Cold Injuries: Prevention, Treatment, and Survival

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When the mercury drops, keeping your body warm and functional isn’t just about comfort—it’s a necessary form of preparedness that everyone needs to address. Overexposure to cold goes beyond shivering; it can become dangerous if you aren’t equipped with the right knowledge and resources. The reality is that for the underprepared, cold injuries can occur quickly.

Preventing and dealing with these injuries requires pairing layered clothing systems with actionable, effective know-how. This article provides simple, step-by-step actions to prevent cold injuries and handle first aid if things go sideways. Whether you’re prepping for daily life in a cold climate, a backcountry adventure, or an SHTF scenario, these are skills you need in your prepping toolkit.

Disclaimer: This article contains affiliate links through which I may receive a small commission at no cost to you if you choose to purchase a product through a link on this page.

TL;DR: Cold injuries such as hypothermia, frostbite, trench foot, and chilblains can be prevented with layered clothing and diligent foot care. Recognize symptoms early, rewarm gently, avoid direct heat, and seek medical help for severe cases.

Cold Weather Injury Prevention — Build Your Cold-Weather Defense

Cold weather doesn’t mess around. When it comes to freezing temperatures, prevention isn’t optional—it’s mandatory. That means employing systems and habits that meet your needs, rather than just grabbing gear at random and hoping for the best.

The 3 Ws of Layering: Wicking, Warmth, Weather

Your clothing works best as a system of layers. I like to think of my cold-weather clothing preparedness in terms of the “3 Ws”—Wicking, Warmth, and Weather. This approach keeps you agile, adaptable, and protected.

1. Wicking (Base Layer): This layer sits next to your skin. Its job is to draw sweat away from your body, keeping you dry and warm by interrupting the body’s natural evaporative cooling process. For my base layer, I rely on merino wool, alpaca, or other high-quality natural fibers. Some purpose-built synthetics also work well. Be cautious with cotton—wet cotton draws core body heat away, drastically increasing the risk of cold-weather injury.
2. Warmth (Mid Layer): This is your main insulator. Fleece, synthetic puffy jackets, or even a heavy wool shirt trap critical air and help retain your body heat. Layer up or down depending on the weather conditions and your activity level.
3. Weather (Outer Layer): The outer shell shields you from wind, rain, and snow. This is your rain shell, wind jacket, or parka—something that blocks the harmful elements but also breathes when you’re on the move.

🏆 Pro TipThe rule of thumb for dressing in cold weather is to be comfortably cool when active and comfortably warm when stationary. ~Josh Enyart

The goal is to know when and how to layer effectively and adapt on the fly. Sweat cools you down, so if you’re active (chopping wood, hiking, or shoveling snow), go lighter on your layering. When you stop moving, layer up immediately to stay warm.

Don’t forget: Use hoods on every layer, use zippers to vent heat fast, and always stash an extra set of dry socks in your bag.

 Protect the Extremities: Details That Matter

• Hands & Feet: Insulated gloves and waterproof boots are crucial. Cold, wet feet aren’t just miserable—they are the breeding ground for trench foot and frostbite. Change socks regularly, wear moisture-wicking footwear, and keep your feet clean and dry.
• Head & Face: Your head is roughly 7% – 10% of the surface area of your body. So, you definitely want to protect it from the cold. A quality hat does just that, serving double duty as both a source of warmth and sun protection. Add a balaclava or neck gaiter as conditions demand.

Fuel Up, Drink Up

Your body burns more energy when trying to stay warm. Stock up on high-calorie snacks, and drink warm fluids when possible. Dehydration can sneak up on you in cold weather, so keep drinking. If you’re prepping for your family or a group, factor everyone’s needs into your plan and make hydration (and snacks) part of your routine.

Alcohol Warning: Drinking alcohol creates a false sense of warmth by dilating your blood vessels. That dilation brings warm blood to the skin’s surface, which makes you feel warm. When that happens, your warm blood cools down, causing your core body temperature to drop faster and increasing the risk of hypothermia faster than if you had not drunk alcohol.

Prep for the Long Haul: Layered Gear Systems

When it comes to prepping for cold weather, whether it’s your EDC (everyday carry), a get-home bag, or a 72-hour bag, you should be ready for the coldest weather in your area. For example, while Texas is known for its hot summers, it has experienced subzero temperatures in the winter. So, be sure to pack accordingly.

Immediate Action and First Aid for Cold Weather Injuries

Even with the best preps in place, sometimes the situation doesn’t go according to plan. You or a family member might get caught in the cold, less prepared than you hoped.

