Cold

Cold weather can have adverse impacts on our health including hypothermia, the dangers of icy conditions, risks of carbon monoxide poisoning, and heightened exposure to winter viruses. The advice provided in the following sections should act as a guide to help you stay safe during the cold weather. Further advice is available on the HSE website. In addition, Met Éireann provide up-to-date forecast information and issue warnings for predicted cold snaps. The Government’s Be Winter Ready campaign provides advice on how to prepare for winter.

The negative health effects of cold weather start at temperatures of 4-8°C (39 - 46°F) or below. Colder temperatures can cause a range of health problems:

• Can affect your body’s ability to fight off viruses and other infections. The body is not as effective at fighting a virus when cold air enters the nose and upper airways, so viruses such as the common cold, the flu and COVID-19 often spread more easily in the winter.
• Can worsen underlying health conditions such as heart and lung disease.
• Can increase the risk of a heart attack, stroke, falls, injuries, and hypothermia.
• Also associated with an increased risk of mental health problems, such as depression and anxiety.

You’re at greater risk of illness in cold weather if you:

• are aged over 65
• are under the age of 5
• have a long-term health condition such as heart, lung or kidney disease
• have a disability
• are struggling to afford heating
• are homeless or sleeping on the streets

Get Vaccinated

It is especially important to get vaccinated for Flu, COVID-19, and Pneumococcus ahead of the winter months.

Flu vaccine

Getting the flu vaccine is the best way to protect you against flu.

You can get a free flu vaccine if you are:

• aged 65 years and older
• aged 2 to 17 years
• a healthcare worker
• pregnant
• living in a nursing home or other long-term care facility
• in regular contact with pigs, poultry, or waterfowl
• someone with a health condition that puts you at higher risk of flu
• living with someone who has a health condition that puts them at higher risk of flu
• a carer for someone who has a health condition that puts them at higher risk of flu

The best time to get your flu injection is in September or October. But if you missed it then, make sure to get it as soon as you can.

COVID-19 vaccine

You should also ensure that you are up to date with your COVID-19 vaccinations.

Pneumococcal vaccine

Pneumococcal vaccination is recommended for those over aged 65 and those with certain chronic health conditions. See the HSE website for further information on the benefits of vaccination against pneumococcal disease.

Safe Room Ventilation During Cold Weather

When it’s cold outside we tend to keep our windows closed more to keep the heat in. Ventilation, however, remains very important even during cold weather. With low temperatures we use more heating devices and some of these (especially older models) can create carbon monoxide, which can be extremely dangerous. It’s still possible to ventilate a room while heating it by following the advice below. Another reason it’s important to continue ventilation is to reduce the risk of transmission of viruses, including COVID-19 and flu.

By following these tips, you can keep yourself and your home as warm as possible while allowing for safe ventilation at the same time.

Staying Warm: Keep Yourself Warm

• It is best to avoid getting too cold in the first place.
• Wear several layers of light clothes instead of one thick layer.
• Wear clothes made of wool or fleecy synthetic fibres (cotton is only effective if the clothes stay dry). Thermal underwear can be very effective.
• In very cold weather put extra blankets or duvets on your bed.
• Put on a coat, hat, scarf, gloves and warm shoes or boots when you go outside.
• Eating a healthy, balanced diet will help keep you warm and healthy in the winter. Make sure you and your family eat at least one hot meal a day and have plenty of hot drinks throughout the day.
• Avoid too much alcohol or caffeine.
• Listen to or watch the weather forecast and don’t go out in extreme weather if possible.
• Keep active indoors. Moving around will help keep you warm.

Staying Warm: Keep Your Environment Warm

Research shows that cold homes have a negative impact on health and wellbeing:

• Keep the rooms you spend most of your time in warm. This is especially important for infants, the elderly or those with chronic health conditions.
• Ideally all rooms used during the day should be heated:
  • living room to around 18-21°C (65-70°F)
  • the rest of your house to at least 16°C (61°F).
• If you can’t heat all your rooms, make sure that you keep one room warm throughout the day.
• Close doors to separate heated areas from unheated areas of your home
• Use draught excluders to stop draughts around doors, windows, and skirting boards.
• Never block wall vents as they are essential for good air quality in your home.

Carbon Monoxide Poisoning

Carbon monoxide poisoning can be fatal, so if you have a natural gas or oil boiler, solid fuel fire, gas fire or standalone gas heater:

• Check all air vents around the home to make sure they are not blocked.
• Install carbon monoxide alarms - visit carbonmonoxide.ie for helpful information and advice.
• Remember alarms should also be fitted in caravans, boats, garages, and any other location where fuel is burned, or generators are in use.

See advice on how to safely ventilate your home during cold weather.

