What constitutes cold stress and its effects can vary across different areas of the country. In regions that are not used to winter weather, near freezing temperatures are considered factors for "cold stress." Increased wind speed also causes heat to leave the body more rapidly (wind chill effect). Wetness or dampness, even from body sweat, also facilitates heat loss from the body.

Cold stress occurs by driving down the skin temperature, and eventually the internal body temperature. When the body is unable to warm itself, serious cold-related illnesses and injuries may occur, and permanent tissue damage and death may result.

Types of cold stress include: trench foot, frostbite, and hypothermia.

Immersion/Trench Foot

Trench foot is a non-freezing injury of the feet caused by prolonged exposure to wet and cold conditions. It can occur in temperatures as high as 60°F if feet are constantly wet. Injury occurs because wet feet lose heat 25-times faster than dry feet.

What are they symptoms of trench foot?

Reddening skin, tingling, pain, swelling, leg cramps, numbness, and blisters.

First Aid

• Call 911 immediately in an emergency; otherwise seek medical assistance as soon as possible.
• Remove wet shoes/boots and wet socks.
• Dry the feet and avoid working on them.
• Keep affected feet elevated and avoid walking. Get medical attention.

Frostbite

rostbite is caused by the freezing of the skin and tissues. Frostbite can cause permanent damage to the body, and in severe cases can lead to amputation. The risk of frostbite is increased in people with reduced blood circulation and among people who are not dressed properly for extremely cold temperatures.

What are the symptoms of frostbite?

Reddened skin develops gray/white patches in the fingers, toes, nose, or ear lobes; tingling, aching, a loss of feeling, firm/hard, and blisters may occur in the affected areas.

First Aid

• Follow the recommendations described below for hypothermia.
• Protect the frostbitten area, e.g., by wrapping loosely in a dry cloth and protect the area from contact until medical help arrives.
• DO NOT rub the affected area, because rubbing causes damage to the skin and tissue.
• Do not apply snow or water. Do not break blisters.
• DO NOT try to re-warm the frostbitten area before getting medical help, for example, do not use heating pads or place in warm water. If a frostbitten area is rewarmed and gets frozen again, more tissue damage will occur. It is safer for the frostbitten area to be rewarmed by medical professionals.
• Give warm sweetened drinks if alert (no alcohol).

Hypothermia

Hypothermia occurs when the normal body temperature (98.6°F) drops to less than 95°F. Exposure to cold temperatures causes the body to lose heat faster than it can be produced. Prolonged exposure to cold will eventually use up the body’s stored energy. The result is hypothermia, or abnormally low body temperature. Hypothermia is most likely at very cold temperatures, but it can occur even at cool temperatures (above 40°F) if a person becomes chilled from rain, sweat, or immersion in cold water.

What are the symptoms of hypothermia?

An important mild symptom of hypothermia is uncontrollable shivering, which should not be ignored. Although shivering indicates that the body is losing heat, it also helps the body to rewarm itself. Moderate to severe symptoms of hypothermia are loss of coordination, confusion, slurred speech, heart rate/breathing slow, unconsciousness and possibly death. Body temperature that is too low affects the brain, making the victim unable to think clearly or move well. This makes hypothermia particularly dangerous because a person may not know what is happening and won’t be able to do anything about it.

First Aid

• Call 911 immediately in an emergency:
• Move the worker to a warm, dry area.
• Remove any wet clothing and replace with dry clothing. Wrap the entire body (including the head and neck) in layers of blankets; and with a vapor barrier (e.g. tarp, garbage bag) Do not cover the face.
• If medical help is more than 30 minutes away:
  • Give warm sweetened drinks if alert (no alcohol), to help increase the body temperature. Never try to give a drink to an unconscious person.
  • Place warm bottles or hot packs in armpits, sides of chest, and groin. Call 911 for additional rewarming instructions.

