KEEPING WARM IN FREEZING WEATHER

Those people who have their skin prolonged exposure to freezing temperatures or are not dressed appropriately for the freezing weather are in danger of getting frostbite and hypothermia. 

The initial symptom of frostbite is typically numbness. This may be followed with the skin being turned into pink, then white or bluish color The hands, feet, and face are most commonly affected. Later, the exposed fingers, toes, ears and nose will finally turn black. If that happens, they will probably have to be surgically removed. In extreme cases, those frozen parts of your body will definitely have to be removed. 

When I was thirteen years old and living on a small farm in British Columbia, I was playing in the snow with two neighbourhood kids. I was wearing heavy socks and gumboots. Snow got into one of the gumboots and melted by the heat of my feet. Then the snow in my gumboot became water which then slowly solidified.  It was by then, that I couldn’t feel my right foot at all. When I got home, my foster mother looked at my right foot. The skin was white in colour. She poured slightly warm water over my foot to thaw the ice surrounding my foot.  When the foot was warmed up and my foot was no longer numb, that is when I began feeling real pain. When the pain slowly receded in the next day, my foot felt terribly itchy which was driving me crazy. I wanted to scratch it but if I did, I may have torn away the flesh from my foot.

An underlying problem could have involved injury from ice crystals and the formation of blood clots in my small blood vessels following the thawing of my foot. Fortunately for me, those problems didn’t happen otherwise my foot would have had to be amputated.

It was approximately ten days before my foot became normal again.  I had suffered from first degree frostbite.

First degree frostbite is superficial, surface skin damage that is usually not permanent. Early on, the primary symptom is loss of feeling in the skin. In the affected areas, the skin is numb, and possibly swollen, with a reddened border. In the weeks after injury, the skin's surface may come off and later be replaced by new skin.

In second degree frostbite, the skin develops clear blisters early on, and the skin's surface hardens. In the weeks after injury, this hardened, blistered skin dries, blackens, and peels. At this stage, lasting cold sensitivity and numbness can develop and remain for some time.

In third degree frostbite, the layers of tissue below the skin freeze. Symptoms include blood blisters and "blue-grey discoloration of the skin".^[ In the weeks after injury, pain persists and a blackened crust (eschar) develops. There can be long term ulceration and damage to growth plates.

In fourth degree frostbite, structures below the skin are involved like muscles, tendons, and bones. Early symptoms include a colorless appearance of the skin, a hard texture, and painless warming of the skin.  Later, the skin becomes black and mummified. The amount of permanent damage can take one month or more to determine if amputation is required.

Don’t go outside in freezing weather wearing gumboots. If your feet are sweating, the freezing air will reach your sweat and freeze it.

Prevention is brought about by wearing proper clothing, maintaining hydration and nutrition, avoiding low temperatures, and staying active without becoming exhausted.^]Treatment is by rewarming he part of the body that was subjected to freezing air.  This should be done only when refreezing is not a concern. Rubbing or applying snow to the affected part is not recommended since snow crystals will tear at the skin. The use of ibuprofen and tetanus toxoid is often recommended  For severe injuries, iloprost or thrombolytics may be used. Surgery is sometimes necessary. Amputation, however, should generally be delayed for a few months to allow a determination of the extent of injury of any part of the body that was frozen.

Hypothermia is reduced body temperature that happens when a body dissipates more heat than it absorbs. In humans, it is defined as a body core temperature that is below 35.0 °C (95.0 °F).^[2]Symptoms depending on the temperature. In mild hypothermia there is shivering and mental confusion and in moderate hypothermia shivering stops and confusion increases. In severe hypothermia, there may be paradoxical undressing, in which a person removes their clothing, as well as an increased risk of their heart stopping.

Hypothermia has two main types of causes. It classically occurs from exposure to extreme cold. It may also occur from any condition that decreases heat production or increases heat loss.

Commonly this includes alcohol intoxication but may also include low blood sugar, anorexia and advanced age.  The most common age group that is  affected by freezing parts of their bodies and hypothermia are those who are between 30 to 50 years of age.

Body temperature is usually maintained near a constant level of 36.5–37.5 °C (97.7–99.5 °F) through thermoregulation. Efforts to increase body temperature involve shivering, increased voluntary activity, and putting on warmer clothing. Hypothermia may be diagnosed based on either a person's symptoms in the presence of risk factors or by measuring a person's core temperature.

The treatment of mild hypothermia involves warm drinks, warm clothing, and physical activity. In those with moderate hypothermia, heating blankets and warmed intravenous fluids are recommended.^[2] People with moderate or severe hypothermia should be moved gently.^[2] In severe hypothermia, extracorporeal membrane oxygenation  or cardiopulmonary bypass may be useful.^] In those persons who are without  a  pulse cardiopulmonary resuscitation (CPR) is necessay along with the above measures. Rewarming is typically continued until a person's temperature is greater than 32 °C (90 °F).^[2] If there is no improvement at this point or the blood potassium level is greater than 12 mmol/liter at any time, resuscitation may be discontinued

People who are exposed to low temperatures for prolonged periods, such as winter sports enthusiasts, military personnel, and homeless individuals, are at the greatest risk of freezing parts of their bodies.

Many years ago, I saw a newspaper photo of a homeless man who tried to escape the freezing snow by lying in a small alcove outside a building. What made me really sad was that he had no shoes or socks on his feet.

When I was living in an apartment building, A homeless man followed me into the building I lived in.  The temperature outside was well below freezing since the coldness of the air   was caused by the strong blowing wind. He cried out, “Please don’t ask the superintendent to throw me out.” I went to the superintendent and told him that if he sees the homeless man lying on the floor in the lobby, he shouldn’t throw him out of our building. He replied, “I wouldn’t do that and then have that on my conscious for the rest of my life.” I then went to the lobby and told the homeless man that the superintendent said he can remain in the lobby. I soon after brought him a glass of water and some cookies. I didn’t ask him to come with me to my apartments as I was aware that strangers have been known to harm the people who are kind enough to let them sleep overnight in their home or steal from them while their host is asleep.

When I was conducting group sessions with prisoners, one of the men in my group was charged with murdering a woman who put him up in her home for a night since he told her he had no place to sleep. I asked the other prisoners what sentence he should receive. They said life in prison. That is what the judge gave him.

 Years later I put up a woman I knew for a night in my apartment because she had nowhere to sleep. While I was at work in the next morning, she called a male friend and they both stole my colour TV which cost me a thousand dollars. I tracked the woman down and called the police. She was arrested and tried for the theft. She was sentenced to prison for eighteen months. A year after she was released, she died from some illness.

Cities like Toronto in Canada are going to great lengths to rescue homeless people from the street during freezing weather and bring them into shelters where they can get warmth.

In my opinion, homeless persons during the cold winter months can be placed in libraries after they are normally closed, in churches, in armories, in police stations, indoor public gyms and other public buildings where security people will protect them and the property. There are homeless shelters in Toronto but the aforementioned places should be used if the shelters are filled. No person should be found dead in an outside alcove with no shoes or socks.