Cold injury in civil disaster.

Patients exposed to cold environment following a disaster may be suffering from local cold injury or from systemic cold injury (accidental hypothermia). The treatment of the former is well established and consists of rapid rewarming of the frozen parts and physical therapy; early amputation is not advisable. Recommendations for the assessment and treatment of total body cooling, based on case reports of accidental hypothermia, on the results of animal experiments and on the clinical experience with induced hypothermia, are not well established and are controversial. Since, at temperatures below 30 degrees C., death may be caused by cardiac arrhythmias and since, at this low level, spontaneous rewarming may not be possible, active rewarming is recommended at this stage. At a higher temperature level, vigorous warming is dangerous, and the patient's own regulatory mechanisms should be allowed to restore the temperature.