Basic Life Support (when necessary)

Co-workers trained in cardiopulmonary resuscitation (CPR) may help a person suffering from hypothermia that has no pulse or is not breathing:

• Call 911 for emergency medical assistance immediately.
• Treat the worker as per instructions for hypothermia, but be very careful and do not try to give an unconscious person fluids.
• Check him/her for signs of breathing and for a pulse. Check for 60 seconds.
• If after 60 seconds the affected worker is not breathing and does not have a pulse, trained workers may start rescue breaths for 3 minutes.
• Recheck for breathing and pulse, check for 60 seconds.
• If the worker is still not breathing and has no pulse, continue rescue breathing.
• Only start chest compressions per the direction of the 911 operator or emergency medical services
• Reassess patient’s physical status periodically.

Chest compression are recommended only if the patient will not receive medical care within 3 hours.

Environmental cold can affect any worker exposed to cold air temperatures and puts workers at risk of cold stress. As wind speed increases, it causes the cold air temperature to feel even colder, increasing the risk of cold stress to exposed workers, especially those working outdoors, such as recreational workers, snow cleanup crews, construction workers, police officers and firefighters. Other workers who may be affected by exposure to environmental cold conditions include those in transit, baggage handlers, water transportation, landscaping services, and support activities for oil and gas operations.

Risk factors for cold stress include:

• Wetness/dampness, dressing improperly, and exhaustion
• Predisposing health conditions such as hypertension, hypothyroidism, and diabetes
• Poor physical conditioning

In addition to cold stress, there are other winter weather related hazards that workers may be exposed to when performing tasks such as driving in the snow, removing snow from rooftops, and working near downed or damaged power lines.

Winter Driving

Although employers cannot control roadway conditions, they can promote safe driving behavior by ensuring workers: recognize the hazards of winter weather driving, for example, driving on snow/ice covered roads; are properly trained for driving in winter weather conditions; and are licensed (as applicable) for the vehicles they operate.

Employers should set and enforce driver safety policies. Employers should also implement an effective maintenance program for all vehicles and mechanized equipment that workers are required to operate. Crashes can be avoided.

Employers should ensure properly trained workers' inspect the following vehicle systems to determine if they are working properly:

• Brakes: Brakes should provide even and balanced braking. Also check that brake fluid is at the proper level.
• Cooling System: Ensure a proper mixture of 50/50 antifreeze and water in the cooling system at the proper level.
• Electrical System: Check the ignition system and make sure that the battery is fully charged and that the connections are clean. Check that the alternator belt is in good condition with proper tension.
• Engine: Inspect all engine systems.
• Exhaust System: Check exhaust for leaks and that all clamps and hangers are snug.
• Tires: Check for proper tread depth and no signs of damage or uneven wear. Check for proper tire inflation.
• Oil: Check that oil is at proper level.
• Visibility Systems: Inspect all exterior lights, defrosters (windshield and rear window), and wipers. Install winter windshield wipers.

An emergency kit with the following items is recommended in vehicles:

• Cellphone or two-way radio
• Windshield ice scraper
• Snow brush
• Flashlight with extra batteries
• Shovel
• Tow chain
• Traction aids (bag of sand or cat litter)
• Emergency flares
• Jumper cables
• Snacks
• Water
• Road maps
• Blankets, change of clothes

Work Zone Traffic Safety

Workers being struck by vehicles or mobile equipment lead to many work zone fatalities or injuries annually. Drivers may skid, or lose control of their vehicles more easily when driving on snow and/or ice covered roads. It is therefore, important to properly set up work zones with the traffic controls identified by signs, cones, barrels, and barriers, to protect workers. Workers exposed to vehicular traffic should wear the appropriate high visibility vest at all times, so that they can be visible to motorists.

