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Objective: To present recommendations for the prevention, recognition, and treatment of environmental cold injuries.
Background: Individuals engaged in sport-related or work-related physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk.
Recommendations: These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.
Key Words: environmental physiology, hypothermia, frostbite, frostnip, chilblain, pernio, immersion foot, trench foot
Cold injuries are a common result of exposure to cold environments during physical activity or occupational pursuits. Many individuals engage in fitness pursuits and physical activity year-round in environments with cold, wet, or windy conditions (or a combination of these), thereby placing themselves at risk of cold injuries. The occurrence of these injuries depends on the combination of 2 factors: low air or water temperatures (or both) and the influence of wind on the body's ability to maintain a normothermic core temperature, due to localized exposure of the extremities to cold air or surfaces. Cold injuries and illnesses occur in a wide range of physically active individuals, including military personnel, traditional winter-sport athletes, and outdoor-sport athletes, such as those involved in running, cycling, mountaineering, and swimming. Traditional team sports such as football, baseball, softball, soccer, lacrosse, and track and field have seasons that extend into late fall or early winter or begin in early spring, when weather conditions can increase susceptibility to cold injury. Reported rates of hypothermia and frostbite include 3% to 5% of all injuries in mountaineers and 20% of all injuries in Nordic skiers.1 Cold injury frequency in military personnel is reported to range from 0.2 to 366 per 1000 exposures.1-6
As the scope of physical activity participation broadens (eg, extreme sports, adventure racing) and environments with the potential for extreme weather conditions become more accessible, a review of cold injury physiology, prevention, recognition, treatment, and management is warranted....