Posts Tagged ‘hypothermia’

Prevent Cold Weather Illnesses This Winter

Wednesday, January 11th, 2017

Posted January 11, 2017

By Mackenzie Simmons AT, MSEd, ATC

Throughout winter, it is important to be aware of the signs and symptoms of cold weather illnesses, as well as the risk factors and preventative methods. While heat illness usually seems to be on the forefront of environmental issues, cold weather illnesses can cause the same catastrophic results. Athletic Trainers (ATs) and other healthcare professionals need to be knowledgeable in differentiating and diagnosing hypothermia, frostbite, chilblains and trench foot in athletes. A short summary of these cold weather illnesses are listed below.

Hypothermia (mild, moderate or severe) is caused by prolonged exposure to cold, wet or windy conditions, usually during endurance events or outdoor games.


- Core temperature 98.6F to 95F

- Cold extremities

- Shivering

- Pallor


- Core temperature 94F to 90F

- Slowed respiration and pulse

- Cessation of shivering

- Dilated pupils

- Impaired mental function and motor control


- Core temperature below 90F

- Rigidity

- Severely depressed respirations

- Bradycardia

- Usually has fallen into a coma

Frostbite (mild or superficial) occurs when there is an exposure to cold temperatures, often in conjunction with wind or touching cold surfaces


- Area is firm or cold to the touch

- Limited movement

- White or blue-gray colored patches in skin

- Tingling or burning sensation


- Area is hard or cold

- Burning, aching, throbbing or shooting pain

- White, gray, black or purple skin

- Tissue necrosis

Chilblain (or pernio) is caused when the body has prolonged exposure to cold, wet conditions.

- Red or cyanotic lesions

- Tissue necrosis

- Skin sloughing

- Swelling

Trench foot comes from prolonged exposure to cold, wet conditions; it usually occurs with the continued wearing of wet socks, wet shoes or both.

- Burning, tingling or itching

- Loss of sensation

- Cyanotic or blotchy skin

- Blisters or skin fissures

Sometimes, cold weather illnesses cannot be prevented in athletes, but there are risk factors that can predispose an athlete to getting hypothermia, frostbite, chilblain or trench foot. Listed below are a few of the risk factors for cold weather illnesses:

- Lean body composition

- Lower fitness level

- Females

- Older age

- Issues such as cardiac disease, Raynaud’s phenomenon and anorexia

- Previous cold injuries

- Low caloric intake

- Dehydration

- Fatigue

While most risk factors are genetic, there are a few that can be controlled. An AT can encourage athletes to stay properly hydrated and nourished before activity to ensure the body has enough nutrients to efficiently function. Also, make sure the athletes are at the necessary fitness level to perform the event in the cold weather. It is important to encourage the athletes to get a full night of rest leading up to the event so the body is not fatigued.

In addition to controlling the risk factors, the AT can also provide guidance on the proper clothing to wear to the event. When possible, the athlete should keep their hands, feet, toes and ears covered. Also, dressing in layers is essential to keeping warm—the first layer of clothes should allow sweat evaporation, the middle layer for insulation and then the outer layer being water and wind resistant. The AT should also monitor the wind chill before and during the event to make sure the weather is safe for activity.


Cappaert, Thomas A., et al. "National Athletic Trainers' Association position statement: environmental cold injuries." Journal of athletic training 43.6 (2008): 640-658.





The 119th Boston Marathon – Perspectives from Station 25 on the Course

Wednesday, April 29th, 2015

By Mike McKenney, MS, ATC, NASM-CES

Boston Marathon runners passing station 25.

In the weeks leading up to the Boston Marathon, medical volunteers attend conferences, read course manuals and prepare to treat numerous conditions that can occur during a marathon, especially those with life-threatening implications.  Typically, these conditions include cardiac events or environmental illness related to exercise in the heat such as exertional heat stroke.  However, as we marched toward Marathon Monday, the weather forecast began to change.

Station 25 at the 119th Boston Marathon.

Worries of unseasonably high temperatures following an abnormally long winter were quickly replaced with a high temperature of 47°F, 29 mph wind gusts and a 100% chance of precipitation.  This would not be classified as “ideal marathon weather.”  In fact, similar to unseasonably warm weather, it is highly unlikely participants were consistently training in cold conditions, which created an elevated level of concern among the medical staff.

As a medical staff volunteer, nothing quite prepares you for the sight of 30,000 individuals constantly streaming past you for up to 8 hours, all determined to overcome the conditions and complete the last 1.4 miles to the finish line.  As the day went on, runners who reached our location had been running through deteriorating conditions for over 4 hours.  Some had not been dry since they were in their hotel rooms that morning.  Many stood in the rain for up to 3 hours before their wave started.  For most of the afternoon, powerful wind gusts were going directly down Beacon Street into the faces of the runners.  At 1:50pm, we received notification that Medical Tent B, at the finish line, had to divert participants to other locations because they were already at capacity.  By late afternoon, the temperature started to drop again.

