Preventing Winter Injuries

By Leigh Vinocur, MD, FACEP, University of Maryland School of Medicine

Posted on | By Leigh Vinocur, MD, FACEP

Every year, severe winter weather brings with it potentially serious health risks and associated injuries. It's important to be aware of these and take precautions and preventive measures ahead of time. This will allow you to spend this season enjoying the outdoors instead watching it from inside of a hospital.

 

Slip-and-Fall Injuries

Slip-and-falls from icy conditions are commonly seen in the ER after winter storms. Wrist fractures and more serious hip fractures and head injuries from falls top the list during treacherous snow and ice storms.  It’s really best to stay inside until roads and sidewalks have been cleared. However, if you do have to venture out and walk on the snow and ice, follow these safety tips:

  • Take your time with slower and shorter steps.
  • Make sure you are wearing warm insulated footwear with good rubber tread for traction.
  • Be especially careful walking on the side of the road during and after a storm. The combination of sidewalks covered with plowed snow and poor visibility make you extremely vulnerable to getting hit by a vehicle.

Shoveling

 

Shoveling snow poses another serious risk this winter season. Soft tissue injuries of ligaments and muscles, especially in the lower back, are common from the heavy lifting, bending and twisting. Broken bones, most commonly in hands and arms, are also seen. Kids can get hurt by running past and getting hit in the head or horsing around in the area while adults are shoveling. If you have heart trouble, just walking in heavy snow or slush when it’s cold can put a significant strain on your heart, let alone shoveling it. People over 55 years of age are 4 times more likely than those younger to have a heart problem when shoveling snow. Studies found only 7% of the injuries seen shoveling were heart related, but for those with a heart condition, all deaths associated with shoveling were due to heart attacks.

Lessen your chances of getting hurt while shoveling snow:

  • Pace yourself and take frequent breaks.
  • Wear slip-resistant boots and dress accordingly.
  • Try pushing the snow as opposed to lifting it or twisting and throwing it over your shoulders.
  • It’s important to listen to your body and stop immediately if you get short of breath, start sweating profusely, or have chest pain.

For those who think using a snow blower poses no risk, serious hand injuries and finger amputations are seen in the ER every winter.

  • Never stick your hand into the shoot to unclog the snow!
  • Even after you turn it off, there is a period where the blades are still turning. The sharp blades are dangerous even when the machine is not running.

Driving


Driving is another potentially dangerous activity most of us have to do in the winter. Studies find that auto accident claims go up by 12% in the months of January and February. It goes without saying, if you don’t have to be out in a storm or before the roads are adequately cleared, try to stay home. Reduced traction with slippery conditions as well as reduced visibility from snow and flat light conditions all contribute to the many motor vehicle accidents we see in the ER. Another big component is driving too fast for the weather conditions, as well as not leaving enough braking distance between yourself and the car in front. Even all wheel drive vehicles can’t stop on a dime in icy conditions.

  • Take it slow and leave plenty of time to get to your destination when driving in hazardous weather conditions.
  • Avoid changing lanes quickly, cutting people off; they too need more time and distance to adequately brake and stop.
  • Check to ensure your car is in good shape this winter with properly functioning brakes, battery and adequate fluid levels.
  • Try not to go below a half tank of gas in the event of a slow, long commute during stormy weather, or if you get stuck and need to keep the car warm.
  • If you do get stuck and you run your engine, make sure the tailpipe is not blocked with snow – carbon monoxide can leak into the car.
  • It is important to have an emergency kit in your car if you get stranded. It should include a shovel and windshield scraper, warm blankets with an extra set of dry hat, gloves and outerwear, booster cables, sand or kitty litter, tow rope and flashlight, a battery-powered radio, some high-protein food, water, and a basic first aid kit.

Hypothermia


Hypothermia is another risk from being out too long or stuck in your car on the side of the road. That’s why your emergency kit is so important. If possible, it’s recommended to not leave your vehicle to look for help, especially in isolated areas. Staying in the car even without the engine running does provide some shelter from the elements. You can tie a colored scarf to the car to signal you need help.

