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 4 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 172 healthy, acclimatized patients having knowledge of frostbite. A total of 158 (91.86%) males and 14 (8.14%) females with a mean age of 27.8 ± 7 years sustained frostbite at altitudes between 9000-24000 feet with a mean of 14575 ± 3848 feet. First-, second-, and third-degree frostbite comprised 62.2%, 34.3%, and 3.49% of cases, respectively. Fingertips were most frequently affected, followed by toe tips. Of the frostbite cases treated on-site, 57.94% were first-degree and 34.29% 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.