Stranded in a Vehicle

If you are stranded in a vehicle, stay in the vehicle. Call for emergency assistance if needed, response time may be slow in severe winter weather conditions. Notify your supervisor of your situation. Do not leave the vehicle to search for assistance unless help is visible within 100 yards. You may become disoriented and get lost in blowing and drifting snow. Display a trouble sign by hanging a brightly colored cloth on the vehicle’s radio antenna and raising the hood. Turn on the vehicle's engine for about 10 minutes each hour and run the heat to keep warm. Also, turn on the vehicle's dome light when the vehicle is running as an additional signal. Beware of carbon monoxide poisoning. Keep the exhaust pipe clear of snow, and open a downwind window slightly for ventilation.

Watch for signs of frostbite and hypothermia. Do minor exercises to maintain good blood circulation in your body. Clap hands and move arms and legs occasionally. Try not to stay in one position for too long. Stay awake, you will be less vulnerable to cold-related health problems. Use blankets, newspapers, maps, and even the removable car mats for added insulation. Avoid overexertion since cold weather puts an added strain on the heart. Unaccustomed exercise such as shoveling snow or pushing a vehicle can bring on a heart attack or make other medical conditions worse.

Shoveling Snow

Shoveling snow can be a strenuous activity, particularly because cold weather can be taxing on the body. There is a potential for exhaustion, dehydration, back injuries, or heart attacks. During snow removal in addition to following the tips for avoiding cold stress, such as taking frequent breaks in warm areas, there are other precautions workers can take to avoid injuries. Workers should warm-up before the activity, scoop small amounts of snow at a time and where possible, push the snow instead of lifting it. The use of proper lifting technique is necessary to avoid back and other injuries when shoveling snow: keep the back straight, lift with the legs and do not turn or twist the body.

Using Powered Equipment like Snow Blowers

It is important to make sure that powered equipment, such as snow blowers are properly grounded to protect workers from electric shocks or electrocutions. When performing maintenance or cleaning, make sure the equipment is properly guarded and is disconnected from power sources.

Snow blowers commonly cause lacerations or amputations when operators attempt to clear jams with the equipment turned on. Never attempt to clear a jam by hand. First, turn the snow blower off and wait for all moving parts to stop, and then use a long stick to clear wet snow or debris from the machine. Keep your hands and feet away from moving parts. Refuel a snow blower prior to starting the machine; do not add fuel when the equipment is running or when the engine is hot.

Clearing Snow from Roofs and Working at Heights

Employers must evaluate snow removal tasks for hazards and plan how to do the work safely. Workers should be aware of the potential for unexpected hazards due to the weather conditions, for example, layers of ice can form as the environmental temperature drops, making surfaces even more slippery. A surface that is weighed down by snow must be inspected by a competent person to determine if it is structurally safe for workers to access it, because it may be at risk of collapsing. Snow covered rooftops can hide hazards such as skylights that workers can fall through. Electrical hazards may also exist from overhead power lines or snow removal equipment.

Employers can protect workers from these hazardous work conditions, for example, by using snow removal methods that do not involve workers going on roofs, when and where possible. Employers should determine the right type of equipment (ladders, aerial lifts, etc.) and personal protective equipment (personal fall arrest systems, non-slip safety boots, etc.) for the job and ensure that workers are trained on how to properly use them.

Preventing Slips on Snow and Ice

To prevent slips, trips, and falls, employers should clear walking surfaces of snow and ice, and spread deicer, as quickly as possible after a winter storm. In addition, the following precautions will help reduce the likelihood of injuries:

• Wear proper footwear when walking on snow or ice is unavoidable, because it is especially treacherous. A pair of insulated and water resistant boots with good rubber treads is a must for walking during or after a winter storm. Keeping a pair of rubber over-shoes with good treads which fit over your street shoes is a good idea during the winter months.
• Take short steps and walk at a slower pace so you can react quickly to a change in traction, when walking on an icy or snow-covered walkway.

