Man stranded in snowy woods.by James Hubbard, M.D., M.P.H.

In my last post, I talked about how Olympic gold-medal winner Rulon Gardner saved most of his foot despite severe frostbite. The main thing is, he didn’t rewarm it while there was still a chance of the tissue refreezing. (If it had refrozen, it would have been dead meat—literally.) And of course, he was able to get to a medical facility.

But what if you can’t get expert care? What if you’re stranded in some shack or tent? Here are some first-aid dos and don’ts for severe frostbite when help is not on the way.

Remember: Don’t rewarm the tissue until you know you can keep it from refreezing.

1. The best first-aid method for rewarming frostbite is to immerse the area in warm water (100 to 108 F). The tissue should thaw within fifteen to thirty minutes. Of course, you can’t measure the water’s temperature without a thermometer, but you should be able to stick your uninjured hand in it without having to remove it.

  • Do keep the water moving a little. It helps keep the warmest water next to the injury.
  • Don’t let the water get too hot or too cold. Keep the temperature constant, or more skin damage may occur.

2. Expect swelling, large blisters, and severe pain. Those are signs the tissue is rewarming.

  • Do take aspirin or ibuprofen (Advil, Motrin) for pain, if available, since they provide additional frostbite benefits that aid in healing.
  • Don’t remove blisters, even the large ones, unless they’re already leaking. A sealed blister is a sterile environment and limits infection risk.

3. During and after rewarming, keep the following in mind:

  • Do be very gentle with the damaged tissue.
  • Don’t walk, stand, or put pressure on the injured area.

4. Let the injured area air dry.

  • Do handle with care.
  • Don’t towel dry or rub.

5. For swelling, remember:

  • Do keep the injured area at heart level or above.
  • Don’t use restrictive dressings.

6. To keep the blood circulating and aid healing,

  • do consider taking a vasodilator (medicine that opens up the blood-vessel flow). Some blood-pressure medicines help if you’re already on them. Aspirin may help. Niacin is worth a try if you don’t have ulcers. (Niacin may make your overall skin flush and tingle.)
  • don’t smoke. Smoking constricts blood vessels.

7. To dress wounds,

  • do keep absorbent padding, such as gauze or cotton, between injured fingers or toes.
  • do use antibiotic cream. Silvadene (1% silver sulfadizine) is a good one. Triple antibiotic, gentamycin and bactracin are alternatives.
  • do cover the wound with a light dressing or leave it open to the air.
  • do start antibiotics, if available.