Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update

Scott E McIntosh; Luanne Freer; Colin K Grissom; Paul S Auerbach; George W Rodway; Amalia Cochran; Gordon G Giesbrecht; Marion McDevitt; Christopher H Imray; Eric L Johnson; Prativa Pandey; Jennifer Dow; Peter H Hackett

doi:10.1016/j.wem.2019.05.002

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update

Wilderness Environ Med. 2019 Dec;30(4S):S19-S32. doi: 10.1016/j.wem.2019.05.002. Epub 2019 Jul 17.

Authors

Affiliations

¹ Division of Emergency Medicine, University of Utah, Salt Lake City, UT. Electronic address: scott.mcintosh@hsc.utah.edu.
² Everest Base Camp Medical Clinic, Nepal; Yellowstone National Park, WY.
³ Division of Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT.
⁴ Department of Emergency Medicine, Stanford University, School of Medicine, Palo Alto, CA.
⁵ College of Nursing and School of Medicine, UC Davis, Davis, CA.
⁶ Department of Surgery, The Ohio State University, Columbus, OH.
⁷ Faculty of Kinesiology and Recreation Management, Departments of Anesthesia and Emergency Medicine, University of Manitoba, Winnipeg, Canada.
⁸ Emergency Medicine, Peace Health Ketchikan Medical Center, Ketchikan, AK.
⁹ Warwick Medical School, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.
¹⁰ Wound & Hyperbaric Medicine, Bozeman Health, Bozeman, MT.
¹¹ CIWEC Hospital, Kathmandu, Nepal.
¹² Denali National Park and Preserve, AK.
¹³ Division of Emergency Medicine, Altitude Research Center, University of Colorado Denver School of Medicine, Denver, CO; Institute for Altitude Medicine, Telluride, CO.

PMID: 31326282
DOI: 10.1016/j.wem.2019.05.002

Abstract

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the guidelines published in 2014.

Keywords: aloe vera; hypothermia; iloprost; rewarming; tPA; thrombolysis.

Publication types

Practice Guideline

MeSH terms

Frostbite / prevention & control*
Frostbite / therapy
Humans
Practice Patterns, Physicians'*
Societies, Medical
Wilderness Medicine / standards*