What is the treatment for frostbite?

Frostbite Treatment

For severe or deep frostbite, rapidly rewarm the affected part by immersing it in warm water at 37-40°C (98.6-104°F) for 20-30 minutes, but do not attempt rewarming if there is any risk of refreezing or if you are close to a medical facility. 1, 2

Initial Field Management

Immediate Actions

• Remove wet clothing and dry the victim to prevent concurrent hypothermia 1
• Remove jewelry and constricting materials from the affected extremity immediately to prevent further injury as swelling develops 2
• Protect frostbitten tissue from further injury and avoid walking on frozen feet whenever possible 2
• Transport the victim to an advanced medical facility as rapidly as possible 1

Critical Decision Point: To Rewarm or Not

Do not attempt rewarming in the field if:

• There is any chance the tissue might refreeze (repeated freeze-thaw cycles cause worse tissue damage than delayed rewarming) 1, 3
• You are close to a medical facility 1

This is a Class III recommendation (harm) - refreezing after thawing causes significantly more tissue destruction than maintaining the frozen state until definitive care 3, 4

Hypothermia Takes Priority

• If the person has moderate to severe hypothermia, prioritize core rewarming before treating the frostbite 2, 5
• Rewarming extremities first in hypothermic patients can cause dangerous core temperature drops 5, 3

Rewarming Protocol (When Appropriate)

For Severe or Deep Frostbite

• Immerse the frostbitten part in warm water at 37-40°C (approximately body temperature) for 20-30 minutes 1, 2, 3
• If a thermometer is unavailable, test water against your wrist - it should feel slightly warmer than body temperature 2
• Avoid water temperatures above 40°C as this causes further tissue damage 2
• Rewarming should be performed within 24 hours of injury 1

For Minor or Superficial Frostbite (Frostnip)

• Simple, rapid rewarming using skin-to-skin contact such as a warm hand is sufficient 1

What NOT to Use

• Do not place chemical warmers directly on frostbitten tissue - they can reach temperatures that cause burns 1, 2
• Air rewarming can be used as an alternative when warm water immersion is not possible 2

Post-Rewarming Care

Wound Management

• Apply bulky, clean, dry gauze or sterile cotton dressings to affected areas and between toes and fingers 2
• Wrap circumferential dressings loosely to allow for swelling without placing pressure on underlying tissue 2
• First aid providers should not debride blisters associated with frostbite 2

Pain and Tissue Protection

• Administer ibuprofen to prevent further tissue damage and treat pain 2, 6
• The American Heart Association notes that while evidence for NSAIDs in frostbite has not been well established in human studies, ibuprofen decreases systemic levels of thromboxane which has vasoconstrictive effects 1, 6

Post-Thaw Vulnerability

• Frozen and thawed tissues are extremely vulnerable to further injury, infection, pressure sores, and necrosis 5
• Protect rewarmed tissue from refreezing at all costs 2, 4

When to Seek Advanced Medical Care

• All frostbite patients should seek prompt medical attention, especially for deeper injuries 2
• Deep frostbite may require specialized care at a burn center 2
• Immediate medical attention can significantly reduce tissue damage and prevent long-term complications 2

Common Pitfalls to Avoid

• Do not delay vascular consultation waiting for "demarcation" - in acute ischemia, hours matter for limb salvage 3
• Do not assume the patient can sense ongoing tissue damage - a hallmark of acute frostbite is complete inability to sense touch, and patients may be unaware of damage from continued walking or movement 5
• Estimating severity is challenging in the first aid setting, so err on the side of seeking advanced care 5