9 ways to stay out of the emergency room this winter

Fractures, frostbite, and influenza: they're among the health problems that seem to surge every winter, the result of icy temperatures, seasonal activities, or exposure to infectious microbes. If the mercury has fallen where you live, you might be vulnerable to any number of winter hazards. So it's a good idea to consider strategies to stay out of harm's way and avoid a sudden trip to the emergency room.

1. Beware slippery terrain

Navigating slick sidewalks, driveways, or roads can cause you to fall and break a bone. "Whenever we have a deep freeze, we see a large number of people with bone injuries, usually of the wrists, ankles, or hips," says Dr. Scott Goldberg, medical director of Emergency Preparedness at Harvard-affiliated Brigham and Women's Hospital.

To avoid those falls: "Salt sidewalks and driveways before an ice storm. Salt is incredibly helpful in making surfaces safe, especially for people who are mobility impaired or use assistive walking devices," Dr. Goldberg says.

Also: wear shoes with anti-slip treads. Or wear rubber or spiked shoe covers that you pull on over the sole of your sneaker or boot.

2. Dress warmly

Cold weather exposure can cause three conditions. One is hypothermia (when the body loses heat faster than it can produce it), which can trigger a heart attack, kidney or liver damage, or worse. Another is frostnip, freezing of the outer layers of the skin. Frostnip is reversible if you warm up. If you don't, you might get frostbite-frozen skin, nerves, and blood vessels which later die. "Most frostbite cases we see are in folks who've been enjoying winter weather activities such as skiing or snowshoeing," Dr. Goldberg says. "But hypothermia can happen outdoors or even indoors if temperatures drop too low."

To stay warm outdoors, wear a coat and layers of athletic clothing that wicks away moisture. Include a hat, scarf, gloves, and heavy socks. Keep an extra stash of outdoor gear that you can wear indoors, too, in case your heating system goes out. You might also want to use disposable warming pads that you hold in your hand or attach to your shirt.

3. Fortify your home

Temperatures drop indoors if you have drafty windows and doors. And if the furnace goes out, temperatures can plummet, depending on how cold it is outside. This is why we hear each winter about people who've suffered weather-related injury at home.

Prepare now. If it's in the budget, order a furnace check-up to make sure the unit is working properly. And hunt for drafty windows and doors. Try some low-cost fixes such as insulation tape, weather stripping, or shrink-fit window film. Or hang a quilt over the door (inside your home) to block outdoor air.

4. Review space heater safety

Space heaters help when your furnace isn't warming your home effectively. But space heaters can cause burns and fires. "Make sure the heater is rated for indoor use. Read the instructions and learn how to use it properly," Dr. Goldberg says. "Keep it a safe distance from walls, curtains, bedding, and other flammable surfaces. Don't put it right up against a bed."

If electricity goes out and you can't use an electric space heater, don't turn to heaters powered by propane or kerosene; they're dangerous for indoor use and require venting to prevent carbon monoxide buildup. A fireplace or wood-burning stove is better, but it also generates carbon monoxide, so keep the flue clear, install carbon monoxide detectors in your home, and put out the fire overnight. Also: find out if your community opens shelters during winter power outages, and ask if transportation is provided for people who can't get there on their own.

5. Ward off respiratory illness

Respiratory infections such as flu, COVID-19, and respiratory syncytial virus (RSV) peak in the winter, typically because people stay indoors more and trade germs, and possibly because exposure to cold air makes the airways of your lungs vulnerable. Not only can these viruses make you quite sick, they can also increase the risk of heart attacks.

What you can do: Wear a scarf over your mouth and nose outdoors, and wear a mask in public indoor spaces. Also, stay up to date on vaccines: they reduce your risk of infection and risk of heart attack due to illness.

What if you get sick? "If you have a history of coronary artery disease, be cautious and rest. If you have any hints of chest pain that go away, reach out to your primary care doctor or cardiologist. If the pain persists, it's best to go to the ER," says Dr. Christopher Cannon, a cardiologist and editor in chief of the Harvard Heart Letter.

6. Limit alcohol use

Some individuals drink alcohol after being in cold weather. Alcohol makes you feel warmer by enhancing blood flow to the skin. But alcohol, particularly several glasses combined with a rich meal, can cause a potentially dangerous irregular heartbeat, atrial fibrillation. In winter, this is called "holiday heart syndrome."

If symptoms last for hours or are accompanied by shortness of breath and chest pain, go to the hospital. And decrease holiday heart syndrome risk by skipping alcohol or limiting it to one daily drink for women or two for men.

7. Ease into exercise

Is an ambitious new exercise program on your New Year's resolution list? Check with your doctor before starting it, especially if you have heart disease. Exertion increases the heart's demand for oxygen, even more so in cold weather. That also can lead to a heart attack.

The best approach: "If you've had a stress test in recent years and it was okay, then it should be safe to proceed. Just increase exercise duration and intensity slowly, over a period of weeks. That way, if you do develop chest pain or shortness of breath with exercise, you can stop and check in with your doctors," Dr. Cannon says.

8. Shovel snow with caution

Just like an intense new exercise program, suddenly shoveling wet, heavy snow can stress the heart and cause a heart attack. Cold weather adds to the risk by narrowing your blood vessels, which boosts blood pressure and might encourage blood clots to form.

If possible, ask for help removing snow. Turn to loved ones for assistance, or hire a snow removal service. Some cities, religious organizations, and volunteer groups provide snow removal to older or disabled adults. If those aren't options, approach the activity like a strenuous workout: warm up your muscles, stay hydrated, go slowly, and stop if you're dizzy or out of breath.

9. Build your emergency kit

Don't get snowed in without medicine, food, or drinking water (if the pipes freeze). Stock up now on nonperishable food and drinking water (one gallon per person per day). And don't forget medicine. "If a storm's coming, have a few days' worth of food and water and a two-week supply of medicine. Your doctor should be able to write an emergency prescription, and you can keep it as your back-up supply," Dr. Goldberg says.

As part of your kit, include a list of important phone numbers: your family, friends, neighbors, doctors, and local emergency management office.

If possible, offer your assistance to neighbors. Make the connection now. Checking in periodically could provide someone a lifeline to avoid dangerous health consequences.

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