Just yesterday, when I left for the store, it was sunny and 50°F (10°C). I wore shorts, a hoodie, and tennis shoes (no socks—I hate them!). When I came out of the store, a storm had moved in. It was 25°F (-7°C) with a wind chill of 3°F (-16°C). It was brutal, and I definitely wasn’t dressed for it. Thankfully, I keep a full layered winter outfit in my car, so in a real emergency, I was covered—literally.

Unfortunately, that’s not always the case for everyone. Despite our best intentions, things happen. When they do, we need to be ready to manage the problem. In cold weather, that means treating injuries that weren’t prevented.

The key with all medical emergencies is to spot trouble early and act quickly—don’t wait and hope it’ll sort itself out.

 Hypothermia

Hypothermia occurs when your body loses heat faster than it can produce it, causing your core temperature to fall below 95°F (35°C).

Signs of Hypothermia:

• Mild: Shivering, sluggishness, confusion, slurred speech, and loss of coordination.
• Moderate: Shivering stops (a bad sign), confusion worsens, heart rate and breathing slow.
• Severe: Unconsciousness, stiff muscles, extremely slow or irregular heartbeat, possible cardiac arrest.

How to Treat Hypothermia:

1. Move the person to a dry, sheltered place out of the wind immediately.
2. Remove wet clothing and dress them in dry layers, then cover them with blankets.
3. Warm the core body areas (chest, neck, head, and groin) first.
4. If the person is alert and able to swallow, offer warm, non-alcoholic drinks.
5. Seek emergency medical assistance as soon as possible.

Frostbite

Frostbite is a severe injury where body tissue freezes, usually affecting the fingers, toes, nose, ears, or cheeks. It happens when ice crystals form in the tissues, leading to numbness and damage. In serious cases, it can require amputation. Frostbite typically happens when exposed to temperatures below 32°F (0°C).

Signs of Frostbite:

• Frostnip (First Degree): Skin feels cold, looks red, and may tingle or feel numb. As it warms, you might feel “pins and needles.”
• Superficial Frostbite (Second Degree): Skin feels hard or waxy. Stinging or burning sensations occur, and blisters may form within two days of warming.
• Deep Frostbite (Third & Fourth Degree): Skin turns white, blue-gray, or blotchy with severe numbness. After rewarming, large blisters may form, and tissue death (gangrene) can occur.

How to Treat Frostbite:

1. Move to a warm environment immediately. Do not rub or massage the area.
2. Gently rewarm the area using warm (not hot) water at about 104°F (40°C) for 15–30 minutes.
3. Avoid direct heat sources, such as fires or heating pads, because numb skin can burn easily.
4. Loosely bandage the area (place gauze between fingers/toes) and keep the limb elevated.
5. Seek medical attention promptly if frostbite is second-degree or higher.

Trench Foot (Immersion Foot)

Trench foot is a nasty condition that develops when feet are exposed to cold and wet conditions for too long—even at temperatures above freezing. This restricts circulation and damages tissue and nerves.

Signs of Trench Foot:

• Early: Tingling, itching, burning, numbness, or a heavy sensation (feet feel like blocks of wood).
• Advanced: Swelling, redness, and skin that looks pale, waxy, or blue. Blisters may form.
• Severe: Intense pain, foul odor, blackened skin, and high risk of infection.

How to Treat Trench Foot:

1. Remove wet shoes and socks immediately. Clean and dry the feet gently.
2. Rewarm feet gradually with warm (not hot) water (102–110°F) for about 5 minutes.
3. Keep feet elevated to reduce swelling. Avoid tight footwear.
4. Use over-the-counter pain relievers (like ibuprofen) for pain.
5. Seek medical help if severe symptoms or infection appear.

Chilblains (Pernio)

Chilblains are painful, itchy patches that appear on fingers, toes, ears, or the nose after exposure to cold, damp air, followed by rapid rewarming.

Signs of Chilblains:

• Itchy red, purple, or blue patches.
• Swelling and tenderness, often with a burning sensation.
• Dry, cracked, or scaly skin.
• Blisters or ulcers in severe cases.

How to Treat Chilblains:

1. Gently warm the area with lukewarm water or warm clothing. Avoid direct heat.
2. Keep skin clean, dry, and moisturized with unscented lotion.
3. Use calamine lotion or mild hydrocortisone cream for itching.
4. Don’t scratch! This can lead to infection.
5. See a doctor if it doesn’t improve in 2–3 weeks or if signs of infection appear.

The Bottom Line on Cold Weather Injuries

Additional Resources