Repairing Downed or Damaged Power Lines

Repairing and/or replacing damaged power lines in severe winter weather conditions are especially hazardous. A major hazard is snow, because the moisture can reduce the insulation value of protective equipment, and could cause electrocution. In these conditions de-energized work is safer, but if energized work must be done, qualified workers and supervisors must first do a hazard analysis that includes evaluating the weather conditions and identifying how to safely do the job.

Other potential hazards include:

• Electrocution by contacting downed energized power lines, or contacting objects, such as broken tree limbs, in contact with downed energized power lines.
• Fires caused by an energized line or equipment failure.
• Being struck or crushed by falling tree limbs, collapsing poles, etc.

When working on downed or damaged power lines, electrical utility workers should use safe work practices, appropriate tools and equipment (including personal protective equipment (PPE)). Extra caution should be exercised when working in adverse weather conditions.

Working Near Downed or Damaged power lines

Assume all power lines are energized and stay clear of any downed or damaged power lines. Establish a safe distance from power lines and report any incidents to the responsible authority. Only properly-trained electrical utility workers can handle damaged power lines.

Removing Downed Trees

Clearing downed trees is a critical job during severe winter weather conditions. It is usually urgent to remove downed trees that block public roads and damage power lines. Emergency crews are often tasked with clearing downed trees.

Potential hazards include:

• Electrocution by contacting downed energized power lines or contacting broken tree limbs in contact with downed energized power lines.
• Falls from heights.
• Being injured by equipment such as chain saws and chippers.

Workers should wear PPE that protect them from the hazards of the tree removal tasks. Workers using chainsaws and chippers to clear downed trees should use: gloves, chaps, foot protection, eye protection, fall protection, hearing protection and head protection.

Only powered equipment designed for outdoor and wet conditions should be used. Use all equipment and tools (saws, chippers, etc.) properly and for the purpose that they are designed for. Ensure that equipment is always maintained in serviceable condition and inspected before use by a knowledgeable person that can identify any problems with the equipment. Do not use equipment that is not functioning properly. Equipment must have proper guarding (as applicable); safe guards must never be bypassed. All controls and safety features must function as designed by the manufacturer.

It is important for employers to know the wind chill temperature so that they can gauge workers’ exposure risk better and plan how to safely do the work. It is also important to monitor workers’ physical condition during tasks, especially new workers who may not be used to working in the cold, or workers returning after spending some time away from work.

The National Oceanic and Atmospheric Administration (NOAA) Weather Radio is a nationwide network of radio stations broadcasting continuous weather information from the nearest NWS office. It will give information when wind chill conditions reach critical thresholds. A Wind Chill Warning is issued when wind chill temperatures are life threatening. A Wind Chill Advisory is issued when wind chill temperatures are potentially hazardous.

Although OSHA does not have a specific standard that covers working in cold environments, under the Occupational Safety and Health Act (OSH Act) of 1970, employers have a duty to protect workers from recognized hazards, including cold stress hazards, that are causing or likely to cause death or serious physical harm in the workplace.

• Employers should train workers. Training should include:
  • How to recognize the environmental and workplace conditions that can lead to cold stress.
  • The symptoms of cold stress, how to prevent cold stress, and what to do to help those who are affected.
  • How to select proper clothing for cold, wet, and windy conditions.
• Employers should:
  • Monitor workers physical condition.
  • Schedule frequent short breaks in warm dry areas, to allow the body to warm up.
  • Schedule work during the warmest part of the day.
  • Use the buddy system (work in pairs).
  • Provide warm, sweet beverages. Avoid drinks with alcohol.
  • Provide engineering controls such as radiant heaters.

Outdoor workers exposed to cold and windy conditions are at risk of cold stress, both air temperature and wind speed affect how cold they feel. Wind Chill is the term used to describe the rate of heat loss from the human body, resulting from the combined effect of low air temperature, and wind speed. The Wind Chill Temperature is a single value that takes both air temperature, and wind speed into account. For example, when the air temperature is 40°F, and the wind speed is 35mph, the wind chill temperature is 28°F; this measurement is the actual effect of the environmental cold on the exposed skin.

