Which patients with frostbite require urgent referral to secondary care or specialist services?

Patients with frostbite require urgent referral to secondary care or specialist services if they have signs of limb-threatening or life-threatening complications. This includes patients with evidence of tissue necrosis (gangrene), deep tissue involvement, or suspected deep-seated soft tissue or bone infection. Urgent referral is also indicated if there are systemic signs such as fever or sepsis, or if there is clinical concern about limb ischaemia associated with the frostbite injury.

These criteria align with the approach used for limb-threatening conditions such as diabetic foot problems, where immediate referral to acute services and specialist multidisciplinary care is recommended to enable timely assessment and individualized treatment planning.