Frostbite involves crystallization of fluids in the skin or subcutaneous tissue after exposure to subfreezing temperatures. With low skin temperature and dehydration, cutaneous blood vessels constrict and circulation is attenuated because the viscosity of blood increases. Frostbite may occur within seconds or hours of exposure, depending upon air temperature, wind speed, and body insulation. Frostbitten skin can appear white, yellow-white, or purple, and is hard, cold, and insensitive to touch. Rewarming results in intense pain, skin reddening, and swelling. Blister formation is common and loss of extremities fingers, toes, ears, hands, feet is possible. The degree of tissue damage depends on duration and severity of the freezing and effectiveness of treatment.
No data have been published regarding the incidence of frostbite among athletes during training or competition. Since winter running races are rarely postponed when environmental conditions are harsh, and frostbite is the most common cold injury in military settings, it is imperative that runners be aware of the dangers. Crosscountry ski races are postponed if the temperature at the coldest point of the course is less than -C -F, due to the severe windchill generated at race pace.
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Runners risk frozen flesh within minutes if the air temperature and wind speed combine to present a severe windchill. Because runners prefer to have unrestricted movement during races, and because they know that exercise results in body heating, they may not wear sufficient clothing. Runners can avoid frostbite and hypothermia in cold and windy conditions by protecting themselves by dressing adequately: wet skin or clothing will increase the risk of frostbite.
When tissue freezes [skin temperature], water is drawn out of the cells and ice crystals cause mechanical destruction of skin and subcutaneous tissue. However, initial ice crystal formation is not as damaging to tissues as partial rethawing and refreezing. Therefore, the decision to treat severe frostbite in the field versus transport to a hospital should consider the possibility of refreezing. If there is no likelihood of refreezing, the tissue should be rapidly rewarmed, in circulating warm water -.C, -F, insulated, and the patient transported to a medical facility. Research on animals suggests that topical aloe vera and systemic ibuprofen may reduce tissue damage and speed rehabilitation in humans. Other aspects of hospital treatment protocols are detailed elsewhere.
The following suggestions constitute the ideal race medical team. They are offered for consideration, but are not intended as absolute requirements. Staff and equipment needs are unique to each race and may be revised after – yr, in light of the distinctive features of each race. Depending on the weather conditions, of all entrants will typically enter a medical aid station.
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