University of Wisconsin–Madison
Division of Pharmacy Professional Development
UW–Madison School of Pharmacy

Arctic Front: Keeping patients warm and safe

An Arctic Front will make its way through the Great Lakes region and most of the Midwest this weekend. It is expected to last for a week to ten days. Here in Madison, WI temperatures are expected to dip as low as -22 F (-30 C). With 15 mph strong winds, the wind-chill factor may be as severe as -30 F (-34.44 C). In these precarious subzero conditions, frostbite can set in within 15 minutes.

Healthcare providers can help their patients prepare for and safely navigate the inclement winter weather. Here is a list of tips, resources, and considerations to stay safe during the upcoming arctic front.

Basic extreme weather tips An infographic about keeping patients safe and warm

Layer Up

Start with a base layer of thermal underwear, sock and glove liners. Wear a loose fitting second layer like thick woolen socks, sweatpants, and a turtleneck or sweater. The air between the layers helps air circulation. A t-shirt under the sweater can give an extra layer of warmth. The final layer should be a water-resistant winter jacket, mittens, and boots. It is essential to keep the clothes and feet absolutely dry. With extreme weather, it is important to cover as much skin as possible. Trapper hats help protect the ears. Scarves and balaclavas help protect the face.

Moisturize

The lack of moisture in winter air is notorious for causing dry skin. Arctic fronts and wind chills can make this worse. If not taken care of, dry skin may chap, crack and even bleed. Moisturizing several times a day is the best way to combat dry skin and lips. Keep lotion, chapsticks, and other moisturizing products at the workplace and in travel bags so you can moisturize as needed. If possible install a humidifier in your home to ensure optimum humidity levels. Some people may have underlying medical conditions that cause or intensify dry skin. Consult with your doctor or dermatologist to select the right product or get a prescription if necessary.

Be alcohol wise

Hot toddies and other hot alcoholic beverages are popular in winter. Many people will erroneously cite hot drinks or shots of liquor as the remedy to being cold. Alcohol causes the blood vessels to expand which causes rapid heat loss. So even though alcohol makes the body feel warm, it actually causes the body to lose heat. Alcohol also diminishes natural shivering responses and impairs a person’s ability to feel cold and dress appropriately. During strong wind chills and subzero temperatures, alcohol should be avoided or consumed in moderation.

Safety and precautions

If possible avoid going outdoors during a severe wind-chill advisory. Plan ahead to minimize how much time you spend in the cold. Always carry a charged cell phone and let people know your whereabouts. If driving, make sure your car is in good running condition. Tune in to local weather services and highway information to know about the latest winter conditions. Always have a shovel, extra wiper fluid, cat litter, and a winter kit with warm blankets and food in the trunk.

Assisting High-Risk Patients

Some patients have health conditions that are at higher risk during cold weather. Here is a listing of risk factors and tips to manage them.

Infants and the elderly

Infants and the elderly have weaker immune systems. They are usually not as hardy as healthy adults. They are very susceptible to frostbite and hypothermia.

Tips to manage

  • Remind elderly patients and parents with young children to avoid the outdoors if possible
  • Suggest that they set their thermostat to at least 70 degrees if possible. They may need higher temperatures to remain comfortably warm

Patients with heart disease or high blood pressure

Cold weather puts a strain on the heart. In winter the body and circulatory system work extra hard to keep the body warm. Any physical activity can cause additional strain and exertion.

Tips to manage

  • Ask your patients to be extra cautious during cold weather
  • Remind them to take plenty of breaks during strenuous activity like shoveling snow
  • Let them know to call their doctor immediately if they have any pain or uneasiness

Patients with diabetes or Raynaud’s syndrome

Diabetes impacts blood circulation and makes it difficult for people to keep warm, especially in their extremities. Raynaud’s syndrome is a circulation disorder that renders those afflicted susceptible to numbness, tingling, and frostbite in their extremities.

Tips to manage

  • With poor circulation, it becomes extremely important to constantly keep moving to improve circulation. Remind your patients to avoid sitting for a long period of time. Suggest that they set reminders to walk or do light stretches every hour to keep improve circulation.
  • Compression wear can help improve circulation. Request your patients to consult with their doctor if compression gear may be a good solution for them

Patients with Arthritis

Arthritic symptoms can be exacerbated during cold weather. Patients may suffer painful joints and swelling. In addition, stiffness causes difficulty performing everyday activities.

Tips to manage

  • Stretching and yoga can help increase flexibility and alleviate joint pain. A year-round routine of stretching or yoga can help prepare for winter. However, patients can alleviate some discomfort even with short term practice of these exercises.
  • Additional joint supplements and painkillers may help alleviate symptoms. Patients should consult with their doctor to see if supplemental medication is right for them

Patients with Dementia or Alzheimer’s

Dementia and Alzheimer’s disease can affect people’s memory. These patients are at risk of forgetting to wear the right clothing. They may also need extra precautions to prevent them from wandering off or getting lost during severe winter weather.

