With recent frigid temperatures and snow measured in feet instead of inches, emergency departments in cold weather areas of the country are seeing an increasing number of people with frostbite.

Most people bundle up well for winter activities, but what happens when you are unexpectedly facing the bitter cold for prolonged time periods such as if the train is running late and you are waiting for it outdoors, or if your car breaks down? In freezing weather, it is important to be prepared at all times.

Frostbite occurs when cold temperatures kill exposed skin tissue and most noticeably affects fingers, toes, ears, nose, cheeks and chin.

The signs and symptoms start with cold skin and a prickly feeling in the affected area. That may then progress to numbness. Skin may turn red, white, bluish-white, or yellowish-white in color and may become hard or waxy in appearance.

Blistering may occur after rewarming. Superficial frostbite may turn the skin blue and blister up to 24 hours after rewarming. With deep frostbite, the skin may blister up to 48 hours after rewarming. Multiple layers of skin may be damaged, and the condition can cause permanent damage. See a doctor immediately if skin is damaged, blue, or blistered, or if there is numbness after rewarming.

How to avoid frostbite:

• Limit your time outdoors. At 0 degrees Fahrenheit, frostbite can occur in 30 minutes. In -10 below temperatures, it can occur in less than 10 minutes depending on wind chill.

• Dress in loose warm clothing. Air trapped between layers of clothing acts as insulation. Mittens are better than gloves. Be sure to cover ears with a hat or headband. Wear socks and sock liners that fit properly.

• If you are going to be outdoors, don't drink alcohol or smoke cigarettes. Both contribute to frostbite.

• Change out of wet clothing immediately.

• Actively rewarm yourself with a warm, not hot, bath and drink a hot beverage such as coffee, tea or hot chocolate. There may be some pain associated with rewarming as well. This should pass within 30 minutes.

• Eat well and hydrate appropriately.

• Keep moving. Exercise gets blood flow to the extremities.

• Plan well for traveling in your car. Have appropriate clothing (hats, gloves, winter coat) in your car in case you get stranded. Carry extra blankets, water and emergency supplies in the trunk.

--Angelo Pucillo, PA-C, is the assistant chief physician assistant in the emergency department at Hallmark Health System.

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