Frostbite isn't usually a major worry here in Washington, D.C., but with wind chills below zero forecast for half of the Lower 48 by Tuesday morning, millions of people from the Plains to the East Coast will have to start thinking like Arctic explorers while waiting for a school bus or heading to work.
Noses, fingers, toes and ears face the biggest risk. Those body parts have less blood flowing through them and a lot less mass than the body's core. They're also more likely to be exposed to the elements. Obviously, bundling up those tender parts is key.
Some of the things that people try to prevent or treat freezing injuries do more harm than good, doctors say. That includes drinking alcohol to "warm up," when it can actually cool you faster by dilating the blood vessels near the surface of your skin. And rubbing frozen skin, instead of gently warming it.
To get up to speed on frostbite protocol, we called Dr. Seth Podolsky, a vice chair of emergency services at the Cleveland Clinic. It was 2 degrees in Cleveland at 12:15 p.m. Monday, with blowing snow. And the mercury was dropping fast. In those sorts of conditions, frostbite can develop in 30 minutes or less, according to the National Weather Service.
"Prevention really is key," Podolsky told Shots. "The more time and the more skin exposed, the worse it is."
When Podolsky worked in Colorado extremely cold weather wasn't so unusual. "You always had an emergency kit in the car because you never knew when you were going to get stuck," he said. That meant not just warm clothing, but blankets or sleeping bags.
Those measures will also reduce the risk of the other big cold-related health problem, hypothermia. A body temperature below 95 degrees can lead to death if not quickly treated.
In frostbite, tissues literally freeze. Bad frostbite can destroy blood vessels, leading to gangrene and loss of extremities. It's been a longtime risk for soldiers in war, as well as for Arctic explorers and high-altitude mountaineers.
Fortunately for us novices, that sort of catastrophic damage is relatively rare. And frostbite has an early warning sign, called frostnip. The skin reddens and stings, and can feel numb. That's the signal to get out of the elements, fast.
"If you do end up getting frostbite, you need to seek care of a physician," Podolsky says. In the meantime, get to a warm place and take off wet clothing. Try to remove rings or other jewelry, because frostbite causes serious swelling.
Forget that old saw about rubbing snow on numbed skin; that's just making skin colder. In fact, don't rub skin at all, Podolsky says, because that can further damage already injured skin.
The emergency room treatment is simple. "We warm you. We take off your clothes," he says. "We may use a warm water bath." If it's truly frostbite, the thawing process is, unfortunately, painful, as blood flow returns and tissues swell.
Frostbitten skin usually blisters, so warm bulky dressings are used to protect the skin and prevent infection. A tetanus shot is a good idea, Podolsky says. Some studies have found that using aspirin, warfarin or other blood thinners may help reduce the risk of long-term damage.
In the emergency rooms of Cleveland, people who show up with frostbite injuries are typically a mix of outdoor enthusiasts and homeless people with no place to get out of the cold. "We do expect we'll see different types of cold emergency" in this big chill, Podolsky says, including people who just didn't realize how quickly they can be hurt in this intense Arctic chill. "But we're hoping that school will be canceled."