National Weather Service (NWS) Wind Chill Calculator: With this tool, one may input the air temperature and wind speed, and it will calculate the wind chill temperature.

The American Conference of Governmental Industrial Hygienists (ACGIH) developed the following Work/Warm-up Schedule for a 4-hour shift takes both air temperature and wind speed into account, to provide recommendations on scheduling work breaks and ceasing non-emergency work.

Work/Warm-up Schedule for a 4-Hour Shift

Schedule applies to any 4-hour work period with moderate to heavy work activity; with warm-up periods of ten (10) minutes in a warm location and with an extended break (e.g. lunch) at the end of the 4-hour work period in a warm location.

Adapted from ACGIH 2012 TLVs

Outdoor work requires proper preparation, especially in severe winter weather conditions. Although OSHA does not have a specific standard that covers working in cold environments, employers have a responsibility to provide workers with employment and a place of employment which are free from recognized hazards, including winter weather related hazards, which are causing or are likely to cause death or serious physical harm to them (Section 5(a)(1) of the Occupational Safety and Health Act of 1970). Employers should, therefore, train workers on the hazards of the job and safety measures to use, such as engineering controls and safe work practices, that will protect workers' safety and health.

Employers Should Train Workers

At a minimum train workers on:

• Cold Stress:
  • How to recognize the symptoms of cold stress, prevent cold stress injuries and illnesses
  • The importance of self-monitoring and monitoring coworkers for symptoms
  • First aid and how to call for additional medical assistance in an emergency
  • How to select proper clothing for cold, wet, and windy conditions
• Other winter weather related hazards that workers may be exposed to, for example, slippery roads and surfaces, windy conditions, and downed power lines
  • How to recognize these hazards
  • How workers will be protected: engineering controls, safe work practices and proper selection of equipment, including personal protective equipment

Employers Should Provide Engineering Controls

Engineering controls can be effective in reducing the risk of cold stress. For example, radiant heaters may be used to warm workplaces like outdoor security stations. If possible, employers should shield work areas from drafts or wind to reduce wind chill.

Employers should use engineering controls to protect workers from other winter weather related hazards, for example, aerial lifts or ladders can be used for safely applying de-icing materials to roofs, to protect workers from the hazard of falling through sky lights.

Employers Should Implement Safe Work Practices

Safe work practices that employers can implement to protect workers from injuries, illnesses and fatalities include:

• Providing workers with the proper tools and equipment to do their jobs
• Developing work plans that identify potential hazards and the safety measures that will be used to protect workers
• Scheduling maintenance and repair jobs for warmer months
• Scheduling jobs that expose workers to the cold weather in the warmer part of the day
• Avoiding exposure to extremely cold temperatures when possible
• Limiting the amount of time spent outdoors on extremely cold days
• Using relief workers to assign extra workers for long, demanding jobs
• Providing warm areas for use during break periods
• Providing warm liquids (no alcohol) to workers
• Monitoring workers who are at risk of cold stress
• Monitoring the weather conditions during a winter storm, having a reliable means of communicating with workers and being able to stop work or evacuate when necessary
• Acclimatizing new workers and those returning after time away from work by gradually increasing their workload, and allowing more frequent breaks in warm areas, as they build up a tolerance for working in the cold environment
• Having a means of communicating with workers, especially in remote areas
• Knowing how the community warns the public about severe weather: outdoor sirens, radio, and television

Employers Should Consider Protective Clothing that Provides Warmth

Employers must provide personal protective equipment (PPE), for example, fall protection, when required by OSHA standards to protect workers' safety, and health. However, in limited cases specified in the standard (29 CFR 1910.132), there are exceptions to the requirement for employers to provide PPE to workers. For instance, there is no OSHA requirement for employers to provide workers with ordinary clothing, skin creams, or other items, used solely for protection from weather, such as winter coats, jackets, gloves, parkas, rubber boots, hats, raincoats, ordinary sunglasses, and sunscreen (29 CFR 1910.132(h)(4)). Regardless of this, many employers provide their workers with winter weather gear such as winter coats/jackets and gloves.