Tips to manage

  • Work with their caretaker team to ensure their comfort and safety
  • Make sure that the caretakers check in on them to ensure that the thermostat is at the right temperature and that they remember to bundle up to stay warm

Other patient considerations

Even though some patients are more at risk than others, all patients are at risk during cold fronts. Here are some other considerations to help your patients manage extreme cold.

  • Some prescription medications may impact circulation and temperature regulation. Some over the counter medication (OTC) could affect them as well. Make sure that patients are aware of any side effects that impact body heat. Advise them to check the side effects and risk factors of OTC medication. Have an action plan in place in case any of these effects manifest.
  • Many low-income patients may need additional help and resources to help stay warm during winter. Build trust and communication with your patients. Check in to see if they have heat and warm clothing. Make a list of local energy assistance groups and low-income resource groups to share with your patients in need. Wisconsin has an energy assistance program. Wisconsin residents can call 1-866-HEATWIS (432-8947) for help. 
  • In addition to energy assistance, some elderly and differently abled patients may need additional assistance. They may need help grocery shopping, clearing the snow or weatherproofing their homes. Check in with your patients to see if they have all the resources to stay safe throughout winter. Connect them with local groups that offer assistance. For snow removal assistance City of Madison residents can contact the Building Inspection Division at 608-266-4551 and speak to the Property Maintenance Inspector. The building inspection division helps pair residents in need of help clearing snow with agencies that offer assistance. 
  • Educate all patients about frostbite and hypothermia. Everyone is at risk of these two cold weather complications. Knowing the signs and what do can help prevent long term injuries and even prevent death.

Cold Weather Complications

Frostbite

Frostbite is the freezing of skin and tissue beneath. The skin is most vulnerable in windy weather and frostbite can occur through gloves and protective gear as well.

There are three stages of frostbite

  • Frostnip is the first stage. The skin may turn red and slightly numb. There will be tingling when the skin warms up. There is no risk of permanent damage in this stage and medical treatment may not be needed. However, if there is any fever, blistering, or swelling after a frostnip it is advisable to see a doctor.
  • The second stage is superficial frostbite. The skin starts to turn white or pale at this stage. Instead of numbness, there may be a slight pain. When the skin warms up from this stage it may burn or sting instead of tingling. Small blisters may appear after 12+ hours. It is advisable to see the doctor if there is suspicion of superficial frostbite.
  • Deep frostbite is the final stage. In this stage, the skin turns into a bluish gray color. The entire region may feel numb and devoid of any warmth or pain. Joints and muscles may feel stiff or stop moving. If not addressed immediately the tissue may turn black hard and die. Seek emergency medical help in case of deep frostbite.

It is better to catch frostbite sooner than later and warm the skin up slowly. For any stage of frostbite get indoors to a warm place immediately. Take pain medication if needed. In case of more severe stages avoid rubbing the skin to get warm.

Hypothermia

Hypothermia is caused when the body loses heat rapidly and reaches dangerously low temperatures. It usually occurs when body temperature falls below 95F. If not treated appropriately it can lead to permanent damage to organs, heart or respiratory failure, and even death.

Signs and symptoms of hypothermia include

  • Shivering
  • Slurred speech
  • Shallow breaths
  • Weak pulse
  • Disorientation
  • Clumsiness
  • Fainting

In case of suspected hypothermia call 911 immediately. Gently move the person to a warm dry place until help arrives. If their clothes are wet, undress them and cover in warm blankets.

With proper awareness and precaution, both frostbite and hypothermia can be prevented. The CDC publishes a complete extreme cold guide that includes prevention, indoor and outdoor best practices, preparation for storms, and other valuable resources: https://www.cdc.gov/disasters/winter/guide.html

We hope this blog post helps you keep your patients safe during severe cold spells and winter in general. The UW-Madison Division of Pharmacy Professional Development is committed to improving patient care and health outcomes. Our wide variety of online courses and in-person conferences help pharmacists and other healthcare professionals keep up with the latest in patient care and earn accredited CE. Find our complete list of courses here: https://ce.pharmacy.wisc.edu/icep-joint-accreditation-provider/

References

https://www.arthritiswa.org.au/content/page/winter-amp-arthritis.html
https://www.nia.nih.gov/health/cold-weather-safety-older-adults
https://www.getprepared.gc.ca/cnt/rsrcs/sfttps/tp201101-eng.aspx
https://www.parents.com/baby/safety/outdoor/winter-weather-safety-guide/
https://www.diabetes.co.uk/diabetes-and-cold-weather.html
https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571
https://www.mayoclinic.org/diseases-conditions/hypothermia/symptoms-causes/syc-20352682
https://www.mayoclinic.org/diseases-conditions/frostbite/symptoms-causes/syc-20372656
https://www.cdc.gov/disasters/winter/pdf/extreme-cold-guide.pdf