Winter Weather Safety
Sunday, January 29, 2012
By Karla Robinson, MD
As we go into the new year, winter weather is around the corner.  Therefore, it’s important to make sure you are aware of the top reasons for injury during the winter weather season.  Here we will review some of the health risks associated with the snow and ice and provide some tips on practicing winter weather safety.
Falls: Emergency room visits for broken bones, bumps, and bruises skyrocket in the winter months.  The culprit? Icy sidewalks and streets.  Ankle fractures, wrist fractures, and hip fractures are the most common serious injuries sustained from a fall on ice.  This can have some dire consequences particularly in the elderly.  It is estimated that the death rate in the elderly is as high 25%-35% for up to a year following a hip fracture.  In addition to a high incidence of fragile bones and osteoporosis, it is also important to remember that balance is often compromised in the elderly, so taking extreme care when walking outside during winter weather conditions is a must.
Tips: Use extreme caution when walking on icy ground and be sure to wear proper footwear with adequate traction.  Never allow the elderly to walk unassisted on ice or snow.
Heart Attacks: Believe it or not, there is an increased incidence of heart attacks during the winter months.  According to the second National Registry of Myocardial Infarction (NRMI-2), there are 53% more heart attacks in the winter months as compared to the summer months.  There are many factors contributing to the increased incidence including overexertion with snow shoveling and cold temperatures leading to blood vessel constriction, increased heart rate, increased blood pressure, and increased stress on the heart.  The American Journal of Emergency Medicine reported that the unusual demands on the heart during snow shoveling can significantly increase the heart rate into dangerous zones after only 2 minutes.
Tips: If there is a prior history of heart disease or heart attacks in the past, always get medical clearance prior to shoveling.  If you are not physically fit, and generally inactive, it is always best to start     slow, taking frequent breaks, and clearing small amounts of snow at a time.  If any signs of chest pain, shortness of breath, dizziness, sweating, neck/jaw/shoulder pain, or unusual fatigue are experienced during shoveling, always seek medical attention immediately.
Car Accidents: Icy road conditions can lead to increased accidents during winter weather.  Often times these collisions are at low speeds and are low impact, so typically minor injuries result.  However, sometimes these accidents can be the result of losing control at higher speeds and the injuries much more serious.  Even the most skilled driver can lose control in slick conditions.
Tips: Always keep a safe braking distance and drive at slower speeds.  Avoid overcorrecting and always turn the wheels in the direction you want to go when skidding.  Be sure to keep regular car maintenance up to date including (tire pressures, and adequate treads).  ALWAYS clear snow and ice debris completely from the car including roof, headlights/taillights, and windshield for optimal visibility.
Sporting Activities: Winter recreational sports like sledding, skiing, and ice skating are great ways to get some exercise in the winter months, but beware of the risks.  The risks of injury from sledding or skiing into obstacles such as trees, cars, posts, fences, and other people are high.  Helmets are actually recommended for amateur ice skaters as they experience a high rate of face and head injuries.  This is often because attempts to break falls with arms and hands are unsuccessful due to the icy surface.  The U.S. Consumer Product Safety Commission reports there were over 74,000 emergency room visits from sledding/snow tubing related injuries in 2004.  The bulk of the injuries were in kids 14 years old and under.  While keeping the kids busy during winter months, be sure you are practicing safety first.
Tips: Never sled in a parking lot or on steep hills where the possibility of sledding into the street exists.  Always ski or sled in wide open spaces where the danger of hitting trees, posts, and other obstacles is low.
Frostbite: Known as cold-induced damage to the skin and surrounding tissues, frostbite can be extremely dangerous.  Symptoms range from itching, pain, numbness/tingling in the initial stages, to blistering and gangrene in severe cases.  Particularly vulnerable are the ears, fingers, toes, and tip of the nose.  Prolonged exposure to temperatures at or below freezing (320F or 00C) without any protective gear can lead to frostbite.  People wearing wet clothing or those with diseases such as diabetes or poor circulation are at increased risk.
Tips: Always wear gloves, masks, hats, ear muffs and other protective clothing when out in cold temperatures.  If you experience symptoms of frostbite, rewarm the affected body part gently, by wrapping it in warm blankets and moving to a warmer environment, or by immersing the affected area in warm water.  NEVER rewarm a frostbitten area until you are sure to be in warmer temperatures for a prolonged period.  Refreezing a frostbitten area after warming it leads to more injury.
Icy ponds: The dangers of playing on or near iced ponds or lakes are numerous.  It is never a good idea to walk or skate across them because they are often unstable and the ice may not be the same thickness throughout.   Drowning and hypothermia (decreased body temperature) are the biggest risks with any freezing body of water.
Tips: Stay away from icy ponds and lakes.  They are never considered safe and there is always the danger of falling through the ice.
Winter Weather Safety-Urban Legends
1.       Only the elderly and those with fragile bones need to be concerned about falls in snow and ice.   This is untrue.  The elderly are certainly at high risk for more serious consequences from falls on snow and ice, but everyone needs to use caution when walking on icy surfaces.  Ankle, wrist, and hip fractures, head injuries, and back strains are common injuries from these types of falls and can affect anyone.  Be sure to wear proper footwear in the winter.  
2.       You can’t have a heart attack from shoveling snow.  This is not true.  In fact, the incidence of heart attack doubles during the winter season.  Many shoveling snow aren’t physically fit and don’t realize how strenuous clearing the snow really is.  If you have a history of heart disease, always be sure to get medical clearance before shoveling.  If you develop chest pain or shortness of breath while shoveling, seek medical attention immediately.
3.       Helmets are not necessary for sledding and ice skating.     Helmets are actually recommended for sledding, skiing, and ice skating due to the high risk of falls and possible head injury.  Attempt to break falls with arms and hands are often unsuccessful leading to a high rate of head injuries.  Always practice safety first and wear a helmet. 
4.       If I have symptoms of frostbite I should aggressively rub my hands together and warm them in hot water.   This is not true.  Rewarming of frostbitten areas should always be done gently to avoid further damage.  Always use WARM water to rewarm frostbitten areas and avoid cold and hot extremes.  This allows for proper restoration of blood flow to the tissues and minimizes damage.
5.       It is safe to ice skate on frozen ponds if the outside temperature is below freezing.   It is NEVER safe to play on or near frozen ponds or lakes.   It is estimated to take a thickness at least 4 inches of ice to support an average person’s weight.  Regardless of the outside temperature, these ponds are usually unstable and the ice is not the same thickness throughout.  Stay away from frozen ponds and lakes and avoid the risk of falling through the ice.
This was printed in the January 29, 2012 - February 11, 2012 Edition

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