Harsh winter weather and a growing number of people experiencing homelessness are contributing to an increase in the number of frostbite cases and frostbite-related amputations. Beth Klingenberg, director of health services, explains how frostbite develops and how early treatment helps improve outcomes.
Q: At what point does frostbite become a real risk?
“Frostbite can happen as soon as the temperature goes below zero. It’s a lot more common for our clients because they’re outside for longer periods of time and don’t always have access to dry clothing.”
Q: How much do wet clothing and fluctuating temperatures contribute to frostbite risk?
“Wetness always makes the risk of frostbite worse. Water freezes at minus one, so you can literally have ice right beside your skin. That temperature change from melting to freezing creates so much more damage, because the skin weakens and loses its ability to protect itself.”
Q: Do you notice an increase in frostbite cases right away in a cold snap?
“Frostbite doesn’t always show up immediately. The first really cold day might not bring many cases, but the days after are when we see the increase. The injury keeps getting worse over the next 24 hours, very similar to how a burn progresses.”
Q: How many severe frostbite cases does Hope Mission typically see?
“Over a winter month in this downtown area, we can have up to 20 clients with severe frostbite. Each one of those cases can require an hour or more of wound care, and that’s every single day, sometimes twice a day.”
Q: What does severe frostbite look like when someone comes in for care?
“When frostbite is severe, the tissue literally dies. We can see black fingers down to the knuckle, exposed bone, or deep wounds with a lot of fluid and infection. Once that tissue has died, there’s no feeling left there, but the pain becomes extreme where the living tissue is starting to be affected.”
Q: What happens when someone has frostbite severe enough for hospital care?
“If the frostbite is severe enough, clients are sent to hospital, but they usually have to wait. They may need debridement (surgical removal of dead tissue) or amputation, but that doesn’t happen right away. Often they’re waiting at least a week or longer before surgery, and during that time the wound still needs daily care.”
Q: Why is daily wound care so important during that waiting period?
“During that waiting period, wound care has to happen every single day. If it doesn’t, the damage gets worse, the infection gets worse, and the pain gets worse. Missing even a couple of days can completely change the outcome for that person.”
Q: Can early treatment prevent amputations?
“If we can intervene quickly, we can slow the progression of frostbite. We can do careful rewarming, and we can send people to hospital early enough to receive medications like Iloprost. That medication can significantly reduce the number of amputations, but it has to be given within a very short window.”
Q: Is frostbite the only kind of wound care you provide?
“Frostbite is only one type of wound we treat. We also see burns, abscesses, infections, and wounds related to substance use. Wound care is one of the most frequent services we provide, second only to emergency overdose response.”
Q: Why does it matter that Hope Mission provides this care onsite?
“If we weren’t here doing this work, clients would have to leave their shelter and go somewhere else every single day for wound care. Being able to receive treatment in the same place they’re sleeping makes a huge difference, especially when it’s cold and they’re already injured.”
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