Edmonton sees record increase in frostbite amputations, despite innovative treatment

the likes of many Albertans at this clip of twelvemonth, joe louis Francescutti is thought about the weather.

But not because of its impact on him.

“The snow fell last night, so temperatures are well below zero,” said the Edmonton emergency physician.

“As we speak, there are probably men and women out there developing frostbite right now. And so my colleagues probably later today or tomorrow will start treating this year’s round of frostbites.”

Some of those frostbite injuries will eventually lead to amputations — particularly if the person lacks housing and gets frostbite again on the same tissue, he said.

“About two to three weeks ago, I saw two patients that had infected amputation sites from last year’s frostbite,” said Francescutti.

“In other words, we are still dealing with frostbite from a year ago. And now these men and women are still homeless and chances are they’re going to reinjure themselves again.”

Edmonton had 113 amputations performed with a diagnosis of frostbite last winter — more than five times the number recorded in fiscal 2019.

More than half of those procedures were performed on patients recorded as experiencing homelessness.

“That’s a pretty devastating figure when you think about what a tiny percentage of the population that we’re talking about here,” said Quinn Strikwerda, a co-chair of the Edmonton Coalition on Housing and Homelessness.

Those numbers contrast with Calgary, which recorded one fewer frostbite amputation than the previous winter, marking three straight years of decreases.

However, more than three quarters of Calgary’s amputations were performed on patients recorded as experiencing homelessness — a sharp increase from the previous year.

Since 2021, a total of 188 frostbite amputations have been performed on patients experiencing homelessness in Edmonton. In Calgary during that time period, the total was 111.

Overall frostbite cases also increased in both cities.

The number of diagnoses of frostbite or excessive cold in Edmonton’s emergency departments last winter jumped to 1,307 from 896 — the largest increase since at least 2011, as well as by far the most of any single year in that time period. 

More than half of those patients last winter were recorded as unhoused.

In Calgary, frostbite diagnoses increased to 685 from 630.

Scott MacLean, an emergency physician at the Royal Alexandra Hospital in Edmonton, said there are multiple factors at play.

“We lost a lot of shelter space last year, especially during the winter in the daytime,” he said.

“So many of our patients were coming in saying, ‘Yeah, I was in shelter last night,’ and they left in the morning and then they got frostbite.”

Another factor might be a more proactive approach to recognizing and treating frostbite resulting in a more accurate picture.

“Our numbers probably were actually higher in previous years,” said MacLean.

MacLean is leading a study examining the treatment of severe frostbite with iloprost, a medication used to dilate constricted blood vessels.

The technique, developed in Whitehorse in 2017, can reduce the risk of amputation after frostbite, but is considered off-label for that purpose by Health Canada, meaning it requires special approval.

After being successfully used in Calgary, MacLean and his colleagues brought it to Edmonton last winter as part of a study to evaluate its effectiveness.

The results are promising: patients who received iloprost were less likely to need amputation.

But MacLean and his team created a metric to measure the “grade” of amputations for patients in the study. They found that iloprost was associated with “improved digit salvage, with 10 per cent fewer digit segments requiring amputation.”

The fact that iloprost was previously used in Calgary but not Edmonton was cited last year as a possible reason why Calgary’s frostbite amputation numbers decreased during the 2023-2024 winter while Edmonton’s went up.

But with those trends continuing despite the use of the drug in both cities, the reason for the divergence is less clear.

Data from Environment and Climate Change Canada indicates that the two cities recorded similar daily minimum temperatures last winter. And while Calgary’s unhoused population was significantly larger than Edmonton’s a decade ago, the two cities have found comparable figures in recent counts.

However, one possibility is the cities’ differing responses to cold weather.

When temperatures are forecast to drop below –20 C for a minimum of three days, the City of Edmonton activates additional services to protect vulnerable people from the elements, including adding a fourth shelter shuttle bus and funding 50 overnight shelter spaces at Al Rashid Mosque.

