NATA Position Statement Review Part 2: Environmental Cold Injuries

As a certified athletic trainer or a student preparing for the BOC exam, you’ve likely heard of NATA position statements. These comprehensive documents are more than just clinical guidelines — they reflect the consensus of leading experts and contain best practices that inform daily decision-making in sports medicine.

But did you know these documents also appear frequently on the BOC exam?

Whether you’re studying for the exam or just striving to provide the best patient care possible, understanding these position statements is essential. In this post, we’ll focus on key highlights from one of the most critical: the National Athletic Trainers’ Association Position Statement on Environmental Cold Injuries.

What the Cold Injuries Position Statement Covers

• Prevention strategies for cold-related injuries and illnesses
• Physiological responses to cold and how they affect athletes
• On-site first aid and emergency care for cold-related conditions
• Special considerations for high-risk populations

Key Conditions Defined

Hypothermia

Hypothermia is defined as a core body temperature below 95°F (35°C). It’s categorized as:

• Mild: 95°F to 98.6°F (35–37°C)
• Moderate: 90°F to 94°F (32–34°C)
• Severe: Below 90°F (32°C)

Watch for symptoms like shivering, lethargy, poor coordination, and changes in mental status.

Frostbite & Frostnip

Frostbite is the actual freezing of tissues and progresses in severity:

• Frostnip: Superficial freezing with no permanent damage
• Mild Frostbite: Involves skin and subcutaneous tissues
• Severe Frostbite: Affects deeper tissues including muscle and bone

Chilblain (Pernio)

Caused by prolonged exposure (1–5 hours) to cold, wet conditions. It presents with red, itchy, swollen skin, usually on the hands, feet, or thighs. Tissue may not freeze but inflammation and hypoxemia are common.

Immersion Foot (Trench Foot)

Results from exposure to cold, wet environments for 12 hours to several days. Commonly seen in outdoor workers or athletes in wet footwear. It affects nerves and blood vessels and can lead to tissue breakdown.

Top Recommendations for Athletic Trainers

Prevention

• Conduct preparticipation exams to identify at-risk individuals
• Educate athletes and coaches about cold injury risks
• Use layered clothing systems that wick moisture, insulate, and repel wind/water
• Provide warm-up opportunities and hydration during cold-weather activity
• Monitor environmental conditions using wind-chill guidelines

Recognition and Immediate Care

Use a low-reading rectal thermometer to assess core temperature. Other temperature readings are unreliable in cold environments.

For mild hypothermia:

• Move the person to a warm environment
• Remove wet clothing and insulate with dry, warm layers
• Rewarm trunk first, not limbs (to avoid afterdrop)
• Provide warm fluids (non-alcoholic)

For moderate/severe hypothermia:

• Handle the athlete gently — sudden movement can trigger arrhythmia
• Begin CPR if needed, and activate emergency response
• Continue rewarming and monitor vital signs

For superficial frostbite:

• Rewarm with body heat or room temperature, protect tissue
• Do not massage or pop blisters

For deep frostbite:

• Use warm water immersion (98–104°F) for 15–30 minutes
• Administer pain medication as needed
• Avoid refreezing and weight-bearing if feet are involved

Supplies to Have on Hand

• Insulated water bottles with warm fluids
• Heat packs, blankets, extra dry clothing
• Low-reading rectal thermometer
• Communication devices
• Warm immersion tubs

The NATA’s position on cold injuries is both a clinical guide and an educational resource. As a certified athletic trainer or someone preparing for certification, you’re expected to know how to manage these risks proactively and respond appropriately in the moment.

Make sure to review this position statement thoroughly — not just to keep your athletes safe, but because it’s likely to appear on your BOC exam.

Stay ready. Stay informed. And stay warm.