Dressing Properly for the Cold

Dressing properly is extremely important to preventing cold stress. When cold environments or temperatures cannot be avoided, the following would help protect workers from cold stress:

• Wear at least three layers of loose fitting clothing. Layering provides better insulation.
  • An inner layer of wool, silk or synthetic (polypropylene) to keep moisture away from the body. Thermal wear, wool, silk or polypropylene, inner layers of clothing that will hold more body heat than cotton.
  • A middle layer of wool or synthetic to provide insulation even when wet.
  • An outer wind and rain protection layer that allows some ventilation to prevent overheating.
• Tight clothing reduces blood circulation. Warm blood needs to be circulated to the extremities. Insulated coat/jacket (water resistant if necessary)
• Knit mask to cover face and mouth (if needed)
• Hat that will cover your ears as well. A hat will help keep your whole body warmer. Hats reduce the amount of body heat that escapes from your head.
• Insulated gloves (water resistant if necessary), to protect the hands
• Insulated and waterproof boots to protect the feet

Safety Tips for Workers

• Your employer should ensure that you know the symptoms of cold stress
• Monitor your physical condition and that of your coworkers
• Dress appropriately for the cold
• Stay dry in the cold because moisture or dampness, e.g. from sweating, can increase the rate of heat loss from the body
• Keep extra clothing (including underwear) handy in case you get wet and need to change
• Drink warm sweetened fluids (no alcohol)
• Use proper engineering controls, safe work practices, and personal protective equipment (PPE) provided by your employer

Blizzard Warning: Issued for sustained or gusty winds of 35 mph or more, and falling or blowing snow creating visibilities at or below 1/4 mile; these conditions should persist for at least 3 hours.

Wind Chill Advisory: Issued when wind chill temperatures are expected to be a significant inconvenience to life with prolonged exposure, and, if caution is not exercised, could lead to hazardous exposure.

Wind Chill Warning: Issued when wind chill temperatures are expected to be hazardous to life within several minutes of exposure.

Winter Storm Warning: Issued when hazardous winter weather in the form of heavy snow, blizzard conditions, heavy freezing rain, or heavy sleet is imminent or occurring. Winter Storm Warnings are usually issued 12 to 24 hours before the event is expected to begin.

Winter Storm Watch: Alerts the public to the possibility of a blizzard, heavy snow, heavy freezing rain, or heavy sleet. Winter Storm watches are usually issued 12 to 48 hours before the beginning of a Winter Storm.

Winter Weather Advisories: Issued for accumulations of snow, freezing rain, freezing drizzle, and sleet which will cause significant inconveniences and, if caution is not exercised, could lead to life threatening situations.

From: National Oceanic and Atmospheric Administration (NOAA)

Anyone working in a cold environment may be at risk of cold stress. Some workers may be required to work outdoors in cold environments and for extended periods, for example, snow cleanup crews, sanitation workers, police officers and emergency response and recovery personnel, like firefighters, and emergency medical technicians. Cold stress can be encountered in these types of work environment. The following frequently asked questions will help workers understand what cold stress is, how it may affect their health and safety, and how it can be prevented.

How cold is too cold?

What constitutes extreme cold and its effects can vary across different areas of the country. In regions that are not used to winter weather, near freezing temperatures are considered "extreme cold." A cold environment forces the body to work harder to maintain its temperature. Whenever temperatures drop below normal and wind speed increases, heat can leave your body more rapidly.

Wind chill is the temperature your body feels when air temperature and wind speed are combined. For example, when the air temperature is 40°F, and the wind speed is 35 mph, the effect on the exposed skin is as if the air temperature was 28°F.

