Frostbite is the freezing of the skin.   It is incredible how quickly exposed areas of skin can freeze in deep cold, especially with wind.   The face, especially the nose and cheeks are susceptible.   Of course, prevention is the only approach.  Your clothing system is key.   Please refer to our Clothing main section, especially the Head Gear and Eyewear section.   Frostbite is very serious and it can kill you or disfigure and maim you, so you must be aware, knowledgeable, and prevent it.

I had mild frostbite on my nose once because I failed to detect the warning signs, and once was enough.  Signs of impending frostbite include a sensation of needles in the skin, but on a quick freeze event you may not sense this.  The skin turns into an unnatural white patch – it’s too late then, that’s frostbite.  There are no visual signs of onset.  Pain followed by numbness is also a sign, so stay alert.  The pain stage is the stage to act.  On those very cold days, check your buddy’s faces and ask that they check yours.   Fingers and toes typically go through the pain stage first as they are getting too cold (which we all experience), and you must deal with them at this stage.  Don’t let fingers and toes get to the numbness sensation stage.   Numbness does not mean frostbite (deep freezing) has set in, but once in that stage, you may not know when freezing does set in and it may happen fast.

Don’t forget your face mask for the extreme deep cold! Although it looks like the winter trekker may be frozen, in fact his neoprene facemask is warm and preventing frostbite on the face, and especially the nose. Ski goggles would completely seal in the face if necessary. In fact he’s steaming hot in 3 layers of breathable fleece and on a rest break while hauling sled at -35 deg C!

Mild frostbite on the face on surface skin layers can be dealt with by warm skin contact.  Warm your face thoroughly with your hand, and put on the appropriate face gear (balaclava, face mask, goggles).   It may be so mild that only one or two layers of skin will die and peel, similar to a sunburn.  I have had this on the cheeks and it’s not been a big deal.  But the skin layers on your nose are very thin, so once your nose has been injured by frostbite, you may be more susceptible to it, so always work on prevention.  If your nose freezes deep, you may lose it, so it’s a very serious matter.  Check your nose throughout the day with your bare hand.  On the nose it’s easy to miss the signs.  If you feel that painful tingling sensation, re-warm.    If you have read our Clothing main section’s Handwear subsection, you will note how we emphasized the usefulness of gauntlet gloves and mitts.   Gauntlets allow for that continual easy on-off with a bare hand to do things like re-warm the nose.

We all get cold fingers, especially for those of us who prefer to use gloves all the time.  I wear gloves loose enough so I can withdraw my fingers inside the hand to re-warm them.   Cold fingers and toes can be warmed by a fire or the woodstove.  If on the trail and its getting painful, stop, get out of the wind and make a fire.  When fire is not practical, feet and hands can be warmed on your buddy’s bare stomach and underarms – skin to skin contact.    Again we are talking prevention here, not treatment of serious injury.   Barring any accidental water immersion through the ice or slush, if you get to this point of needing serious assistance to re-warm yourself to prevent frostbite, then you have done something wrong with your traveling style and clothing system.  We are all human and we all make mistakes, but this serious re-warming event is not supposed to be anywhere near a common occurrence.  You should not be getting to this stage, so if this is happening, you and your group need to perhaps stop your trip, return to camp and re-assess.

Late morning warming toes by the woodstove in the hot tent before heading out for the day. In double insole Sorel boots during the day’s trekking and in the evening our crew’s toes never get cold. But in the late morning when one is sedentary during breakfast and the legs have not really been used yet, it’s common to get cold toes, even in hot tents where the floor may be quite cold.

Since we are not medical professionals, we will not pretend to prescribe treatment for severe frostbite in the field.    The mild frostbite of a couple layers of skin can be field treated with re-warming by skin to skin contact.  If the skin returns to normal (albeit blackened on the surface as the skin dies), and if the feet or hands return to normal dexterity and feeling, then you are good to continue.   Severe frostbite injury, such as deep freezing of fingers and toes are an emergency, and you need to evacuate and get to a hospital immediately while warming affected areas with skin to skin, or hot (but not scalding) water bottles.   Prevention is so important we cannot over-emphasize it.  Your clothing system is key.  Your skills to act decisively with an immersion event are also key.

Recommended reading authored by medical and physiological professionals includes:

Gordon Giesbrecht and James A. Wilkerson.  2006.  HYPOTHERMIA, FROSTBITE, AND OTHER COLD INJURIES: Prevention, Survival, Rescue, and Treatment, 2nd Edition.  The Mountaineers Books.  160p.

State of Alaska’s Cold Injuries Guideline (2003)

The University of Manitoba’s website for Dr. Giesbrecht’s research has links to many excellent state of the art resources on this subject including the ones above.