The definition of hypothermia is a core temperature less than 95°F. Those at a greater risk for developing hypothermia are the elderly who have problems regulating their body temperatures, anyone on medications, such a beta blockers, sedatives and antipsychotic drugs or anyone drinking too much alcohol, infants and very young kids who lose body heat faster than adults and can’t tell you they are cold. People with medical conditions that also impair the body’s ability to regulate heat, such as Parkinson's, diabetes, stroke and hypothyroidism, are at risk too. Getting wet causes you to lose body heat faster through evaporation and conduction.

The symptoms of hypothermia are sometimes referred to as the “umbles" – stumbles, fumbles, mumbles and grumbles – which correspond to loss of coordination, slurred speech, and eventual loss of consciousness with cardiac arrest.

First aid for hypothermia:

  • Move the victim to a warm area and remove any wet clothing.
  • If they are awake and conscious, give them warm non-alcoholic beverages.
  • Start CPR if they have no pulse or are not breathing.
  • Do not apply direct heat to extremities, which causes a further drop in core temperature.

The acronym COLD can help you remember how to avoid hypothermia:

  • Cover - yourself and all exposed areas, including hands, face and neck
  • Overexertion - avoid activities that cause you to sweat which can make you damp and lose more heat
  • Layers - wear loose layers that trap air and insulate. Your outer layer should be tight-weave and water repellant
  • Dry - stay as dry as possible. Make sure that no snow can enter into your clothing and get you damp and wet

Frostbite

 

Frostbite can occur in an exposed area of your body within 5 minutes when the temperature is between 0° and -19° Fahrenheit. This is when your tissue literally freezes with ice crystals forming within the tissue around the cells. Initially the top layer freezes, the skin becomes whitish-gray; if treated early, good recovery is expected.

However if you continue to be exposed to the elements and the tissue freezes all the way through, it causes permanent damage to muscles, nerves and blood vessels. This is known as third-degree or deep frostbite. It behaves and is treated similar to a full thickness, third-degree burn. The skin is blotchy, bluish-black with blisters. Often, gangrene sets in and the area demarcates as well as auto-amputates, but if infection develops in the area that part has to be amputated also.

First aid treatment:

  • Getting the victim out of the cold.  
  • Remove any constricting wet clothing, especially around affected frostbitten area. 
  • Elevate that area to reduce swelling. 
  • Never rub or massage the area; it damages the tissue further. Never rub with ice or snow.  
  • Never re-warm an affected frostbitten area. If there is a chance of re-freezing, it is better to leave the part frozen, since more damage occurs to the tissue if it thaws and then freezes again.

Burns and Carbon Monoxide Poisoning

Lastly, during severe storms, we also paradoxically see burn injuries, and carbon monoxide poisonings. House fires commonly occur from inadequate space heaters or lit candles that overturn at night. Using a gasoline generator during a power outage from a storm that is placed too close to the vents of your house can cause carbon monoxide to leak into the house. Leaving your car running while you are stuck in the snow waiting for help is another carbon monoxide danger. Carbon monoxide can leak into the car if your tailpipe is obstructed.

Initially, the symptoms of carbon monoxide poisoning are non-specific, almost flu-like with a bad headache, dizziness and confusion, as well as shortness of breath. If these signs are not recognized, higher levels result in unconsciousness and death. Pregnant women, infants and small children as well as the elderly and those with chronic medical conditions are more at risk for carbon monoxide poisoning. 

Protect yourself and family members:

  • Do not use fuel-burning heaters in un-vented enclosed spaces.
  • Make sure your house has functioning carbon monoxide monitors with fresh batteries.
  • If a monitor goes off, do not consider it a false alarm. Open all windows to ventilate, and call a technician to check the heating system and ensure all is working properly.
  • Do not ignore anyone with symptoms; seek medical help in an ER immediately.
  • First aid for victims: remove them from the contaminated area to fresh air or give oxygen if available.
  • Start CPR if necessary and call 911.

Article written by Leigh Vinocur, MD, FACEP
Board-certified Emergency Physician, Adjunct Assistant Professor LSU Health-Shreveport