groin. Don’t rewarm the extremities — doing so could send cold blood to the trunk of the body, resulting in a drop in core temperature and possibly causing cardiac arrhythmias and death. Also, don’t apply friction massage to the tissue because it can increase damage if frostbite is present. Consume warm fluids and foods.


Defined as the freezing of body tissue, frostbite is a localized response to a cold, dry environment that becomes worse when sweat cools the tissue. Signs of mild frostbite include swelling, the appearance of redness or mottled gray skin, stiffness and momentary tingling or burning. Deep frostbite symptoms are excessive fluid buildup, mottled gray skin appearance, tissue that feels hard and doesn’t rebound, blisters and numbness or loss of sensation.

When dealing with frostbite, first check for hypothermia. After that is ruled out, treat the frostbite by rewarming the tissue. This can be a painful experience, so you might want a physician to prescribe pain medication. Also, only rewarm the tissue if there isn’t a chance of it refreezing.

To rewarm, immerse the affected area into a bath of warm, gently circulating water for 15 to 30 minutes. This process should be done slowly, and the water temperature shouldn’t exceed 98 degrees. The tissue is fully thawed when it is pliable and color and sensation have returned.


This is a nonfreezing injury of the extremities that can be caused by extended exposure to cold, wet conditions. Symptoms consist of small red bumps, swelling, tenderness, itching and pain.

To treat, remove wet or constrictive clothing and gently wash and dry the area. Next, elevate the area and cover it with warm, loose, dry clothing or blankets. Don’t disturb the red bumps or apply friction massage. Also avoid lotions, creams and high levels of heat. Don’t put weight on the affected area.

Immersion foot

This is another nonfreezing injury that affects the extremities. Immersion foot is also known as trench foot. This is the result of prolonged exposure to cold, wet environments and is common with hikers. Symptoms include feet that are burning, tingling or itching; loss of sensation, bluish or blotchy skin; swelling; pain or sensitivity; blisters; skin fissures; and severe skin wrinkling.

If these symptoms are present, thoroughly clean and dry your feet. You can also apply warm packs or soak the affected area in warm water for about five minutes. Put on clean, dry socks, and don’t reuse your shoes until they have completely dried.

Tips to stay warm

Athletic trainers are aware of these risks and signs to watch out for, but our primary goal is to help prevent these situations. Here are some tips to help you stay warm, safe and active:

  • Wear insulated clothing that also allows moisture to evaporate.
  • Dress in layers that can be adjusted with changes in the weather.
  • Have extra shoes, socks and gloves available to replace wet clothing—a major risk factor with all cold injuries.
  • Use external heaters.
  • Take regular indoor breaks.
  • Maintain a well-balanced diet.
  • Stay hydrated.

NATA has created as environmental cold injuries infographic to help keep the public informed and protected during the winter months. Have fun but be safe and stay warm.


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