Maryland Department of Health
Office of Preparedness and Response

Resources: Extreme Cold

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Extreme cold weather can lead to serious health issues. Exposure to cold may lead to low body temperature, frostbite, hypothermia, and even death. Shoveling snow or exercising in the cold could lead to heart attacks and stroke.

The Maryland Department of Health monitors extreme cold conditions from November through March.

View our Cold-Related Illness Surveillance Reports
MDH Extreme Cold Emergency Plan: 2024-2025

​CLICK HERE TO FIND A WARMING CENTER LOCATION NEAR YOU​

What are hypothermia and frostbite?​

 
​Hypothermia: body temperature falls below 95ºF. Nearly 600 Americans die each year from hypothermia.

 Symptoms of hypothermia may include:

  • Uncontrollable shivering
  • Cold, pale skin
  • Numbness
  • Fatigue
  • Poor circulation
  • Disorientation
  • Slurred speech
  • Bluish or puffy skin

Frostbite: freezing and subsequent destruction of body tissue. This happens when skin temperatures get below 32ºF. The areas most likely to freeze are toes, fingers, ears, cheeks, and the tip of the nose.

Symptoms of frostbite include:

  • Gradual numbness
  • Hardness and paleness of the affected area during exposure
  • Pain and tingling or burning in affected area following warming
  • Possible change of skin color to purple

NEVER MASSAGE OR RUB FROSTBITTEN AREAS. THIS MAY CAUSE FURTHER DAMAGE TO THE SKIN​.

How are hypothermia and frostbite treated?

 

If you suspect someone is experiencing hypothermia:

  • Get the person indoors to a warm room or shelter.​
  • Remove wet clothing and dry t​he person off, if needed.
  • Warm the center of the body first (chest, neck, head, and groin) using an electric blanket, if available. You can also use skin-to-skin contact under loose, dry layers of blankets, clothing, towels, or sheets. Do not warm the hands and feet first. Warming extremities first can cause s​​hock.
  • Warm the person by wrapping him or her in blankets or putting dry clothing on the person.
  • Do not immerse the person in warm water. Rapid warming can cause heart arrhythmia.
  • Do not jostle, massage, or rub.​
  • If using hot water bottles or chemical hot packs, wrap them in cloth. Don't apply them directly to the skin.
  • If the person is not breathing normally, begin CPR and continue until the person begins breathing or emergency help arrives.
  • Give the person a warm drink if they are conscious. Avoid caffeine or alcohol.
  • Once the body temperature begins to rise, keep the person dry and wrapped in a warm blanket. Wrap the person's head and neck as well.
  • At the hospital, health care providers will continue warming efforts, including intravenous fluids and warm, moist oxygen.

If you suspect someone is experiencing frostbite:

  • ​Get into a warm room as soon as possible. 
  • Unless absolutely necessary, do not walk on frostbitten feet or toes. This increases the damage. Immerse the affected area in warm — not hot — water (the temperature should be comfortable to the touch for unaffected parts of the body). 
  • Or, warm the affected area using body heat. For example, the heat of an armpit can be used to warm frostbitten fingers. ​
  • Do not rub the frostbitten area with snow or massage it at all. This can cause more damage. 
  • Do not use a heating pad, heat lamp, or the heat of a stove, fireplace, or radiator for warming. Affected areas are numb and can be easily burned.​
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Who is at an increased risk for cold-related illness?

 
​People with an increased risk for hypothermia include:

  • Small children, especially babies. They have a lot of skin surface area compared to the size of their little bodies and tend to lose heat quicker than older children and adults.
  • People who suffer from illnesses, have impaired mental function, or take strong medications that can interfere with the body’s ability to regulate temperature. All of these factors can add up to significant risk increases among elderly persons.
  • Persons who are hungry or dehydrated.
  • Persons with inadequate or wet clothing, both of which lead to faster loss of body heat.
  • Persons who have been drinking alcohol, which speeds up heat loss through the skin and lowers awareness levels.

People with an increased risk for frostbite include: 

  • Those with impaired circulation
  • Elderly people
  • Young children and babies
  • Anyone who remains outside for prolonged periods. The danger increases if the individual becomes wet.
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How can I prevent cold-related illness?

 
Use the layered approach when going outdoors:

  • Base Layer: Wear fabrics that keep your skin dry.
  • Insulating Layer: Wear a vest or shirt made of fleece or wool. This may be added or removed depending on how cold you feel.
  • Windproof and Water-Resistant Outer Layer: Wear a jacket, preferably with a hood.
  • Briefs: Wear briefs made of synthetic fabric. Cotton or cotton-blend fabrics hold moisture and won't dry quickly.
  • Tights or Long Johns: A pair of tights or winter-weight pantyhose may be helpful when temperatures are below 30°F, especially when it is windy. Long john bottoms are best. Tights or pantyhose can also help prevent chafing and chapped skin on the thighs and calves. 
  • Hands: Keeping your hands warm is essential for cold weather comfort. Mittens are much better than gloves. If you keep your fingers together, they all help warm each other. 
  • Socks and Shoes: 
    • ​It​ is important to protect your feet from the elements when you are walking in cold weather.
    • Wear hiking socks under wool socks. You may prefer a non-itchy wool sock that is machine washable. Be careful that you don't buy a sock so padded and bulky that it crowds your toes in your shoes.
    • Wear light hiking boots or trail running shoes that are waterproof. Be sure the shoes have a flexible sole.  
  • ​Protect your eyes, lips, skin, neck, and face: 
    • ​Wear sunglasses, sunscreen, and lip balm. 
    • Sunscreen is especially important in winter, as the sun's radiation is more intense and less expected. 
    • Lip balm with sun protection will prevent chapped lips. Both can also help protect your skin from wind and cold.
    • Wear a hood that goes over your head and neck, protecting your ears and leaving only your face exposed. This can also be pulled up over your mouth or nose if necessary.​

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Is it safe to use a space heater?

