Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.

Kimberly Brown, MD, MPH is an emergency medicine physician, speaker, and best-selling author.

Experts often recommend using ice to soothe the pain, inflammation, and swelling caused by an injury. However, if you leave an ice pack on your injury for too long, or if you place it directly on your skin, this can lead to an ice burn or frostbite.

Here's what to know about how ice packs can cause burns and how to use ice on injuries safely.

Water freezes at 32 degrees Fahrenheit, but the ice that comes out of the freezer is likely to be much colder than that. Putting ice or any kind of chemical cold pack—homemade or otherwise—directly on the skin can lead to frostbite in minutes.

Ice crystals form in the skin cells and blood flow slows, depriving the tissues of oxygen. As it progresses, the ice burn causes permanent damage to your skin and underlying tissues. In severe cases, it can lead to gangrene (tissue death) and amputation.

When you use an ice pack, pay attention to how your skin feels. The first stage of ice burn is known as frostnip. Frostnip causes your skin to get red or pale with a tingling and prickly sensation. It’s a sign that you should remove the ice pack and warm the area so you don't damage your skin.

It can be helpful to use the acronym CBAN. This stands for cold, burn, ache, and numb. These are four sensations you feel when your skin is exposed to ice for too long. First, you’ll notice the cold, and soon after a burning feeling. After a few minutes, you may notice that the area feels achy before the skin finally feels numb. As soon as you feel any numbness, remove the ice to avoid causing ice burn.

Make sure to watch the clock. The time between the initial cold sensation and numbness can be anywhere from 10 to 20 minutes, so don’t leave an ice pack on the injury for more than that. A good rule of thumb is 20 minutes on followed by 20 minutes off. Never fall asleep with an ice pack on your skin.

Don’t put ice or ice packs directly on the skin. A plastic bag isn’t enough to protect your skin from ice burn. You should always wrap the ice in a towel or other thin cloth. 

Don’t use ice on your skin if it already feels numb. When your skin is numb or tingly, you may not be able to tell when the ice is causing damage. Also, don’t use an ice pack on an area that’s already injured with a blister or burn. When the skin is already damaged, you are more likely to develop an ice burn. 

Certain medical conditions, such as vascular disease and diabetes, may make your tissues more likely to be damaged with ice burn. If you have questions about your risk for frostbite, speak to your healthcare provider about whether it’s safe for you to ice your injury.

If you have mild frostbite, you may notice skin redness. More severe frostbite can have a blue, white, gray, or waxy color along with swelling and blisters. Severe cases may cause the skin to eventually turn black.

Remove the ice pack. Soak the affected area in warm water, making sure the water is comfortable and not hot, for 30 minutes or less. Gently wash and dry the area and wrap in a sterile bandage. Do not rub your skin—it can cause further damage if you have frostbite. Seek medical care if you have signs of frostbite.

It varies based on the degree of injury. Mild ice burns may take a few days to heal. Deep, severe burns can take months and may require surgery to remove dead skin and tissue.

Millet JD, Brown RK, Levi B, et al. Frostbite: Spectrum of imaging findings and guidelines for management. Radiographics. 2016;36(7):2154-2169. doi:10.1148/rg.2016160045

American Academy of Pediatrics. Care of the young athlete patient education handouts: Use of ice and heat.

Laskowski-jones L, Jones LJ. Frostbite: Don't be left out in the cold. Nursing. 2018;48(2):26-33. doi:10.1097/01.NURSE.0000529802.75665.d7

By Rod Brouhard, EMT-P Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.

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