Preparing for Cold Weather

Power cuts

The risk of power cuts or blackouts increases in winter. You should prepare yourself for a potential power cut:

• Have batteries for torches and alternative light sources in the event of power cuts.
• Keep a torch beside your bed and in your living room. Check the batteries regularly.
• Keep mobile phones charged up - have local emergency numbers in your phone.
• If you depend on medical equipment at home, such as such as home dialysis machine, a ventilator or an oxygen concentrator, make sure to register as a vulnerable customer with your electricity supplier. More information on how to register as a vulnerable customer can be found here.

Personal Safety

• Stock up on a small supply of non-perishable, easy-to-prepare foods like a carton of long life UHT milk, a loaf of bread in the freezer, and some tinned and dried foods.
• Keep extra supplies of essential medication in case it is difficult to get to the doctor or pharmacy.
• Have enough fuel for heating and cooking. And, if possible, have another suitable option in case your main supply fails.
• Know how to turn off your water supply in the event of a big freeze or snowstorm (to avoid leaks when the thaw comes). If your water supply is disrupted due to severe weather, you will find health advice on drinking water here.
• Try to have a water container available that you can fill with drinking water if needed.
• Consider buying salt to put on the footpaths near your home. Salt helps to melt ice.
• Have a suitable snow shovel for clearing snow.
• Get your vehicle serviced before winter sets in to make sure it is ready for bad weather (which often comes when you least expect it). See the Road Safety Authority (RSA) website for advice on vehicle maintenance and safety.

See the Government's be winter ready campaign for further advice on how to prepare for a predicted cold snap.

Preventing Falls and Trips

While both young and old present to Emergency Departments as a result of falls on ice, as we get older a fall can result in broken bones, a loss of confidence, and loss of mobility and fear of leaving the home. Our advice is to:

• Stay indoors, if possible, when the weather is bad.
• If you need to go outside in icy conditions, be extra careful and follow these tips from the Road Safety Authority:
  • If a journey cannot be avoided walk on a footpath, not in the street. If there are no footpaths walk on the right-hand side of the road (towards oncoming traffic). Be extremely careful as frost, ice and snow will make walking on footpaths very dangerous.
  • Remember that footpaths may not be treated so walk with extreme care, make sure you are wearing appropriate footwear (footwear with good grips and no high heels) and in extreme conditions consider an appropriate walking stick or walking pole.
  • Avoid walking in the streets at all costs if possible. Remember, cars and trucks slip and slide, too! If it’s an emergency, and you can’t avoid the street, wear bright or reflective clothing.
  • Visibility is reduced in snowy condition so wear high visibility clothing or carry a torch
  • Wear clothing that does not restrict your vision. Stay warm, but DO NOT impair your vision with hoodies, ski masks, scarves, hats, etc. This type of clothing could prevent you from spotting icy conditions that may lead to a fall or not enable you to see a car that is spinning out of control.
  • Snow and ice cause havoc quickly, so use extra caution when crossing roadways, and always cross at pedestrian crossings.
  • Ice can easily hide under a light dusting of snow. Just because you don’t see the ice doesn’t mean it’s not there waiting for your unsuspecting footfalls.
  • If you can’t avoid the ice and snow, bend your knees slightly and take slower, shorter steps to help reduce the chance of a slip and fall and an injury.
  • If forced to use the steps at someone’s home, apartment, or other public building, walk slowly and take shorter steps when descending. The same is true of driveways and other hilly terrain; these areas can be very dangerous when they become slippery with ice or snow. Steps especially can be hard to clear and build up ice easily.
  • Be aware of overhead hazards! Falling icicles and chunks of snow pose a serious risk. In extreme cold weather icicles can build up in size very quickly and are potentially lethal. Their size and dagger-like formation are extremely dangerous for pedestrians. Be aware of what’s happening above you and stay clear from the edges of buildings.

(The above 10 points are taken directly from the RSA's tips on how to avoid slips and falls on ice).

Staying Safe on the Road

The golden rule is to drive, cycle or walk with extreme care and caution and expect the unexpected. 

The following advice will help reduce the risk of injury:

• Get your vehicle serviced before winter sets in to make sure it is ready for bad weather (which often comes when you least expect it). See the Road Safety Authority (RSA) website for advice on vehicle maintenance and safety.
• The RSA strongly recommends that motorists carry a number of essentials in the boot of their car all year round. These items should include:
  • High visibility vest
  • A working torch
  • A hazard warning triangle
  • De-icing equipment (for glass and door locks)
  • First aid kit
  • Blanket (to help keep you warm if your car breaks down in cold weather and you are waiting for help)
• No matter how short the car journey is, it is always a good idea to bring a warm coat and waterproof jacket with you in case of car breakdown.
• In severe weather conditions consider whether you really need to travel.
• Consider whether it’s possible to delay your trip until the weather and road conditions improve.
• If you absolutely need to travel, use public transport where available.
• If you really have to travel by car, check the weather forecast for the area you will be travelling in and make sure the route is passable before starting your journey.
• Be prepared for severe conditions and follow the advice from Road Safety Authority (RSA) on driving in severe weather.