 
Portable electric space heaters can be a convenient source of supplemental heat for your home in cold weather. Unfortunately, they can pose significant fire and electric shock hazards if not used properly. Fire and electrical hazards can be caused by space heaters without adequate safety features, space heaters placed near combustibles, or space heaters that are improperly plugged in.​​
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Here are some tips for keeping your home safe and warm when it’s cold outside:

  • ​Make sure your space heater has the label showing that it is listed by a recognized testing laboratory.
  • ​Before using any space heater, read the manufacturer’s instructions and warning labels carefully.
  • ​Inspect heaters for cracked or broken plugs or loose connections before each use. If frayed, worn or damaged, do not use the heater.​
  • Never leave a space heater unattended. Turn it off when you’re leaving a room or going to sleep, and don’t let pets or children play too close to a space heater.
  • Space heaters are only meant to provide supplemental heat and should never be used to warm bedding, cook food, dry clothing or thaw pipes.
  • Install smoke alarms on every floor of your home and outside all sleeping areas and test them once a month.
  • ​Proper placement of space heaters is critical. Heaters must be kept at least three feet away from anything that can burn, including papers, clothing and rugs.
  • Locate space heaters out of high traffic areas and doorways where they may pose a tripping hazard.
  • Plug space heaters directly into a wall outlet. Do not use an extension cord or power strip, which could overheat and result in a fire. Do not plug any other electrical devices into the same outlet as the heater.
  • ​Place space heaters on level, flat surfaces. Never place heaters on cabinets, tables, furniture, or carpet, which can overheat and start a fire.
  • ​​​Always unplug and safely store the heater when it is not in use​​.
Source: Electrical Safety Foundation International

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What is carbon monoxide?

 

​Carbon monoxide (CO) is a colorless, odorless gas that can cause sudden illness and death. It is produced whenever fuel is burned, such as gas, oil, kerosene, wood, or charcoal. If appliances that burn fuel are used properly, the amount of carbon monoxide produced is usually not hazardous. However, if appliances are not working properly, are used incorrectly, or are not well ventilated, dangerous levels of carbon monoxide can result.​​​


What are the symptoms of carbon monoxide poisoning?

 
​Moderate levels:

  • Severe headaches
  • Dizziness
  • Confusion​​
  • Nausea
  • Fainting
Low levels: 

  • Shortness of breath
  • Mild nausea
  • Mild headaches
  • May have long-term effects on your health. 
If you experience symptoms that you think could be from carbon monoxide poisoning:

  • GET FRESH AIR IMMEDIATELY. 
  • Open doors and windows, turn off combustion appliances and leave the house. 
  • GO TO AN EMERGENCY ROOM and tell the physician you suspect carbon monoxide poisoning.
  • If carbon monoxide poisoning has occurred, it can often be diagnosed by a blood test done soon after exposure.
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What can I do to prevent cold-related illness for my pets?

 

  • ​​​​Bring your pets insi​de. 
  • If you cannot bring your pet inside, make sure they have fresh, unfrozen water to drink and a shelter with adequate warmth.
  • ​Do not leave your animal in a car in cold weather.​
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What do winter weather warnings, watches, advisories, and alerts mean?

 

According to the National Weather Service​, winter weather-related Warnings, Watches, and Advisories are issued by your local National Weather Service office. Each office knows the local area and will issue Warnings, Watches, or Advisories based on local criteria. For example, the amount of snow that triggers a “Winter Storm Warning” in the Northern Plains is typically much higher than the amount needed to trigger a “Winter Storm Warning” in the Southeast.

A warning means you need to take action.

A watch means you should be prepared.

An advisory means you should be aware.

Here's a graphic that explains it in terms that all Marylanders can understand!

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A Code Blue Extreme Cold alert means temperatures, including wind chill, are expected to be extremely cold and pose particular danger for certain vulnerable populations. Though all area residents who are subject to a Code Blue Extreme Cold alert are encouraged to take precautions to ensure warmth, the alert triggers additional response effort and services, particularly for the homeless and seniors. 

For more information about winter weather warnings, watches, and advisories, visit https://www.weather.gov/safety/winter-ww.


What is wind chill?

 

​The wind chill index is the temperature your body feels when the air temperature is combined with the wind speed. 

Wind chill is based on the rate at which exposed skin loses heat, caused by the effects of wind and cold. As wind speed increases, body heat is lost more quickly. This causes skin temperature to drop.

High winds can lead to serious health problems, even when temperatures are only cool.


Is there anything special I need to do to prepare for a cold weather road trip?

 
Before you hit the road for a cold weather trip, be sure to pack a fully stocked emergency vehicle kit in case your car breaks down. Be sure to include:

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When will my road be plowed?

 

Depending on the amount of snow, roads can take time to be plowed. The Maryland Department of Transportation plows Interstates, roads with U.S. numbered routes, and roads with Maryland numbered routes only. Other roads (like neighborhoods) are plowed by your County's Department of Public Works. 

As a rule, roads are plowed in this order:

  • First priority: emergency roads
  • Second priority: main roads
  • Third priority: secondary roads and cul-de-sacs

According to one county, general snow plowing timelines to treat every county road once are:

  • 0-6 inches: about 8 hours
  • 6-12 inches: about 8-12 hours
  • 12-18 inches: 12-30 hours
  • 18-24 inches: 30 hours

The type of snow, temperature, and wind conditions could affect this schedule. Plows can also move more quickly if cars are not parked on the street. 

For specific information about snow removal where you live, reach out to your county's Department of Public Works.