Wilderness medicine is basically what we all do as part of a MRA team. In keeping with this thought, I want to bring information to you that is relevant to what we do either with technical ropes and providing medical care in colder temperatures.
Jørgen Melau published in his Substack under the title “Frozen Fingers, Fumbling Hands: The Physiology of Lost Dexterity in the Cold” excerpting from an upcoming book on performance physiology. For those not familiar with Jørgen, he is a PhD human thermophysiologist who works at the Cold Weather Operations Medical Research Office for the Norwegian Armed Services.
His article goes over what most of us know who have spent time in the cold. Our hands get cold and our ability to perform delicate maneuvers deteriorates. When skin temperature gets below 15 degrees C (59 degrees F), our ability to use our fingers and hands for precise movement decreases. Once skin temperature hits 10 degrees C (50 degrees F) our dexterity and sensation drop even more.
His research, highlighted in the article, shows that both sensation, strength and dexterity become victims of the cold at moderately chilly temperatures. Cold hands indicate a cooling core as the body shunts blood from extremities to core to stay warm. As rescuers, it is difficult to function if our hands are cold and simple tasks are slow or ineffective. Below are some take home points from Jørgen’s article that bear thinking about as we enter into the colder rescue season.
Excerpts from article:
When preparing for medical work in the field, plan for glove removal. Keep thin liner gloves on even when performing tactile tasks to protect against frostbite and maintain minimal insulation. Have spare liners in the IFAK or trauma kit, as they quickly become wet and contaminated.
Protecting the core temperature is one of the best ways to protect dexterity. A warm trunk maintains higher peripheral perfusion. When people’s hands fail in the cold, the problem is often their torso insulation, not only their gloves.
Through both experience and research, we have found that a three-layer glove system works best for most operations. A thin liner sits next to the skin to maintain a microclimate and allow limited dexterity even when outer gloves are removed. Over this, an insulating layer — often wool — traps warm air. The final shell should be windproof and waterproof, preferably with a breathable membrane such as Gore-Tex. Mittens outperform gloves for insulation because they reduce surface area and allow fingers to share warmth, but they sacrifice precision.
When working in cold environments:
Keep spare liner gloves in an accessible pocket or IFAK.
Dry or replace wet gloves during rest periods.
Avoid tight wrist closures that restrict circulation.
Rewarm hands against the body or using chemical heat packs between tasks.
These small habits often decide whether you can still function after several hours outdoors.
Once dexterity is lost, recovery depends on restoring both local temperature and circulation. Passive rewarming through glove replacement and core heating can be effective, but active hand rewarming — such as placing hands in the axillae or against the neck — is faster. Immersion in warm water (around 40 °C) restores function within minutes but is rarely available in the field.
After long cold exposure, the return of dexterity can lag behind the rise in temperature because of transient nerve conduction block and metabolic fatigue in the muscles. It is common to feel awkward and uncoordinated even after the fingers feel warm again. This has implications for post-mission recovery and readiness assessment.
Field note: Don’t rush the hands
After rewarming, give the hands time before demanding fine tasks. Apparent warmth does not equal full function. A few minutes of rest can prevent further mistakes.
Dexterity is the first casualty of the cold — and the last to recover. Protect it as you would any vital organ.
Jørgen Melau, Mixed Physiology SubStack, October 17, 2025
