A crucial bit of preparation to do before heading off into the snowy wilderness is to make sure you are at least three-quarters fit for what you are planning to do. Unfit adventurers are more likely to have accidents, more likely to need rescuing, and more likely to have a miserable time. Exercising in unfamiliar media, with strange appliances strapped to you, leads to wrenches and strains, so pack some kind of joint support in case of injury, especially if you have injured a joint in the past. Sports supports are excellent if you have a recurring problem, but crepe bandages are most adaptable because they can be used to wrap around any joint, (they regain their stretchiness when washed).
It is easy to get seriously cold in snow. Make sure you are adequately equipped and informed about your journey. Ask about local conditions before venturing out and be prepared for the worst possible weather: ensure everyone has adequate footwear in particular – plus mittens. Carry two sets of clothes with the spares in a plastic bag so that you can get warm and dry once you reach a safe place. The next day, change back into the previous day’s sweaty, damp clothes. Rest for a day and dry out if you cannot face this. Mittens keep hands warmer than gloves. Even if it is sub-zero cold, sunburn is a hazard in bright conditions, and it is important to wear sunscreen and goggles. It is also possible, although this is more likely at altitude, to get sunburned inside the nose from sun reflected up off the snow if sunscreen is not applied there too.
Exposure is most likely when cold, wet, exhausted and hungry. As body temperature falls, you feel inappropriately comfortable. Content, you lose the drive to get somewhere safe. Sometimes the confusion of exposure makes people act in bizarre ways: they take off their clothes or sit in puddles. This is why it is so dangerous: people die of cold without ever realising they are in trouble. Heat is lost more rapidly after drinking alcohol.
Watch the people you are walking with and be forceful if you think they are getting into trouble. Stumbling is an early warning sign of both exposure and exhaustion. People with early exposure shiver, but this ceases as the temperature continues to fall. Exposure and altitude sickness both cloud judgement, so it is up to the unaffected to protect sufferers. The symptoms are dangerous in themselves, and also make people prone to accidents. Plan carefully, and be alert and cautious.
The treatment for exposure is slow, gentle re-warming. One technique is to put the victim in a sleeping bag with someone else. Making them too warm, too soon, can make things worse, so hot baths are not advisable (even if available), nor is drinking alcohol. Shivering is a good sign as it shows survival processes are returning to normal. Even so, it takes hours to re-warm someone thoroughly. Space blankets help but do not work well if the wearer is lying uninsulated on the ground. So on an insulated mat, shelter from the wind, change into dry clothes and take hot drinks if possible.
Adventurers get frost-bitten most often when they are poorly equipped or try something different on a whim, like venturing off-piste or attempting a high pass. Frostbite occurs when living tissue becomes frozen. In deep frostbite the toes (or other more intimate parts) look more like a piece of chicken straight from the deep freeze. It is more likely to occur if you are wet, walking at altitude, where there are chilling winds, at low temperatures (below -10°C), if your boots are constricting and also in smokers. Contact with metal (for example, earrings) makes the skin more susceptible to frostbite, as it conducts heat away from the body.
Cold injury starts as frost-nip, usually of the ears, nose, cheeks, fingers, toes or chin. It makes the part numb and blanched (white/very pale), but this is entirely reversible and, so far, no damage has been done. However, many people ignore these early warning signs and, even at this stage, it can be difficult to get extremities warm again. If you succeed in re-warming, the skin becomes red and tingly. If the part is not re-warmed, the extremities go on to suffer superficial frostbite, where the surface layer has actually frozen.The skin looks yellow-grey and is leathery to the touch, but the tissues underneath are still soft.
On re-warming the skin is mottled with red-purple patches and some blanched areas. If freezing continues the tissues go on to suffer the most serious end of the spectrum of cold injury, deep frostbite.
Climbers will know times when their feet and hands have been numb for hours. Unfortunately, deep frostbite feels no worse; it is not painful until re-warming begins. The painlessness of frostbite makes it dangerous, as it is easy to injure a frostbitten limb and feel nothing. This is why gangrene and infection often set in, with amputation often the final result. With deep frostbite the flesh is hard, white or very pale and obviously frozen. The response should be immediate evacuation and avoidance of exposure to cold conditions for at least several months.
The basic treatment is evacuation to a lower, safer, warmer place (walk on the still frozen foot if necessary). Do not thaw if there is any chance of it refreezing. Once in a safe haven, re-warm the affected part by immersion in a saucepan of warm (not hot) water (40°C) for periods of 20 minutes. Deeply frost-bitten skin will look mottled blue or grey. Do not knock or even rub the limb. Never immerse in hot water.
After being defrosted, the skin must be kept clean and the limb used as little as possible. The greatest danger to frost-bitten skin is infection, which can enter through any small breaks in the skin. A few hours after thawing, the limb swells, and over the next two days huge blisters will erupt. These should be left intact; they will be reabsorbed over the next week. The frost-bitten limb becomes horribly discoloured, even black and shrivelled if gangrenous. If the frostbite has been superficial, new pink skin will form under the black dead shell. If there was deep frostbite the toe or finger tip will eventually, painlessly but revoltingly, fall off.
If surgery is required, there are advantages in waiting at least a few weeks, and it is best done by a surgeon experienced in frostbite damage. Return to a hospital in the developed world if possible. A frost-bitten limb suffers permanent damage that makes it more likely to be frost-bitten again – once frost-bitten, twice frost-shy. All this can be avoided, though, by good preparation and planning.
Avalanche accidents have become a major cause of injury and death in snowy conditions – even in Scotland where wet snow and slab avalanches commonly occur. When going out in the hills in snow, it is important to know that it is dangerous to climb in gullies or on steep open slopes, especially convex ones, during or immediately after heavy snowfall. Most avalanche accidents happen within 24 hours of a heavy fall of snow; thereafter snow usually settles sufficiently to reduce the danger. If out in a heavy fall of snow, keep to safe buttresses or ridges.
Most people who are killed or injured by avalanches are off-piste downhill and cross-country skiers. Avalanches can occur in many kinds of terrain, including tree-covered slopes at angles as little as 15°. Skiers have been killed by avalanches less than 20m wide that flowed only 100m. Knowing about avalanches will protect you.
If caught in an avalanche, try swimming to stay near the surface. Keep your mouth closed and, as the slide slows, try to clear a space around your mouth and chest to give you room to breathe. After the avalanche has stopped moving, you will be trapped and will have to await rescue. When I asked mountain rescue experts for tips on increasing the chances of survival once buried, they all said “avoid the avalanche”.
And finally, before heading off into the snowy wilderness, get used to your equipment and realise that tight, ill-fitting boots predispose to frostbite. Take a map and compass and make sure you know how to use them. Take some emergency food and a small survival pack too, as well as that change of clothes. And be aware that there have been a few deaths from poisoning with carbon monoxide from butane stoves left burning in badly ventilated tents all night. Others have been burned alive.