Advice on Medications, Medical Appointments, and What to Do if Others Feel Unwell

Medications

• Keep extra supplies of essential medication in case it is difficult to get to the doctor or pharmacy.
• Store medicines at the recommended temperature (read the storage instructions on the packaging).
• Store medicines in their original containers or packaging and keep out of sight and reach of children.

Medical Appointments

• If travel services or roads are disrupted due to bad weather, you may need to change planned visits to hospital or other health centres for appointments. Even a planned operation may need to be changed.
• If severe disruption occurs, some health services may have to change their opening times.
• If you have a question about a planned appointment, phone the hospital or clinic that you are due to attend to check on any changes to services.

What to Do if You or Others Feel Unwell

As temperatures fall, emergency departments become busier and there are increased hospital admissions.

• Common illnesses like sore throats, colds, earaches and fevers in children can be managed at home without needing to go to a GP or Emergency Department for treatment. 
• See the HSE website for tips on how to treat common illnesses at home.
• If you are worried about your health during a cold snap and feel you need treatment, contact your GP for advice.
• If you feel very unwell or have any unusual symptoms, you should attend your local emergency department.
• Know your EIRCODE so that emergency services can easily find you in an emergency.

Cold weather brings health risks, and it is important that health and care professionals remain cognisant of these for those they care for. Promoting vaccination against common winter viruses, including COVID-19, flu, and pneumococcus is an important preparatory step that can be performed in advance of cold weather and the increased risks of viral transmission that follow. Other risks over the winter months include the dangers of icy conditions and associated risks of falls and injury, cold-related illnesses including hypothermia and frostbite, and an increased risk of carbon monoxide exposure and poisoning. Further advice is available on the HSE website. In addition, Met Éireann provide up-to-date forecast information and issue warnings for predicted cold snaps. The Government’s Be Winter Ready campaign provides advice on how to prepare for winter that can be shared with the population you care for in advance of cold weather events. Hospital managers should support staff through the winter months by providing access to training and enabling capacity development to allow for safe and effective care delivery.

Those particularly vulnerable to cold weather include those:

• Over the age of 65,
• Under the age of 5,
• With chronic health problems such as cardiac, respiratory, or kidney disease
• With a disability,
• Who have dementia or memory problems,
• Experiencing homelessness and financial difficulties.

 Keeping the Environment Warm

It is important to keep the environment warm to ensure that patients/clients do not suffer the adverse effects of low temperatures. Reduce draughts where possible and heat rooms to a comfortable temperature. The need, however, for reducing exposure to cold must be balanced with an ongoing requirement for good ventilation, given the increased risk or virus transmission. Re-iterate advice that people should take care when attending social gatherings and take visiting into consideration over the winter period. Consider adjusting individual patient care plans and/or increasing the frequency of monitoring of patient vital signs so that any exposure to cold can be identified early.

Safe Room Ventilation During Cold Weather

Effective ventilation remains important even when the temperatures are low. Fresh air circulation helps to reduce the risk of virus transmission. The guidance below details how to enable fresh air circulation whilst minimising exposure of patients/clients to low temperatures.

Hypothermia

Hypothermia is life-threatening and must be recognised immediately.

Hypothermia is defined as a core body temperature below 35°C. Signs of hypothermia include:

• Core body temperature < 35°C
• Cold skin in areas normally covered by clothing, for example, abdomen/axilla
• Shivering
• Drowsiness
• Slurred speech
• Slow breathing
• Confusion or disorientation
• Incoordination
• Thready pulse

Anyone with signs of hypothermia should undergo immediate medical review. Follow your facility protocol for the management of patients with hypothermia. Be aware that cardiac arrest can be more easily precipitated in hypothermic patients and therefore gentle handling of the patient is mandatory.

Advice for Patients with Specific Medical Conditions

Consider reaching out in advance to patients you care for in the community who may experience increased risks during cold weather. For example, those with chronic kidney disease, who are on dialysis therapy, may require changing of appointments if access routes are likely to be closed; ensure those with diabetes have access to insulin therapy and that they are aware that insulin may not work if it has frozen and thawed. Advise those with respiratory conditions, such as asthma, to ensure proper regular use of preventive inhalers and to keep relievers close to hand as cold weather may trigger asthma. Chest infections are also more common during the winter months. Those with cardiac disease should be reminded that strenuous activity, such as clearing snow, might place extra strain on their heart and that they should avoid this. Additionally, cold weather can increase the risk of clots and therefore of myocardial infarctions and cerebrovascular accidents/strokes. People with osteoporosis will need to take extra care in icy conditions as they will have a higher predisposition to fractures.