Cold stress occurs by driving down the skin temperature and eventually the internal body temperature (core temperature). This may lead to serious health problems, and may cause tissue damage, and possibly death.

What are the risk factors that contribute to cold stress?

Some of the risk factors that contribute to cold stress are:

• Wetness/dampness, dressing improperly, and exhaustion
• Predisposing health conditions such as hypertension, hypothyroidism, and diabetes
• Poor physical conditioning

How does the body react to cold conditions?

In a cold environment, most of the body's energy is used to keep the internal core temperature warm. Over time, the body will begin to shift blood flow from the extremities (hands, feet, arms, and legs) and outer skin to the core (chest and abdomen). This shift allows the exposed skin and the extremities to cool rapidly and increases the risk of frostbite and hypothermia. Combine this scenario with exposure to a wet environment, and trench foot may also be a problem.

What are the most common cold induced illnesses/injuries?

• Hypothermia
• Frostbite
• Trench Foot

What is hypothermia?

Hypothermia occurs when body heat is lost faster than it can be replaced and the normal body temperature (98.6°F) drops to less than 95°F. Hypothermia is most likely at very cold temperatures, but it can occur even at cool temperatures (above 40°F), if a person becomes chilled from rain, sweat, or submersion in cold water.

What are the symptoms of hypothermia?

• Mild symptoms:
  • An exposed worker is alert.
  • He or she may begin to shiver and stomp the feet in order to generate heat.
• Moderate to Severe symptoms:
  • As the body temperature continues to fall, symptoms will worsen and shivering will stop.
  • The worker may lose coordination and fumble with items in the hand, become confused and disoriented
  • He or she may be unable to walk or stand, pupils become dilated, pulse and breathing become slowed, and loss of consciousness can occur. A person could die if help is not received immediately.

What can be done for a person suffering from hypothermia?

• Call 911 immediately in an emergency; otherwise seek medical assistance as soon as possible.
• Move the person to a warm, dry area.
• Remove wet clothes and replace with dry clothes, cover the body (including the head and neck) with layers of blankets; and with a vapor barrier (e.g. tarp, garbage bag). Do not cover the face.
• If medical help is more than 30 minutes away:
  • Give warm sweetened drinks if alert (no alcohol), to help increase the body temperature. Never try to give a drink to an unconscious person.
  • Place warm bottles or hot packs in armpits, sides of chest, and groin. Call 911 for additional rewarming instructions.
• If a person is not breathing or has no pulse:
  • Call 911 for emergency medical assistance immediately.
  • Treat the worker as per instructions for hypothermia, but be very careful and do not try to give an unconscious person fluids.
  • Check him/her for signs of breathing and for a pulse. Check for 60 seconds.
  • If after 60 seconds the affected worker is not breathing and does not have a pulse, trained workers may start rescue breaths for 3 minutes.
  • Recheck for breathing and pulse, check for 60 seconds.
  • If the worker is still not breathing and has no pulse, continue rescue breathing.
  • Only start chest compressions per the direction of the 911 operator or emergency medical services^*
  • Reassess patient’s physical status periodically.

^*Chest compression are recommended only if the patient will not receive medical care within 3 hours.

What is frostbite?

Frostbite is an injury to the body that is caused by freezing of the skin and underlying tissues. The lower the temperature, the more quickly frostbite will occur. Frostbite typically affects the extremities, particularly the feet and hands. Amputation may be required in severe cases.

What are the symptoms of frostbite?

• Reddened skin develops gray/white patches.
• Numbness in the affected part.
• Feels firm or hard.
• Blisters may occur in the affected part, in severe cases.

What can be done for a person suffering from frostbite?

• Follow the recommendations described above for hypothermia.
• Do not rub the affected area to warm it because this action can cause more damage.
• Do not apply snow/water. Do not break blisters.
• Loosely cover and protect the area from contact.
• Do not try to rewarm the frostbitten area before getting medical help; for example, do not place in warm water. If a frostbitten area is rewarmed and gets frozen again, more tissue damage will occur. It is safer for the frostbitten area to be rewarmed by medical professionals.
• Give warm sweetened drinks, if the person is alert. Avoid drinks with alcohol.

