Frostbite - Treating frostbite

Treatment for frostbite depends on how severe your symptoms are. You should always seek medical attention if you suspect you or someone else has frostbite.

If the symptoms of frostbite are minor, call your GP or NHS 111 for advice.

If symptoms are severe, go immediately to your nearest accident and emergency department, or call 999 and ask for an ambulance if you cannot move.

See symptoms of frostbite for more information about the stages of frostbite.

First aid

If medical assistance is not available, steps can be taken to treat frostbite and hypothermia:

If possible, move to a warmer place – it's best to avoid walking on frostbitten toes and feet as this can cause further damage, although in emergency situations this may not always be possible.
Replace wet clothing with soft, dry clothing to stop further heat loss.
Warm the body by wrapping it in blankets and protecting the frostbitten parts.
Do not rub the affected area or apply direct heat (such as from a fire or heater) as this can cause further injury.
Do not allow the person to smoke as this can affect blood circulation.

Re-warming of the frostbitten area

The affected areas need to be re-warmed. Do not try to do this until you are out of the cold. If the warming process is started and the frozen parts are re-exposed to the cold, it can cause further irreversible damage.

Re-warming should be done under medical supervision because:

it can be a painful process that requires access to painkillers and expert medical assessment
the best results are achieved using a whirlpool bath that contains a mild antiseptic

The affected area should be re-warmed slowly by immersing it in warm (but not hot) water. A bath of water at a temperature of 40-41ºC (104-105.8ºF) is recommended.

Re-warming should last at least 30 minutes and should only be stopped once the affected body part has a red-purple colour and can be easily moved.

This process can be repeated twice a day until there are clear signs that the affected body part is beginning to heal, such as the growth of new skin and the return of normal skin colour.

As re-warming can often be painful, painkillers are required. Depending on the severity of pain, this may require very strong painkillers such as morphine.

People with frostbite should also take the painkiller ibuprofen as it has additional protective properties for frostbite.

After re-warming

After the frostbitten area has been thawed, it should be wrapped very gently in clean bandages, with the fingers and toes separated. It is very important to keep the skin clean to avoid infection.

Too much movement should be avoided, and the limbs should be elevated if possible. Avoid walking on affected parts that have been re-warmed as the tissues will be very delicate.

After re-warming, the skin will be discoloured and blistered. It will eventually scab over. If the frostbite is superficial, new pink skin will form beneath the discoloured skin and scabs. The area usually recovers within six months.

Severe frostbite

In cases of severe frostbite, you will need to be admitted to a specialist unit that has experience in treating these sorts of injuries.

This is often a specialist burns unit, as exposure to very high temperatures can cause the same sort of injury as exposure to very cold temperatures.

If it is thought that there is a very high risk of major damage, you may be given a type of treatment called thrombolysis. This involves giving you injections or medication through a drip in your arm that helps to break up small clots in the frostbitten blood vessels.

This should help improve blood flow to the affected body part, which can help stimulate healing and prevent more damage.

You may also be given antibiotics to prevent the affected body part from becoming infected.

If some of the tissue of the affected body part has died, which is a condition known as gangrene, it will need to be removed. This is known as debridement. In the most serious cases, it is necessary to remove an entire part of the body, such as toes or fingers.

A decision to perform debridement or amputation is normally delayed for several weeks, as often what appears to be dead tissue can heal and recover over time.

Long-term effects

Some people are left with permanent problems after frostbite, such as increased sensitivity to cold, numbness, stiffness and pain in the affected area.

Not much can be done to treat sensitivity to cold, numbness or stiffness.

A medication called amitriptyline can sometimes be effective in controlling the pain associated with the long-term effects of frostbite.