Safety Upon Patient Discharge

Discharge planning teams should take into consideration discharge destinations for patients to ensure that room temperatures will not expose a patient to hypothermia once they have left the hospital. A discussion with patients’ families may be appropriate to alert them to the potential for increased needs and risks during cold weather upon their discharge. For those with financial difficulties, who may find it difficult to heat their home, consider supports they may be entitled to in advance of discharge.

Also consider those who reside in supported accommodation and that attending carers are aware of the potential increased needs and risks during cold weather. Also check that the patient has up-to-date contact information for their primary care GP should they require medical advice from the community.

Air pollution leads to health problems every year in Ireland. Most of these problems are caused by the burning of solid fuels, such as coal or wood. Indoor air pollution can be a real problem during the colder months, when we are more likely to light a fire to keep our homes warm.

If you have no alternative and do need to light a fire, follow the Environmental Protection Agency advice and infographic on how best to burn fuel to reduce the amount of air pollution produced by your fire. Also make sure you exercise good fire safety. You can check your local air quality at airquality.ie. The HSE provides air quality health advice for during times of “poor” or “very poor” air quality.

In the longer term, improving the insulation of your home is a good way of reducing the need for additional heating (including the lighting of indoor fires). The Sustainable Energy Authority of Ireland provide useful energy saving advice, and grants are available to help with Home Energy Upgrades.

Safe Room Ventilation

When it’s cold outside we tend to keep our windows closed more to keep the heat in. Ventilation, however, remains very important even during cold weather. With low temperatures we use more heating devices and some of these (especially older models) can create carbon monoxide, which can be extremely dangerous. It’s still possible to ventilate a room while heating it by following the advice below. Another reason it’s important to continue ventilation is to reduce the risk of transmission of viruses, including COVID-19 and flu.

By following these tips, you can keep yourself and your home as warm as possible while allowing for safe ventilation at the same time.

Frostbite is damage to skin and tissue caused by exposure to any temperature below minus 0.55 degrees Celsius. It can affect any part of the body but is most likely to affect your child’s hands, feet, ears, nose, and lips. One or more of these areas might look pale, grey, and blistered. Your child might be complaining of pain, numbness, or tingling.

Hypothermia is a dangerous drop in your child’s temperature (usually below 35 degrees Celsius). It is a medical emergency that needs hospital treatment. If you think your child has hypothermia, go to your Emergency Department, or call 999 or 112.

A baby with hypothermia might be cold to touch, their skin may be red. They might seem floppy, or be quieter than usual, sleeping and refusing to feed. Older children may be shivering, have pale, cold and dry skin, their lips may be blue. They may be breathing slowing or seem tired or confused.

While you are waiting for help move your child indoors and remove any wet clothing. Wrap them in a blanket or a dry towel. Give older children a warm drink, and some sugary food like chocolate. Keep them awake, and make sure you stay with them. Offer your baby a breastfeed or a warm formula feed.

Frostbite and Hypothermia

Frostbite and hypothermia are cold-related illness that are both very dangerous medical emergencies and require immediate medical attention. If you think your child might have frostbite or hypothermia, get medical help immediately by calling 999 or 112, or going straight to your local emergency department. Follow the care steps below while you wait for medical help to arrive.

Frostbite

Frostbite is damage to skin and tissue caused by exposure to cold. It is most likely to affect your child’s hands, feet, ears, nose, and lips. One or more of these areas might look pale, grey, and blistered. Your child might be complaining of pain, numbness, or tingling.

If you think your child has frostbite, take them indoors to a warm area immediately and call your GP or your Out of Hours GP service for advice. If their symptoms are severe contact your Emergency Department.

Hypothermia

Hypothermia is a dangerous drop in your child’s temperature. It is a medical emergency that needs hospital treatment. If you think your child has hypothermia, go to your Emergency Department, or call 999 or 112.

A baby with hypothermia might be cold to touch, their skin may be red. They might seem floppy, or be quieter than usual, sleeping and refusing to feed.

Older children may be shivering, have pale, cold and dry skin, their lips may be blue. They may be breathing slowly or seem tired or confused.

While you are waiting for help:

• move your child indoors and remove any wet clothing,
• wrap them in a blanket or a dry towel,
• give older children a warm drink, and some sugary food like chocolate,
• keep them awake, and make sure you stay with them,
• offer your baby a breastfeed or a warm formula feed.

If you are in any doubt, contact your GP or out-of-hours service for advice.