As temperatures began dropping in February and the ice and snow arrived, Austin hospitals were planning for something that they don’t see often in Central Texas: frostbite.
They planned to triage and treat frostbite in their emergency rooms, as well as perform necessary surgery, up to five days after the event. They were not prepared for the actual volume of cases they saw or for how long cases continued to come in.
Ascension Seton Medical Center doctors saw about 50 people with frostbite, including more than a dozen people who had to be hospitalized. They amputated 11 feet; five people had both feet amputated.
Other people needed parts of feet or hands removed.
Seton would have seen more cases, but getting patients to the hospital during the storm was difficult because of the icy roads.
“It was such a burden in the city,” said Dr. Jayson Aydelotte, chief of trauma and burn surgery at Dell Seton Medical Center.
It was like nothing his doctors, who have worked in Minnesota and Michigan, had experienced. Aydelotte even called other doctors he knew in colder climates, such as Philadelphia, and asked if they had needed to amputate as many feet.
The answer was no.
“This was unique to Austin,” said Dr. Brian Kelley, a hand and reconstructive plastic surgeon at Seton, who did his residency at the University of Michigan.
Most of the people the doctors at Seton saw were 35 to 55 years old. While they did treat people who developed frostbite in and around their homes, most of the people suffering from the condition were homeless.
“A large number of homeless people here are not used to cold in any way and are not prepared,” Kelley said. The big difference from what he saw in Michigan was that the homeless population there was better supplied for the weather and more likely to be staying in shelters during winter weather rather than in tents, he said.
A month later, doctors are still seeing people come in with frostbite damage, especially to their feet, that hasn’t healed. It’s been especially true in people who already had poor circulation from heart issues or diabetes.
“I don’t think we have a good grasp of the whole problem,” said Dr. Pedro Teixeira, director of vascular surgery at Dell Seton Medical Center.
Frostbite happens when ice crystals form in skin tissue. The blood clots, causing the tissue to die. Symptoms include cold or numb skin at first, then redness or even blistering that resembles a burn. The skin doesn’t blanch when touched. In extreme cases, the skin turns black.
Frostbite is like a stroke in that the speed of treatment matters. Doctors warm up the skin with warm water and give anticoagulant medication to prevent blood clots.
Because travel was precarious during the storms, most patients arrived more than 24 hours after frostbite set in, too late for anticoagulant medication, said Kelley, the Seton surgeon. At that point, treatment became about which tissue would need to be removed.
Frostbite is more common and happens quicker the colder it gets, and wind chill causes heat in our bodies to quickly dissipate, speeding up the process.
The frostbite victims, especially the people who needed both feet removed, “now have a lifelong disability,” said Dr. Brent Egeland, who specializes in hand and reconstructive plastic surgery at Seton.
If people have a good support system, they might be able to get prosthetics and learn to walk again over time, but many will need a wheelchair for the rest of their lives, he said: “The rest of us are back to normal. … They have a lifelong need from one short period of time.”
Aydelotte, the Dell Seton Medical Center trauma chief, estimates that the five people who lost both feet probably will not be able to work and need a combined $1 million in medical care for the rest of their lives.
As a sunbelt city, Aydelotte said, “we weren’t really prepared.”