What is immersion/trench foot?

Trench Foot or immersion foot is caused by prolonged exposure to wet and cold temperatures. It can occur at temperatures as high as 60°F if the feet are constantly wet. Non-freezing injury occurs because wet feet lose heat 25-times faster than dry feet. To prevent heat loss, the body constricts the blood vessels to shut down circulation in the feet. The skin tissue begins to die because of a lack of oxygen and nutrients and due to the buildup of toxic products.

What are the symptoms of trench foot?

• Redness of the skin, swelling, numbness, blisters

What can be done for a person suffering from immersion foot?

• Call 911 immediately in an emergency; otherwise seek medical assistance as soon as possible.
• Remove the shoes, or boots, and wet socks.
• Dry the feet.

How can cold stress be prevented?

Although OSHA does not have a specific standard that covers working in cold environments, employers have a responsibility to provide workers with employment and a place of employment which are free from recognized hazards, including cold stress, which are causing or are likely to cause death or serious physical harm to them (Section 5(a)(1) of the Occupational Safety and Health Act of 1970). Employers should, therefore, train workers on the hazards of the job and safety measures to use, such as engineering controls and safe work practices, that will protect workers’ safety and health.

Employers should train workers on how to prevent and recognize cold stress illnesses and injuries and how to apply first aid treatment. Workers should be trained on the appropriate engineering controls, personal protective equipment and work practices to reduce the risk of cold stress.

Employers should provide engineering controls. For example, radiant heaters may be used to warm workers in outdoor security stations. If possible, shield work areas from drafts or wind to reduce wind chill.

Employers should use safe work practices. For example, it is easy to become dehydrated in cold weather. Employers therefore, can provide plenty of warm sweetened liquids to workers. Avoid alcoholic drinks. If possible, employers can schedule heavy work during the warmer part of the day. Employers can assign workers to tasks in pairs (buddy system), so that they can monitor each other for signs of cold stress. Workers can be allowed to interrupt their work, if they are extremely uncomfortable. Employers should give workers frequent breaks in warm areas. Acclimatize new workers and those returning after time away from work, by gradually increasing their workload, and allowing more frequent breaks in warm areas, as they build up a tolerance for working in the cold environment. Safety measures, such as these, should be incorporated into the relevant health and safety plan for the workplace.

Dressing properly is extremely important to preventing cold stress. The type of fabric worn also makes a difference. Cotton loses its insulation value when it becomes wet. Wool, silk and most synthetics, on the other hand, retain their insulation even when wet. The following are recommendations for working in cold environments:

• Wear at least three layers of loose fitting clothing. Layering provides better insulation. Do not wear tight fitting clothing.
  • An inner layer of wool, silk or synthetic to keep moisture away from the body.
  • A middle layer of wool or synthetic to provide insulation even when wet.
  • An outer wind and rain protection layer that allows some ventilation to prevent overheating.
• Wear a hat or hood to help keep your whole body warmer. Hats reduce the amount of body heat that escapes from your head.
• Use a knit mask to cover the face and mouth (if needed).
• Use insulated gloves to protect the hands (water resistant if necessary).
• Wear insulated and waterproof boots (or other footwear).

Safety Tips for Workers

• Your employer should ensure that you know the symptoms of cold stress.
• Monitor your physical condition and that of your coworkers.
• Dress properly for the cold.
• Stay dry in the cold because moisture or dampness, e.g. from sweating, can increase the rate of heat loss from the body.
• Keep extra clothing (including underwear) handy in case you get wet and need to change.
• Drink warm sweetened fluids (no alcohol).
• Use proper engineering controls, safe work practices, and personal protective equipment (PPE) provided by your employer.