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Telemedicine Facilitates expert opinion in austere locations or with prolonged evacuation times Hospital General Approach Follow standard ATLS/ ACLS guidelines as needed based on clinical picture Moderate or severe Hypothermia should be addressed first This approach may mean initially ignoring a frostbitten limb Clinical photography Photography should be performed at admission and throughout treatment Documents appearance, prevents need for repeated dressing removal Imaging Multiple imaging modalities can provide important prognostic information Technecium99 (99Tc) triple-phase bone scanning accurately predicts amputation risk at 48 hours in 84% of cases [20] MRA (magnetic resonance angiography) has been show to estimate level of tissue loss Potential advantage over 99Tc scan because it allows direct visualization of occluded vessels, clearer demarcation of ischemia [21] Fluoroscopic angioraphy shows vessel patency, should be considered in all patients in which thrombolysis is being considered The role of CT angiography is not yet known

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