On-site Management of Frostbite in the Himalayas

Introduction: Frostbite is a common debilitating condition seen in travelers and residents at high altitudes. Emergent on-site management is warranted in the absence of institutionalized care and compromised evacuation facilities. This prospective, observational study assessed the outcome of on-site emergent management in low-resource, high altitude healthcare setups in the field, applicable in situations of delayed evacuation.Methods: This is a prospective cohort study. All frostbite patients presenting at ۴ Himalayan regions were included. Patients were diagnosed, assessed clinically, and evaluated for causation. On-site emergent management was given in situations of delayed evacuation, and responses were monitored. Further prevention was advised for all patients.Results: Frostbite presented in ۱۷۲ healthy, acclimatized patients having knowledge of frostbite. A total of ۱۵۸ (۹۱.۸۶%) males and ۱۴ (۸.۱۴%) females with a mean age of ۲۷.۸ ± ۷ years sustained frostbite at altitudes between ۹۰۰۰-۲۴۰۰۰ feet with a mean of ۱۴۵۷۵ ± ۳۸۴۸ feet. First-, second-, and third-degree frostbite comprised ۶۲.۲%, ۳۴.۳%, and ۳.۴۹% of cases, respectively. Fingertips were most frequently affected, followed by toe tips. Of the frostbite cases treated on-site, ۵۷.۹۴% were first-degree and ۳۴.۲۹% were second-degree.Conclusion: Frostbite can occur in people who are cold-experienced and knowledgeable. Therapeutic and preventive rewarming can be attempted in limited-resource setups outside the hospital. Frostbite up to second-degree can be treated under high altitude field conditions; however, this is advisable only in situations of delayed evacuation.

Keywords:

Frostbite , On-site management , Rewarming , Cold acclimatization , Himalayas