By Bill Mitchell
With record cold temperatures closing schools and crippling transit around the country, one population remains especially exposed: people living outside.
Every night in Boston, a van from the Pine Street Inn searches for people at risk for frostbite and hypothermia on the city’s streets. Two nights a week, the van team includes Jim O’Connell, M.D., who helped found the Boston Health Care for the Homeless Program in 1985 and now serves as its president. In this edited Q&A, he addresses the medical risks that extreme cold presents to people living without shelter – and what passersby can do to help.
What have you learned about the impact of frigid temperatures on people who live on the street?
After four years of medical school and three years of residency, I was struck – in this job – by how little I knew about frostbite, hypothermia and related issues. I was uniquely unprepared to know how to handle the complexities of these medical problems.
Often people wake up to find that a finger or a toe has fallen off in bed.
When I started to learn about the concept of hypothermia, I discovered that Hannibal lost 50 percent of his Army crossing the Alps in 218 B.C. In the War of 1812, Napoleon lost 50,000 troops to hypothermia during their retreat from Moscow. And 10 percent of U.S. casualties during the Korean War were related to the cold. Interestingly, most of the literature about weather-related medical issues comes out of the military and from those crazy mountain climbers. Exposure to the elements is a fundamental part of wilderness literature, but not prominent in everyday medical literature.
What happens to the body during hypothermia?
Only about 33 to 40 percent of hypothermia cases are related to exposure to weather. Most cases involve an infection that causes the body to lower its temperature or a reaction to medication or use of drugs or alcohol.
The worst cases of weather-related hypothermia we see in our program are not during bitterly cold periods but in the shoulder season between fall and winter. The temperature might be in the 40s during the daytime and people on the street feel comfortable. But when the temperature plummets into the 20s at night, those who have fallen asleep outside can unwittingly experience extreme hypothermia, especially if they have been drinking alcohol or using drugs, or if their clothing is wet from rain or the ground.
On a warm day, your body cools down by opening blood flow to skin by sweating. The opposite happens in the cold. The body shuts down blood going to the surface of your skin in order to preserve warmth closer to the heart. This can leave the extremities, particularly the hands and feet, with insufficient blood flow to withstand the cold temperatures.
What is autoamputation?
Each year at our medical respite facility, the Barbara McInnis House, we care for between 10 and 15 people suffering from frostbite that threatens digits and limbs. Hands and feet and tips of noses can swell and develop blisters as if they’d been burned. Bloody blisters indicate deep tissue damage and more severe frostbite. Over the course of two to four weeks, the skin turns black and necrotic.
Because we don’t know how much viable tissue, if any, is below these blackened digits, surgery is not usually done and we are left to watch and wait for one to three months — with considerable horror to our patients and our staff — for the fingers and toes to autoamputate (a spontaneous detachment of an appendage from the body). Continue reading