Medical supplies on-hand to treat runners needing medical attention.

Medical Station 25, on the corner of Beacon Street and Park Drive, was well organized by our team leaders and separated into sections with different roles and responsibilities.  Our location consisted of an emergency medical physician, myself (an Athletic Trainer), paramedics, 3 teams of EMTs to go out on course and retrieve injured participants, a sports psychology consultant, two HAM radio operators and representatives from the Massachusetts Department of Public Health and the American Red Cross.  With this setup, the care participants received was a true example of inter-professional collaboration.

Our focus quickly shifted to recognizing and treating hypothermia.  As runners stopped for one reason or another, they began to succumb to the deteriorating weather.  What may have started out as an exercise-associated muscle cramp, could quickly drift into a life-threatening medical condition.  As an Athletic Trainer, I felt prepared to treat everything from severe medical conditions, to a runner with hip pain who just wants to finish the race.  There were times where I ran down the course with athletes to give them a Mylar blanket for warmth because they were afraid to stop.  At one point or another, we all stood in the pouring rain handing out water or cheering on runners who were battling through the conditions.  Quick assessment, management and collaboration among all the volunteers at our station allowed us to effectively treat everyone we saw and complete the job we had set out to do.

Thanks to the advance planning by the medical directors for the Boston Athletic Association, we were well equipped to handle any situation.  It was a memorable experience, and I can’t wait for next year’s marathon!

The 119th Boston Marathon – Perspectives from the Finish Line Sweep Area

Tuesday, April 28th, 2015

By Beth Wolfe, CAGS, ATC

Diane Sartanowicz, District 1 NATA Treasurer, (left) and Beth Wolfe, CAGS, ATC (right) at the 119th Boston Marathon.

Rain Won’t Stop Us…

Just days after the events of the 117th Boston Marathon in 2013, President Obama said, “this time next year, on the third Monday in April, the world will return to this great American city to run harder than ever, and to cheer even louder, for the 118th Boston Marathon.  Bet on it” (Los Angeles Times, 2013).  On April 21, 2014, for the 118th time, Boston did just that.  We ran again.  Now, 2 years later, we continue to run.

On Patriots’ Day, April 20, 2015, approximately 30,000 runners ran in the 119th Boston Marathon.  Although the weather was cold, raw and rainy, the spirit and energy of the race was just as strong as ever.  Thousands of volunteers gathered from Hopkinton to Copley Square to cheer for the wet and cold runners, and 1,600 medical volunteers, from all realms of healthcare, provided care for those who were injured or ill.  At the beginning of the day, the medical volunteers knew hypothermia was going to be an issue for our runners, but BAA Medical Coordinator Chris Troyanos, ATC, and the Marathon Leadership Team were prepared.  Once again the Boston Marathon medical staff stepped up to the challenge and cared for the patients in front of them.

The finish line of the Boston Marathon is a relatively large area that stretches about 8-10 street blocks, which includes Boston Common.  Medical personnel and wheelchairs were placed throughout the entire finish line area in order to assist any runner within the secured sweep/finish area. These medical volunteers were charged with identifying runners who were in need of medical attention and transport them to their assigned medical tent.  From the corner of Boylston and Berkeley streets, the day started off relatively slowly for both the runner flow and the rain.  However, by mid-afternoon the showers became steady, the wind began to swirl through the high rises and the runners began to file in by the thousands.  There were very few runners who were not shivering, and hypothermia quickly became a concern for both the runners and the medical volunteers.

From the beginning, Chris Troyanos made it clear all volunteers needed to take care of themselves in order to take care of others.  The Finish Line Sweep Team volunteers came prepared with layers of clothing, ponchos, food and water.  As the day progressed, Sweep Team volunteers rotated their shifts so they could go inside a medical tent or building to re-warm and dry off, as they were just as at risk for hypothermia as the runners.  Standing in the rain and wind for several hours is not the most pleasurable experience; however, the kind gestures, words of gratitude and thanks from the runners and their families overrode any uncomfortable moments.  Even during the worst gusts of wind and downpours of rain, the runners continued to tell the medical volunteers, “Thank you for being here.”  Countless times, we heard, “Thank you for volunteering.”  These simple words kept our Sweep Teams focused on doing their jobs, poised to treat the person in front of them and to not become frustrated or discouraged by the forces of Mother Nature.

As we look forward to the Boston Marathon in the years to come, let us remember and honor what this race and the city of Boston have given our country and our profession.

