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Cold Related Illness

What is Cold Related Illness (CRI)?

Cold temperatures can cause cold-related illness (CRI), especially for those under or unprepared. Cold weather will not always lead to illness. However, harm to health can happen at temperatures as warm as 60 degrees Fahrenheit. During cold weather, actions need to be taken to prevent CRI. You should watch for symptoms of CRI in yourself and others. Do first aid or get medical care as necessary. This will help protect people from CRI and treat CRI when it happens.

How to Recognize and Treat CRI

Frostbite happens with reduced blood flow to the extremeties.
  • Snow blindness happens when sunlight reflects off snow and ice and damages your eyes. Symptoms are dry, irritated eyes; pain when moving the eyes, blinking, or being exposed to light; swollen eyelids; tearing; and redness of the eyes. Treatment includes using cold compresses, lightproof bandaging, and ophthalmic ointments.
  • Chilblains are more likely to happen in cool (above freezing) weather than other CRIs. Symptoms include blistering, itching, redness, inflammation, and ulcers if severe. The redness and itching generally happens in the fingers, toes, ears, and cheeks. Don't scratch affected areas. This will help avoid worsening blisters and ulcers or creating open sores. Warm affected areas gradually. Clean and bandage blisters and ulcers. Put corticosteroid creams on affected areas to treat swelling and itching.
  • Trench foot happens when feet are in cold or cool water for a long period of time. Symptoms include red skin, leg cramps, tingling, blisters, ulcers, numbness, swelling, bleeding under the skin, and gangrene, a type of tissue death. Try to get medical attention. If medical attention is not available, take off wet socks and shoes. Get the feet dry and try not to walk. Keep the feet elevated to prevent further damage.
  • Frostbite happens with reduced blood flow to the arms, hands, legs, or feet. Signs include numbness, tingling, blisters, stinging, aching, and bluish, white, or grayish-yellow skin that feels firm or waxy. To treat frostbite, move to a warm place. Do not walk on or rub frostbitten areas, since this can cause damage. Warm affected areas using body heat. Do not use space heaters, heating pads, hot water, stoves, fireplaces, or heat lamps. Numbness from frostbite can lead to burns if more intense heating methods are used. Drink warm sweet drinks that do not contain alcohol. Sugar will increase body temperature. Get medical help as soon as possible.
  • Hypothermia include shivering, exhaustion, coordination problems, slurred speech, confusion, disorientation, blue or bluish skin, pupil dilation, slower pulse and breathing, and loss of consciousness. In infants, symptoms are cold red skin and lack of energy. Hypothermia is a medical emergency. Call 911 if someone's temperature is below 95 degrees or they feel cold to the touch. If medical care is not available, move the person to a warmer location. Respectfully remove wet clothing, replacing it with dry clothing and blankets. Wrap the person in a vapor barrier like a tarp or garbage bag. This will keep moisture out. Focus on warming the center of the body. Provide warm drinks without alcohol. Alcohol increases sensitivity to cold. Do CPR if the person has no pulse. Do not give someone a drink if they are not conscious, as they may choke.

Who is at Risk?

Anyone can suffer from CRI. Infants, older adults, people who are outdoors for a long time, people who use alcohol or drugs, and people with health conditions have higher risk. Some groups at risk include outdoor workers and people experiencing homelessness. Alcohol increases the rate at which heat leaves the body. All psychoactive drugs can affect a person's ability to make decisions and keep themselves safe. Health conditions that increase risk are respiratory and cardiovascular diseases, high blood pressure, hypothyroidism (a condition causing slow metabolism), diabetes, mental illness, arthritis, vascular diseases, Parkinson's disease, Alzheimer's disease, and dementia.

