For much of the country, simply stepping outside right now can result in frostbite.
Temperatures are plunging, with highs that read like extreme lows on the worst winter days. In Chicago, the high on Wednesday was predicted to be -11 Fahrenheit, Thursday’s high was predicted to be only 3. Wind chills are worse, closer to -50 degrees.
The deep freeze is the perfect setting for frostbite. Public health officials have declared emergencies, urging residents to stay indoors and not venture out for fear of frostbite.
But what is frostbite?
“It’s when the tissue itself becomes damaged from the cold,” Baruch Fertel, an emergency room physician at the Cleveland Clinic, told the Daily Beast.
Getting frostbite is a fast process—it takes less than 30 minutes for a person to go from normal to frostbitten—but first, there’s frostnip, which occurs five minutes into the frostbite process when real temperatures are at about -5 degrees Fahrenheit and wind chills are in the negative teens.
“Frostnip is more superficial than frostbite,” Richard Viglione, a doctor at Northwestern Medicine Lake Forest, said, calling it a “mild” form of frostbite. It starts out with numbness in protruding, exposed parts: nose, ears, chin, fingers, toes.
From there, it’s a pretty fast spiral into dangerous territory: the heart rate spikes up as the body tries to keep itself as warm as possible.
“Your body has to work harder to re-warm the body’s core temperature,” Fertel said, likening the body responding to a thermostat. When it’s hot outside, the body works extra hard and tries to cool the body down; when it’s cold, the body goes into overdrive to warm itself up.
When it’s cold enough, though, that can be practically impossible. Blistering starts to occur, blood vessels contract in exposed areas, and skin tissue begins to die. When that happens, the actual tissue itself changes from its normal color to red, then white, then blue, and then—in the most severe cases—black.
That’s when people go to the emergency room. Viglione said that usually it takes a couple days in the emergency room to get a person back to normal, when their “skin changes will manifest after 48 to 72 hours.”
In a perverse way, frostbite resembles burns, notes Stathis Poulakidas, the chair of the burn surgery department at Cook County Health in Chicago, whose research on burn victims has carried over to frostbite patients, and figuring out how to not only save their skin tissue but, in severe cases, avoid amputation.
“Frostbite burns come in first, second, or third degrees,” he told the Daily Beast. “There’s actually a fourth degree burn where you burn the bone off and you can ultimately end up getting amputated. It’s a really severe injury and can cause the loss of a limb—and sometimes the loss of life with severe temperatures.”
All this is complicated by hypothermia, a condition that often works in tandem with frostbite.
“We can divide it into two processes: hypothermia and frostbite,” Fertel said. “Hypothermia is when the core body temperature drops below normal, necessary levels for maintaining metabolic processes."
In the heart of the polar vortex in the Midwest, Poulakidas said, it takes just three to five minutes to start frostbite and hypothermia. “That’s shortened down to a minute with wet socks and shoes,” he added.
While bundling up, being cognizant of your body, and frequently entering a warm space help increase the amount of time a person can be outside in such severe cold, every doctor The Daily Beast interviewed urged people to stay indoors.
Viglione recalled a case when a teenager trudged through snow sockless, gloveless, and in a pair of gym shoes. He made it to his friend’s house 25 minutes later with frostbite on his nose, fingertips, and ears. There was a happy ending there, though. “Over the course of a three-month period of time, we resurrected tissues that had superficially had been dead,” Viglione said.
Poulakidas stressed that people lose limbs from frostbite and can die. Even with proper treatment and fast attention, “nerves get changed indefinitely. It can be lifelong, even if they feel fine.”
There are a few ways to protect oneself against frostbite. The basic, most fundamental rule if you must be outside is to swath yourself in as many layers as possible and have as little skin exposed as possible. Viglione stressed “protect[ing] the areas that stick out the most, primarily on your face.” You lose the most heat from your head, so drop the fashion nonsense and wear a hat. Socks and hand warmers of some kind (gloves are good, mittens are better because they keep fingers together) are essential because blood vessels get smaller the more distant they are from the main body.
Even after bundling up, there are a few basic rules.
First, don’t drink alcohol or take drugs. The drunk jacket myth is especially dangerous when it comes to subzero temperatures and wind chills that put Antarctica to shame. Intoxicants are often numbing, which is dangerous because the first clues to impending frostnip and frostbite are pain. Minutes are precious during frostbite and hypothermia, and can mean the difference between an amputated limb or saving an appendage, or even life and death.
Every doctor The Daily Beast spoke to said many of their frostbite patients had been drinking prior to landing in the emergency room. “People who drink alcohol brave the cold and stay out there longer and don’t feel the numbness on their skin,” Viglione explained. “So they go out in the cold for 20 or 30 minutes from bar to bar around 2 am” and get frostbite.
Second, don’t let shoes get wet. Viglione said one of the first places to lose circulation and get dead tissue are cold, wet feet. Dry socks are key; once socks and boots get wet, it’s only a matter of seconds before the frostnip/frostbite process begins.
Third, keep an eye on vulnerable populations. Poulakidas said that the elderly and the homeless are most prone to frostbite. Older people might slip on ice while outside and sustain an injury, but not be able to move and ask for help. “Our homeless populations are dependent on their hands and feet for survival,” Poulakidas added. “They don’t have proper coverage and clothing, and their clothing might get wet”—setting the stage for frostbite.
If a patient does get frostbite, there are some ways science is moving forward in making the aftermath less painful and life-altering.
Poulakidas said one method many doctors have looked into is using the same clot buster used in heart attack patients to restore blood flow to the injured muscle. But Poulakidas said that doing so can cause “horrific pain, even if it saves digits.”
The most promising emerging method is what Poulakidas describes as “something like a womb vac,” which sucks oxygen back into the tissues to help them come back to life. It works and isn’t as painful, but Poulakidas said the major drawback is that it can be too late. “The unfortunate thing is that these folks present late,” he pointed out, meaning that patients aren’t usually at the emergency room when their fingers are turning red, white, or blue but at the very severe stage when it’s black. “By then, the cat’s out of the bag and the tissue is already dead. We can’t save [limbs at that point] without preventing sepsis by amputation.”
In a weird way, the extreme cold can be helpful. Fertel recalled a frostbite patient he had a couple years ago who was intoxicated. “He was lying unconscious outside and had developed hypothermia,” Fertel recalled. “His heart had stopped beating, and he was in a state of suspended animation, if you will.”
The person was functionally dead. But after 60 minutes of CPR and warming him, he was “relatively OK. He had mild cognitive difficulties, but it [the cold] preserved his neurological function.”
Poulakidas has seen similar situations. “People freeze to the ground and appear to be dead because they’re so hypothermic,” he said. “You’d think they’re dead, but we rewarm them and resurrect them with warming techniques. They might have a lifelong disability but they’re alive.”