Dick Hoyt, who was the Grand Marshal of the 2015 Boston Marathon and who pushed his son in 32 Boston Marathons, stated that the bombing in 2013 “Doesn’t stop us” (Los Angeles Times, 2013).  President Obama added that Dick Hoyt’s statement is “What you’ve taught us, Boston … to push on. To persevere ... not grow weary … not get faint.  Even when it hurts.  Even when our heart aches.  We summon the strength that maybe we didn’t even know we had, and we carry on. We finish the race” (Los Angeles Times, 2013).

Let us embrace the story of Maickel Melamed, a man with muscular dystrophy, who completed this year’s Marathon in 20 hours while enduring the rain, wind and cold (WCVB, 2015).  It is for runners like Maickel who keep us motivated and passionate about our work as Boston Marathon volunteers.  The weather conditions this year were far from optimal, but as a community, nation and profession a little rain does not stop us and will not stop us.

To all of the Athletic Trainers and athletic training students, thank you for doing a phenomenal job and for all of your hard work and efforts.  See you all next year when we will run again. Rain or shine. #BostonStrong


Los Angeles Times. (2013). Transcript: Obama’s remarks at Boston Marathon memorial. April 18, 2013, retrieved from:

WCVB. (2015). Runner who finished the Boston Marathon 20 hours after start ‘did it for Boston’: Maickel Melamed born with muscular dystrophy. Retrieved from:

Dehydration Precautions in Winter Weather

Friday, November 15th, 2013

Frostbite and hypothermia are not the only health hazards associated with frigidly cold temperatures. People lose a great deal of water from the body in the winter due to respiratory fluid loss through breathing. The body is also working harder under the weight of extra clothing and sweat evaporates quickly in cold, dry air.

Dehydration can occur when athletes don’t take in enough water to compensate for the water lost during routine processes or exercise. Awareness, recognition and education are the ways to help prevent dehydration during cold weather training. The goal is to replace 100% of sweat and electrolytes lost during exercise outdoors. Read more about dehydration and performance and cold weather nutrition and hydration from Jeffrey A. Kline, ATC, NASM-PES.

During warmer weather we are very aware of water loss because of the sweating mechanism our body uses to keep cool, but it is harder to recognize when there is cold weather. Shifting temperatures and not having enough water can cause cramping and increases injuries.

Drinking water or sports drinks before, during and after sports is especially important for children and pre-teens because they have special fluid needs compared to adults, or even teenagers. A good way to monitor proper hydration is to examine urine output - the color should be nearly clear.

As a parent or coach, make sure you take precautions to prevent heat illnesses in children and that they follow recommended sports hydration guidelines. Review the Youth Sports Hydration Guidelines reviewed by Susan Yeargin, PhD, ATC, on

Written By:
Brittney Ryba

12 Safety Tips for the Winter Season - Hypothermia

Monday, December 19th, 2011

Spending time outdoors during the winter season is fun, but requires special precautions. Prevention is a major task for the BOC Certified Athletic Trainer. Here are some things to consider ahead of time when planning for outdoor activities in the cold this winter. Remember, the goal is to be active and avoid injury or illness!

Hypothermia occurs when the body experiences a decrease in core temperature. There are varying severities of hypothermia, the cooler the core body temperature the more severe the hypothermia. Prolonged exposure to cool, wet, windy environmental conditions increases the likelihood of hypothermia. Surprisingly, hypothermia can occur even in cool weather (up to 50º F). When spending time outdoors in colder weather, the body generates heat to maintain core body temperature in two ways: through exercise and by shivering, which is the primary mechanism the body uses to generate heat. Shivering intensity is determined by the severity and duration of cold exposure and generally occurs in the large muscles of the trunk first.

How do you recognize the onset of hypothermia? Look for signs of the "umbles":

  • Grumbling (personality change);
  • Mumbling (having a hard time articulating words);
  • Stumbling (reduced coordination in the arms and legs); and
  • Fumbling (decreased dexterity).

To prevent hypothermia, people should:

  • Wear a hat.  The most significant loss of body heat is from the head and the body has no way to minimize heat loss in this region of the body.
  • Layer clothing.  Wear warm but breathable layers of clothing to stay warm
  • Pay attention to shivering.  Shivering is a good thing because it produces body heat, but if it reaches severe levels, stop exercising and head indoors.
  • Keep up the pace.  Keep your exercise intensity in the cold at moderate to high intensity to help maintain core body temperature. In order to maintain this intensity, take numerous breaks if needed
  • Bring extra clothing.  If you are exercising in a relatively remote area (such as on a long cross-country skiing excursion) bring an extra set of dry clothes with you.

Special considerations for children
Research has shown that, due to a higher surface area to mass ratio and smaller amounts of insulating adipose fat, children lose body heat more quickly than adults.  While the same precautions should be taken for children as for adults, children should take more frequent breaks from exposure to the cold.

Read the previous safety tips. Continue reading the BOC blog posts throughout the month of December to read the full 12 safety tips for the winter season.