By contrast, Calgary’s extreme weather response is activated for the entire period of Dec. 1 to Mar. 31., providing additional services, day spaces and winter supplies.

MacLean argues Edmonton’s benchmark is far too low, something Strikwerda agrees with.

“It's the harshest benchmark that you'll find in Canada,” Strikwerda said. “If somebody's outside in –20 C weather and there's no extreme weather protocols, they can certainly get frostbite in one day, let alone in three days.”

Risk of frostbite begins at temperatures below 0 C, according to the Alberta government.

In response to questions about the City of Edmonton’s extreme weather policy, a spokesperson said in an email that the policy is already being reviewed — a process that began in late 2024 and is expected to be completed and presented to city council in mid 2026.

The review will include “a jurisdictional and literature review on how other municipalities are addressing extreme weather events and best practices,” as well as consultation with front line providers and “people with lived and living experience,” said the spokesperson.

The iloprost study found that 35 per cent of the severe frostbite cases in Edmonton during the 2022-23 and 2023-24 winters occurred when the extreme weather emergency response was not activated.

“Homelessness is a complex challenge that no single organization or order of government can solve alone,” said a City of Edmonton spokesperson in a statement.

“It is a tragedy when vulnerable Edmontonians become injured or lose their lives.”

The statement highlighted new funding to extend day-space hours this winter at four locations in Edmonton.

A spokesperson for Jason Nixon, minister of Assisted Living and Social Services, said in a statement that the statistical increase represents progress.

“The increase in both frostbite diagnoses and amputations are a direct result of co-ordinated, concerted efforts to increase awareness and early intervention of frostbite and cold exposure, improving outcomes for vulnerable Albertans,” said the statement.

Noting provincial funding for 24/7 shelters and navigation centres, the statement said the province “remains committed to working tirelessly to ensure vulnerable Albertans have access to the supports they need, and to working with shelter operators and front-line service providers to ensure every Albertan has access to warm, safe places to go this winter.”

There are many reasons why people may not go to a shelter even when space is available, such as feeling unsafe due to past experience.

A controversial practice in both Edmonton and Calgary has been to dismantle tents and homeless encampments. Both cities confirmed that policy will continue this winter, citing safety concerns.

“When the city responds to an encampment, we do not simply ‘take it down,’” said a statement from a City of Calgary spokesperson.

“Our teams engage directly with occupants and ensure they are offered safe, warm alternatives before any structure is removed. No encampment is dismantled without providing support and connections to appropriate services and shelter options. The goal is always to reduce harm, prevent exposure to the elements, and create a safer outcome than if someone remained outdoors.”

A compounding factor for frostbite amputation is that people without housing are at risk of re-freezing an injury after leaving the emergency department. The Bridge Healing Transitional Accommodation Program is intended to fill that gap.

“Bridge Healing is designed quite simply to ask patients that are experiencing homelessness, ‘Do you want a chance to start your life again?’” said Francescutti, the emergency room physician and professor at the University of Alberta.

If they say yes and qualify, they go directly to one of four 12-unit buildings where they get their own room and a chance to safely recuperate, as well as support such as obtaining a bank account and permanent housing.

According to Francescutti, the program results in an 80 per cent reduction in return visits to the emergency department.

Having a safe place to stay following frostbite treatment means someone is less likely to re-injure the damaged tissue, which reduces the chances of amputation.

Time is also a critical determining factor in the outcome, according to MacLean.

“If it’s been within the last 72 hours, [if] it hasn’t gone through a freeze-thaw-freeze-again cycle, then that gives us some treatment options,” he said. “If it’s been longer than that, then our treatment options are really limited.”

Bridge Healing buildings are constantly full, demonstrating the overwhelming need. While the program is hoping to expand, Strikwerda, the ECOHH co-chair, said there’s only one ultimate solution.

“What we need in this city is not just affordable housing, as in housing that's 80 per cent of market value,” said Strikwerda. “We need social housing that's geared to income.”

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