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y The prevention of frostbite includes early recognition of problems, adequate protective clothing, recognizing the combination of wind and low temperature (see Table 202-1 Windchill Index), adequate fluids, work-rest regimens with heated rest areas, and use of controls such as wind- breaks and heaters. The initial treatment for frostbite includes bringing the individual to a warm location, removal y of clothing in the affected area, and placing the affected parts in warm (100-105°F) water. Do not massage or rub the frostbite area. After the initial treatment, wrap the affected area loosely in sterile gauze and seek medical attention. 202.2.2 Hypothermia Hypothermia results when the body loses heat faster than it can be produced. When this situation first occurs, blood vessels in the skin constrict in an attempt to conserve vital internal heat. Hands and feet are first affected. If the body continues to lose heat, involuntary shivers begin. This is the body's way of attempting to produce more heat, and it is usually the first real warning sign of hypothermia. Further heat loss produces speech difficulty, confusion, loss of manual dexterity, collapse, and finally death. Wet clothes or immersion in cold water greatly increases the hypothermia risk. The progressive clinical presentation of hypothermia may be seen in Table 202-2. Prevention of hypothermia includes planning for outside work in winter conditions, particularly work over water. Planning will include adequate layers of clothing, training employees in recognizing hypothermia in themselves and others, recognition of the combination of wind and temperature (see Windchill Index in Table 202-1), use of controls such as wind-breaks and �. heaters, a work-rest schedule, and adequate fluid intake. Fatal exposure to cold among workers has usually resulted from immersion in low temperature water. Water transmits body heat over 200 times faster than air. Wetsuits or drysuits are recommended for work over water;.with water temperatures below 45°F. Individuals who fall into cold water without wetsuits or drysuits may not be able to swim due to the rapid onset of hypothermia. Prompt treatment of hypothermia is essential. Once the body temperature drops below 95°F, the loss of temperature control occurs, and the body can no longer rewarm itself. Initial y Revised: 11/93 HS-202-2 Woodward-Clyde