How to Write About Frostbite

Are you writing about Frostbite?

If you live anywhere the weather gets a lot of snow or is freezing cold, you’ve probably suffered mild, early frostbite. My parents’ house in Indiana was on a steep hill, so sliding down the snow on sleds or saucers was an annual event. Along with very cold, red fingers, AKA early frostbite, called frostnip.

Frostbite only becomes a problem when it’s prolonged and damages tissues in the body.

Skin, tendons, nerves, blood vessels, blood,  and yes, even bone can freeze.

 

WHAT HAPPENED AT THE 2024 NFL AFC SUPERBOWL PLAYOFF GAME? 

Unfortunately, the weather for January, 2024’s Super Bowl playoff game between the Kansas City Chiefs and the San Francisco 49ers ended up being one of the coldest NFL games on record:  https://tinyurl.com/mvw4tze6

Not only that, the game went into overtime.

I’m going to hazard a safe guess that most in attendance consumed some amount of alcohol, which increases the risk for frostbite.

Unfortunately, seventy percent of the NFL fans who got frostbite at this game are now being advised to undergo amputations.

One fan only exposed his hands for four minutes.

That’s all it took, depending on the temperature and wind chill.

 

Super Bowl LIX 2025 in New Orleans promises to be a much balmier event,

but 8″ of snow on Canal Street just a couple of weeks ago is crazy, once-in-a-lifetime weather for NOLA.

 

It can only take a few minutes to get severe frostbite if weather conditions are right. Just ask fans that went to the 2024 NFL Playoff game between the Chiefs and the 49ers! Share on X

Frostbite is also called “Freezing cold injury.”

FROSTBITE and HYPOTHERMIA are not the same. Learn why at Novel Malpractice. Share on X

 

Frostbite and hypothermia are related because both are cold weather injuries. Frostbite refers to cold damage to skin and body parts that are exposed, such as fingers, hands, toes, feet, face, ears and nose.

 

Hypothermia is an overall body condition.

Frostbite is freezing of superficial or deep tissues to the point where ice crystals form.

Of course, you can have both hypothermia and frostbite.

 

The treatment can be different, but the tissue damage is similar.

Frostbite infographic. Cartoon of frostbite vector infographic for web design

 

How to Write About Frostbite:

If you plan to have a character suffer from frostbite and/or hypothermia, the weather conditions you set need to be right. Learn how at Novel Malpractice Share on X

See my post https://novelmalpractice.com/hypothermia/ for more info on hypothermia – which has helpful air temp and water temp graphs.

Frostbite will occur at 0 degrees C/32 degrees F.

Symptoms of frostbite: The problem is you don’t feel it after awhile!

  • Redness or pain in a skin area after cold exposure
  • White 0r grayness, grayish-yellow, waxy-looking skin
  • Skin that feels too firm or waxy/rubbery
  • Numbness
  • Blisters- filled with clear fluid or even blood, in severe frostbite
  • Black, dead skin (gangrene) in the most severe cases

Character questions you need answers to are:

  1. What size/body build/age is your character? Larger, muscular people are less prone to cold injury BUT exposed noses and fingers will still freeze fairly quick.
  2. Age: babies and small children plus the frail elderly are far more prone to frostbite
  3. What are they wearing? Is this character someone prepared for weather changes? Or more like my clueless Hollywood heroine in Harvest of Hope, who shows up to a Kansas blizzard barefoot in heeled sandals?
  4. Did they bring extra clothing and hand/feet warmers? Is this someone who packs their truck every winter and prepares for every eventuality, like a ski instructor, state trooper, park ranger, or my dad, who was an Eagle Scout? Or are they an average hapless Joe driving into a storm?
  5. HOMELESSNESS and/or drug addiction
  6. Certain medical conditions make a person more prone to frostbite, which include:
    • diabetes
    • malnutrition
    • peripheral vascular disease (PVD) — poor circulation in the legs and feet particularly, but includes the hands
    • Raynaud’s syndrome – this disease causes an oversensitivity to cold. The fingers turn white then blue, and get tingly and numb, even painful. Symptoms are similar to frostnip but are due to autoimmune disease.
    • Hypothyroidism – low thyroid
    • Stroke
    • PRIOR HISTORY OF FROSTBITE

Other things to keep in mind for your characters and scenes:

  1. Risk factors that predispose to frostbite are:
    • Smoking
    • Consumption of alcohol or drugs
    • Very young age, or elderly
    • Frailty
    • Dehydration
    • Altered mental status
    • Immobilized for any reason
    • Hypoxia – lack of oxygen
    • Schizophrenia – many schizophrenics have acrocyanosis (persistently blue extremities) and have trouble sensing cold injury
  2. Environmental factors:
    • Lack of shelter or insufficient shelter from the cold
    • High altitude (also leads to hypoxia)
    • Time – long duration of exposure
    • Wet conditions
    • High wind chill factor
    • Homelessness
    • Actual air temperature
    • Occupations that require prolonged work outside such as linemen, emergency services, etc.

How Frostbite is Graded: (it doesn’t get an A)

Frostbite is graded using the Cauchy prediction algorithm from 1 to 4, with 4 being the most severe. Grades 1, 2 and some 3’s can be treated as outpatients. Grade 4 requires hospitalization, as those are likely to need amputation.

