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Cold Stress

Categories: At-risk Populations, Construction, Outdoor Work

Heavy equipment shoveling heavy snowFor many, a sweater or an extra degree on the thermostat is all that’s needed to keep warm at work on a cold day. Not so for those working outside or in an area that is poorly insulated or without heat. These workers may be at risk of cold stress. What constitutes cold stress and its effects can vary across different areas of the country. In regions relatively unaccustomed to winter weather, near freezing temperatures are considered factors for cold stress. Whenever temperatures drop decidedly below normal and wind speed increases, heat can more rapidly leave the body. These weather-related conditions may lead to serious health problems.

Hypothermia, frostbite, trench foot, and chilblains are all illnesses and injuries caused by cold stress. Hypothermia occurs when the body’s temperature becomes abnormally low.

A body temperature that is too low affects the brain, making it difficult to think clearly or move well, and can eventually lead to death. Frostbite is an injury to the body caused by freezing tissues. It can cause permanent damage and in severe cases, lead to amputation. Trench foot is an injury of the feet resulting from prolonged exposure to wet and cold conditions. The wet feet lose heat faster and the circulation begins to shutdown, resulting in the skin tissue beginning to die. Chilblains are caused by the repeated exposure of skin to temperatures just above freezing to as high as 60°F. The cold exposure causes damage to the groups of small blood vessels in the skin. This damage is permanent and the redness and itching will return with additional exposure.

Preventing Cold Stress Illness and Injuries

There are many steps employers can take to protect workers from cold stress. Employers should try to schedule maintenance and repair jobs in cold areas for warmer months. When this is not possible, these jobs should be scheduled for the warmer part of the day. Employers should reduce the physical demands of workers by using relief workers or assigning extra workers for long, demanding jobs. Employers should provide warm break areas and warm liquids. Monitoring workers who are at risk of cold stress and providing training can also help prevent cold stress illness and injuries.

When cold environments cannot be avoided, workers should follow these recommendations to protect themselves from cold stress:

  • Wear appropriate clothing.
    • Wear several layers of loose clothing. Layering provides better insulation.
    • Tight clothing reduces blood circulation. Warm blood needs to be circulated to the extremities.
    • When choosing clothing, be aware that some clothing may restrict movement resulting in a hazardous situation.
  • Make sure to protect the ears, face, hands and feet in extremely cold weather.
    • Boots should be waterproof and insulated.
    • Wear a hat; it will keep your whole body warmer. (Hats reduce the amount of body heat that escapes from your head.)
  • Move into warm locations during work breaks; limit the amount of time outside on extremely cold days.
  • Carry cold weather gear, such as extra socks, gloves, hats, jacket, blankets, a change of clothes and a thermos of hot liquid.
  • Include a thermometer and chemical hot packs in your first aid kit.
  • Avoid touching cold metal surfaces with bare skin.
  • Monitor your physical condition and that of your coworkers.

For information on hypothermia, frostbite, trenchfoot, and chilblains, including symptoms and first aid, visit the NIOSH topic page on Cold Stress. The topic page also includes information on how to print or order the NIOSH Fast Facts card: Protecting Yourself from Cold Stress, a great portable resource for individuals and for employers to share with their employees.

Ms. Jacklitsch is a biologist and epidemiologist with NIOSH’s Document Development Branch.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. January 23, 2012 at 4:46 pm ET  -   Pau Dalmau

    Thanks for publishing this article, here in Spain in our current legislation, dating from 1997, already provides for action on the protection of workers in environments where they can suffer from heat stress, either by heat or cold. As the latter stated herein and described very well, all those measures and protections that a worker should be equipped in the development work carried out in an outdoor environment and subjected to a constant cold thermal stress along the workday. The publication of guidance on working conditions here in Spain is under the legislation RD 486/1997, which collects temperature and humidity environmental conditions and workplace.

    Thanks for the note on information from Spain I’m happy about the information they publish, as it is very interesting on a personal and professional world for the safety and occupational risks.

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  2. January 26, 2012 at 3:12 pm ET  -   Paul

    I thought this information would be common knowledge, but I guess there are some out there that will find this article very informative.

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    • January 31, 2012 at 2:45 pm ET  -   Brenda Jacklitsch

      What may be common knowledge for one person—say someone who grew up with cold weather conditions—may be new information for someone who has never before experienced snow, ice, or falling temperatures. There is also a lot of misinformation, so by spending a little time providing accurate information to all workers, injuries and illness may be prevented. And yes, in the case of hypothermia, workers can become confused and disoriented (please see the NIOSH Cold Stress topic page for a broader list of symptoms and also first aid). A worker suffering from hypothermia may not recognize the symptoms in themselves, therefore a vigilant supervisor or a buddy system is important.

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  3. January 26, 2012 at 5:10 pm ET  -   All-American Canner

    Does cold stress limit a workers ability to make rational decisions regarding their health?

    If that’s the case, a need for action by the employer might become present, but it seems to me that the information listed under prevention would be common sense and natural to anyone with self preservation instincts, aka everyone.

    Are there actually documented studies showing a need to train workers with this? That seems more like something their mother should have done…

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    • AUTHOR COMMENT January 31, 2012 at 3:22 pm ET  -   Brenda Jacklitsch

      Some occupational illness and injury, cold stress-related studies and articles:

      Anttonen, H., A. Pekkarinen, et al. (2009). “Safety at work in cold environments and prevention of cold stress.” Ind Health 47(3): 254-261.

      Chalupka, S. (2009). “Cold stress in the work environment.” AAOHN J 57(1): 40.

      Holmer, I., K. C. Parsons, et al. (2009). “Cold stress at work: preventive research.” Ind Health 47(3): 205-206.

      Holmer, I. (2009). “Evaluation of cold workplaces: an overview of standards for assessment of cold stress.” Ind Health 47(3): 228-234.

      Makinen, T. M., J. Jokelainen, et al. (2009). “Occurrence of frostbite in the general population–work-related and individual factors.” Scand J Work Environ Health 35(5): 384-393.

      Elliott, F. (2004). “You’d better watch out. Colder weather moves hypothermia and slip-and-fall prevention to the top of many work sites’ hazards list.” Occup Health Saf 73(11): 76, 78.

      Anttonen, H. and H. Virokannas (1994). “Assessment of cold stress in outdoor work.” Arctic Med Res 53(1): 40-48.

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  4. February 3, 2012 at 6:57 am ET  -   Noori

    Thanks Ms. Brenda Jacklitsch for your advices. Mr. Paul although this article is not so informative but there are always some points in usual article which a person don’t know before reading that article.

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  5. February 7, 2012 at 2:30 pm ET  -   Cherisse Cominiello

    Winter is NOT over here in Colorado. We just got about another 6 inches of snow here in Lakewood.

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  6. June 27, 2012 at 9:57 am ET  -   auto shop management software

    Interesting, I think the amount of sunlight during the day has a lot to do with it.

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  7. October 8, 2012 at 5:10 pm ET  -   John Overhemd

    Thanks Ms. Brenda Jacklitsch for your advices. As a lawyer wearing a shirt and suit I normally work from a comfortable office. Last winter it got so cold that my cufflinks had literally frozen to my skin after my car had broken down on the way home. I can confirm that touching cold metal surfaces with bare skin is not a good idea.

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  8. October 8, 2012 at 5:23 pm ET  -   Mike Manchetknoop

    The advice given in the article is useful but in the end also obvious. Here in Europe we say: “Don’t wear an ‘overhemd op maat’ [tailored shirt] to a polar expedition, which basically underlines the recommendations in the article.

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