Individuals experiencing houselessness and
severe frostbite in Edmonton and Calgary: A
three-winter review
Domhnall O’Dochartaigh, Christopher Picard, Alex
Poole, Daniel Tiwana, Elaine Hyshka, Alexis Armour,
Alexis Mageau, Stacey Middleton, Lisa Allen, Sean Crooks,
Matthew Douma, Kathryn Dong, Brian Whiteside, Monty
Ghosh, Heather Briana Boucher, Jevon Brown, Lindsay
Burnett, Michael Zakhary, Jake Hayward, Yvonne Efegoma,
Kimberly Byrnes, Ted Harrigan, Lindsay Robinson, Yvonne
Efegoma, Lisa Watt, Scott MacLean
Background: Edmonton and Calgary are Albertan cities with
populations of more than one million each, and experience
cold winter temperatures, making frostbite a common emergency departments (ED) presentation. In 2024, the estimated
unhoused population was approximately 7,000 across both cities. Our primary objective was to assess the frequency and severity of frostbite injuries in individuals experiencing houselessness
(IEH) compared to those with housing.
Methods: This retrospective study of administrative data
assessed patients treated in Edmonton and Calgary with severe
frostbite over three winters. Data abstracted include patient
characteristics, frostbite grade, and time between injury and ED
presentation. Ambient temperatures at injury time were assessed
from the Alberta Climate Information Service. IEH was determined via clinician notes. Descriptive analysis and statistical
methods were used to compare housing status and the grade
of injury and arrival time to the ED. The relationship between
homelessness and time of injury to arrival at the hospital was
examined using ordinal logistic regression. The dependent variable, Time of Injury to Arrival, was categorized as: <12 hours,
12 to 24 hours, 24 to 48 hours, 48 to 72 hours, and >72 hours.
Results: Two hundred and fifty-seven cases of severe frostbite were abstracted. Mean age 42.5 (SD13.7). Sex male
208/257(80.9%). IEH comprised 140/257 (54.5%) of cases and
unknown in 40/257(15.6%). Houselessness was a precipitating
frostbite factor in 102/257(39.7%). IEH was not found to be a
statistically significant predictor of frostbite grade (p  =  .109);
OR = 1.55 (95% CI = 0.910 - 2.67). IEH experienced delays in
arrival to the ED (p < .001, OR = 2.90, 95% CI = 1.73 - 4.91).
IEH were nearly three times as likely to fall into a higher delay category of arrival time compared to non-IEH. Additionally,
among the IEH population in this study, 43.48% of Grade 4,
25.86% of Grade 3, and 34.48% of Grade 2 cases occurred at
temperatures warmer than -20 degrees Celsius.
Implication and lessons learned: Individuals experiencing houselessness had a threefold increase in the likelihood of
delayed frostbite ED presentation. Additionally, a significant
proportion of frostbite injuries occurred at temperatures warmer
than -20C. This study suggests a need for current cold weather
system responses to reexamine opportunities for prevention,
proactive care, and the availability of shelter for IEH at temperatures warmer than -20C, which is warmer than many cities cold
weather responses.