Resources: Extreme Cold


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.

Click here​ to view our Cold-Related Illness Surveillance Reports. 
Click here to view our 2017 Extreme Cold Emergency Plan.

Expand the sections below to learn more about how to stay safe during extreme cold. ​

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


How are hypothermia and frostbite treated?



  • Get the person indoors to a warm room or shelter.
  • Remove wet clothing and dry the 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 shock.
  • 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.


  • ​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.​

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.

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.

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.

Image source: CDC

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:

  • 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.

What can I do to prevent cold-related illness for my pets?


  • ​Bring your pets inside. 
  • 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.

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.