Article Text

Download PDFPDF
Frostbite: a treatment guideline for prehospital treatment in a military environment
  1. B L Turner1,
  2. T T.C.F van Dongen2,3,
  3. R R Berendsen4,
  4. F J.M de Jong1,
  5. E L Endert1,
  6. R A van Hulst5 and
  7. R Hoencamp2,3,6,7
  1. 1Royal Netherlands Navy, Diving Medical Centre, Netherlands Ministry of Defence, Den Helder, Noord-Holland, Netherlands
  2. 2Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
  3. 3Defence Healthcare Organisation, Ministry of Defence, Utrecht, Netherlands
  4. 4Department of Anaesthesiology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
  5. 5Department of Anaesthesiology, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
  6. 6Department of Surgery, Alrijne Ziekenhuis, Leiderdorp, Netherlands
  7. 7Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
  1. Correspondence to Maj T T.C.F van Dongen, Defence Healthcare Organisation, Netherlands Ministry of Defence, Den Haag, Zuid-Holland, Netherlands; ttcfvandongen{at}


Frostbite remains a severe medical condition that causes long-lasting sequelae and can threaten military operations. Information on prehospital treatment of frostbite is scarce and existing guidelines are aimed at the general population.

This paper provides a guideline on prehospital emergency care of frostbite in the (Netherlands) Armed Forces. The insights gained from studies reporting on frostbite treatment in the prehospital setting were combined with the expert opinions of the authors and applied to the military context. The resulting guideline consists of two stages: (prolonged) field care and care at a Medical Treatment Facility. The cornerstones are rewarming in warm water and evacuation to a medical facility. Additional aspects of prehospital treatment are rehydration, proper analgesia, non-steroidal anti-inflammatory drugs and wound care.

We suggest further collaboration among North Atlantic Treaty Organization partners and other affiliated nations, focusing on the full spectrum of military injury management including state-of-the-art aftercare, long-lasting sequelae and return to duty after frostbite.


Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors BT: planning, conducting. TvD: planning, conducting and reporting/submission. RB: planning, conducting, reviewing. FdJ: planning, conducting, reviewing. EE: conducting, reviewing. RvH: conducting, reviewing. RH: planning, conducting, end review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.