Frostbite Grade      How it looks after rewarming Bone Amputation Risk
Grade 1      No darkness or blueness (cyanosis)      None
Grade 2      Cyanosis of last section of finger (joint to nail)      Moderate risk
Grade 3      Cyanosis up to the middle joint of finger      High Risk
Grade 4      Cyanosis past the middle joint of finger       100%

 

How Frostbite is Treated:

Initial treatment:

  1. Frostbite is first treated on the scene by the victim/family  and/or EMTs and Paramedics before they get to the ER.
  2. If hypothermia is suspected, call 911 for immediate medical help.

DO’s:

  1. Get out of the cold and protect the affected area. Don’t rewarm it if there’s a chance of it refreezing. If not, try to rewarm by tucking your hands under your arms, or have someone else help.
  2. DO Remove any wet clothing, and get into a warm blanket.
  3. DO drink warm, NON-alcoholic beverages. (because, be honest, alcohol probably got you here to begin with if you’re a football fan)
  4. If possible, soak the affected skin area(s) in warm water (not HOT water, you want body temperature water or a degree above) for 30 minutes (tub, bowl, sink, bucket). Circulating water maintains the water temperature.  (98.6-102° F or 37-38º C)
  5. For frostbite on the nose or ears: rewarm with warm wet clothes for 30 mins. Switch cloths out when they cool.
  6. BIG ONE: DO Remove any rings or jewelry! Frostbite will cause swelling down the line and jewelry can turn into unwanted tourniquets. It’s also not always easy to remove rings in the ER (trust me). Plus, it ruins your jewelry.
  7. ANOTHER BIG ONE: Remove any tight or constrictive clothing. Now is not the time to lounge in your Pilates leggings.
  8. DO take an over-the-counter pain medication. Once the skin rewarms, the pain will follow.

DON’Ts:

  • Quick rewarming is NOT recommended.
  • DO NOT APPLY DIRECT HEAT. No heating pads, lamps, blow dryers, car heaters. Your character might make this mistake, but a professional won’t.
  • DON’T RUB THE AREA. This is shown wrong all the time in the movies or on TV. (The poor heroine with frostbitten hands is warmed by a hero who rubs them while looking deep into her sapphire eyes. For frosting, this is okay. Not for frostbite, though)
  • DON’T walk on frostbitten toes or feet. (Also avoid walking on your hands, if you are a gymnast with  frostbit fingers.)
  • DON’T go hop into a hot tub.
  • DON’T drink alcohol or use sedatives. Alcohol and sedatives decrease the awareness of cold and impair judgment. Alcohol causes small blood vessels to dilate and impairs shivering, so frostbite can happen in a warmer temperature than normal.
  • DON’T pop the blisters. This needs to be done only by a healthcare professional.

 

It may sound odd, but doctors who treat frostbite are the same ones who treat burns – plastic surgeons.

Burns and frostbite are two sides of the same coin called “Thermal Damage.”

One is from excessive heat, one is from excessive cold.

Emergency Room treatment for frostbite:

  1. If the skin isn’t already rewarmed, the ER may use a warm water bath described above, or even a whirlpool (physical therapy version of a hot tub)
  2. Xrays and even MRI may be done. It can take 2-4 days for the full extent of damage to be known.
  3. Depending on the size of the area, it may be wrapped loosely in sterile gauze and elevated to reduce swelling.
  4. An antibiotic to prevent infection may be prescribed.
  5. The decision to admit to the hospital is based on the amount of tissue involved and need for further therapy.
  6. Updated tetanus shot if needed

Hospital treatments may include some or all of these:

  • Intravenous fluids
  • Intravenous pain medications
  • Intravenous antibiotics
  • Intravenous injection of anti-clotting drugs “anti-thrombolytic medications” or drugs to dilate the blood vessels.
    • tPA (tissue plasminogen activator), Brand name Alteplase
    • heparin
    • Iloprost
  • Debridement – surgical removal of dead tissue
  • HBO therapy (not the TV channel, but you can watch it from the chamber) — Hyperbaric oxygen therapy, this is a series of treatments.

Long-term complications:

These effects can last months to years or end up being permanent. Frostbite makes you more prone to getting frostbite again.

Can also see:

  1. Frostbite arthritis, stiffness in hands and feet
  2. Nerve damage called neuropathy, which includes pain and tingling
  3. Sweating heavily
  4. Discolored skin
  5. Nail damage or loss of nails
  6. Scarring
  7. Damage to tendons, muscles and bones

 

The moral to this story is either stay out of the cold, or dress appropriately for it.

TIMING TO FROSTBITE:

This is the question most often asked by other writers. How long before my character gets frostbite? Here’s the standard answer, keeping in mind that if your character has risk factors, or is drunk, etc. the time to frostbite may be SHORTER.

 

Copy of the NWS windchill chart, or use this link: https://www.weather.gov/media/unr/windchill.pdf

 

DEEPER DIVES 

https://www.mayoclinic.org/diseases-conditions/frostbite/diagnosis-treatment/drc-20372661

https://my.clevelandclinic.org/health/diseases/15439-frostbite    (Good diagram about frostbite)

https://www.ncbi.nlm.nih.gov/books/NBK448115/     Article on using HBO for frostbite

Share this