Outdoor Workers

The National Institute for Occupational Safety and Health (NIOSH) and the U.S. Occupational Safety and Health Administration (OSHA) have recommendations for those who work outdoors or manage people who do. When the outside temperature is cold, breaks should be spent in warm locations. Outdoor workers should wear appropriate clothing and layer accordingly. Avoid alcoholic and caffeinated drinks. Caffeine can be dehydrating. Instead, drink water and warm drinks. Use the buddy system by letting a trusted individual know where you are. Limit time outside when possible when off work. Workers and employers should watch for signs of cold-related illness. Shivering should not be ignored. It is an early sign of hypothermia.

People Experiencing Homelessness

People experiencing homelessness are exposed to the cold more than people with homes. They should seek out warm indoor public places such as libraries, malls, churches, community buildings, and shelters. Avoid alcohol and caffeine to prevent dehydration and hypothermia. It is better to wear multiple layers of lighter clothing than one or two heavy layers since the air between the layers is insulation. Wool is a great insulator. It will help keep a person warm. It also repels water. In general, people experiencing homelessness should dress warmly with a hat, gloves, boots, and multiple layers. They should stay dry and avoid sweating. Limit time spent sitting and squatting. These actions can prevent blood flow and lead to CRI.

Young Children and Infants

Infants lose heat faster than adults and cannot warm themselves up by shivering the way adults can. When exposed to cold, they should be dressed in warmer clothing than adults. The symptoms of hypothermia are different in infants. If an infant has cold red skin and a lack of energy, check their temperature. If it is below 95 degrees Fahrenheit, get emergency medical care.

Older Adults

Older adults may have slower metabolisms and feel less temperature differences. They are also more likely to have underlying health conditions. Older adults should have a battery-powered thermometer in their home to regularly monitor their temperature. This will let them know if they have hypothermia.

Alcohol and Drug Use

The use of alcohol and drugs should be limited. Alcohol can increase the rate at which the body loses heat. All psychoactive drugs can impair judgment. Staying indoors, wearing appropriate clothing, and having a person with sound judgment with you can help. Don't drink beverages with caffeine. It is dehydrating and will make you more sensitive to cold. Shivering, slurred speech, confusion, fatigue, and disorientation are all symptoms of hypothermia that can be confused with the effects of alcohol and some drugs. People in cold conditions should dress warmly, try to stay dry, and avoid over-exercising.

People with Chronic Health Conditions

Chronic health conditions can increase vulnerability to CRI. Chronic conditions of concern include high blood pressure, hypothyroidism, diabetes, psychiatric conditions, memory problems, Parkinson's disease, arthritis, and respiratory/cardiovascular diseases. People with chronic conditions should talk to their doctors about whether they may be at increased risk for CRI and how to keep themselves safe. Some medications increase risk of cold. These include antipsychotics and medications to treat nausea, depression, or anxiety. Follow the health tips below to help protect against cold.

Health Tips

The following actions can help you and your loved ones to stay safe in the cold.

  • Dress for the weather. Wear multiple layers rather than fewer heavy layers. Wear a hat, gloves, and boots. Wear wool or waterproof clothing when possible. Don't overexert yourself but keep yourself moving to circulate your blood flow. Stay dry. Water loses heat much faster than air.
  • Stay indoors when possible. If you must go outdoors, dress warmly. Monitor symptoms of CRI. Try to go outside during the warmest part of the day, between 10 a.m. and 3 p.m.
  • Ensure that your home is heated safely and equipped for winter weather (thermometer, heating, smoke, and carbon monoxide detectors, etc.)
  • Avoid alcohol and caffeine. Instead drink warm, hydrating beverages.
  • Travel safely: Carry a first aid and emergency kit with you.
  • Watch for symptoms of cold-related illness. Pay attention to shivering, confusion, exhaustion, numbness, tingling, slurred speech, color changes in the skin, and other symptoms. Seek medical attention if needed.
  • Check on others, especially those in high-risk groups.
  • While not considered CRI, many injuries are associated with cold weather. Assure against slips, trips and falls on icy surfaces. Monitor exertion when shoveling snow or working outdoors, especially if you have heart problems.
Cold weather tips