There were a record 12 amputations due to frostbite in Montreal in 2025, but none this year. here’s why
Cold can be difficult to bear. Even more so if you’re homeless.
If there is no place to warm up or change out of wet shoes or wet clothes, constant exposure to cold temperatures and cold air can cause severe frostbite and, in some cases, amputation.
While not all regional health authorities in Montreal track frostbite amputations, they have recorded 46 cases since 2018.
On average, there are about six amputations a year due to frostbite.
Montreal hospitals do not log whether a patient is homeless or not, but de facto, “A.” “Unfortunately, the vast majority of our patients are actually homeless,” said board-certified plastic surgeon Dr. Ali Izadpanah. He is also the director of Montreal’s regional burn center at CHUM, which treats severe frostbite.
“Sure, it happens to someone who’s out to ski or work, but much less frequently,” he said.
The worse the frostbite, the greater the chance of amputation.
But despite the long and cold winter, there have been no reports of amputations due to frostbite in Montreal so far this year.
The two worst years for frostbite amputations were 2023 and 2025, both with 12 cases.
The decline in cases this winter season may be linked to two differences: the addition of hundreds of locations to temporary warming shelters around the city and the use of a new drug protocol to treat frostbite, called iloprost.
On an average, around six cases of dismemberment due to frostbite are recorded in the city every year. In both 2023 and 2025, there were 12. So far in 2026, none have been reported. A new drug and additional warming shelter in place are likely behind the big decline.
Drug dramatically reduces chance of amputation
Iloprost was used to treat frostbite in Canada First developed in Whitehorse And it became more widely used in Quebec last winter.
Like burns, frostbite ranges in severity from stage 1 – frostbite – to stage 4, where the skin and underlying tissue usually become dead and blackened, similar to an electrical burn.
In stages 3 and 4, some type of surgical reconstruction or amputation is usually required, Dr. Izadpanah said.
He says frostbite can be evaluated only after the area has warmed up.
“In cold weather, everything looks blue and dead. You warm it up and see what state it’s going into, what kind of blisters are forming, what the extent of the damage is,” Izadpanah said.
Iloprost treatment protocol is used on patients who have stage 2 or 3 frostbite.
Even if the vessels are damaged, the medicine maintains blood flow, which prevents the tissue from dying and helps it heal.
“So the likelihood of amputation is substantially reduced,” Izadpanah said.
In the past, if frostbite was stage 3, the risk of amputation could be as high as 60 or 70 percent.
“With iloprost, some studies have shown that it reduces it by 10 percent,” Izadpanah said.
The use of iloprost for frostbite has not yet been approved by Health Canada, so it requires special approval. Over the past year or two, Izadpanah says it has gained access to most of the major centers in Quebec. But doses will have to be ordered in advance.
“If you ask for it in the winter season, it’s too late. So we sent the request for this winter season last year,” he said.
particularly harsh winters
While the number of amputations due to frostbite appears to be decreasing in Montreal, frostbite is still a concern for people living on the streets.
Even in cases where dissection is initially avoided, the blood vessels remain fragile.
“An organ that has been frostbitten is always at higher risk of getting frostbite again because the damage has already been done,” Izadpanah said.
About 15 to 20 per cent of Montreal’s homeless population lives outside, says James Hughes, president and CEO of the Old Brewery Mission. Some people live in encampments or abandoned buildings. Others use subway stations or hospital emergency rooms as temporary shelters.
“So they’re hanging out a lot more and are naturally more affected by cold weather than people who are not (homeless),” Hughes said.
This winter, the city of Montreal added hundreds of spots to temporary warming centres. Hughes says the decline in amputations is “appalling” and he fears the number could have been much higher had the additional spots not been in place.
“He has had an absolutely positive impact,” he said.
The Montreal Health Network consists of five regional health authorities as well as the CHUM and MUHC. Among them, regional health centers serving the West Island, the mid-western part of Montreal and the East End said they did not track amputations caused by frostbite.
Three hospitals overseen by CHUM and CIUSSS du Nord-de-l’Île-de-Montréal Nearly 75 per cent of amputations have been performed on the Island of Montreal since 2018. The remainder were performed at the MUHC and CIUSSS du Centre-Sud-de-l’Île-de-Montréal.
Nearly half of frostbite deaths will occur between 2023 and 2025.
Historical weather data shows that in both years there were several days of extremely cold temperatures and bone-chilling wind chills. The winter of 2025 was particularly brutal, with back-to-back storms last February causing about 75 centimeters of snowfall in five days.
‘loss of identity’
Among the homeless population, poor health is undeniable.
Chronic health conditions, such as diabetes, are common, which can make people more susceptible to frostbite. Dependence on drugs or alcohol can also dull the pain of frostbite and delay detection, Hughes said.
Although the front-line staff at the Old Brewery Mission are trained to detect frostbite quickly, it is often too late.
“We see it here literally all the time,” Hughes said. “There are people in our cafes and in our emergency services who have lost limbs.”
He wants the city to invest in more medical staff who can work directly from homeless shelters to catch infections and other health ailments early.
Although psychiatric services are available at many homeless shelters, there is no equivalent for physical health.
“We need primary care here, this would be incredibly helpful because people are often not easily referred. It’s very difficult to get a homeless person an appointment on the other side of town.”
The Maison du Père has 30 beds to support individuals who require additional health care, including patients with amputations due to frostbite.
Since January, the organization has helped care for five people who experienced severe frostbite. Two of them are being kept under observation to see if amputation can be avoided, said Jelle Begarin, who runs the shelter.
Their nurses can change dressings, make sure people are taking medications and assist people receiving rehabilitation.
Begarin said the impact of amputation can be profound. Some people who were on the waiting list for housing may need to start from scratch if they now need adapted housing.
The loss of a digit, leg or hand can also increase mental health problems.
“It’s another burden on top of homelessness, and it often comes with a loss of identity,” Begarin said. “The person no longer recognizes himself and must re-learn how to find himself in a different way.”
While Hughes and Begarin both say the decline in amputations is encouraging, they argue that the use of warming shelters is a Band-Aid solution.
He says the city needs to invest in more housing, so people don’t end up on the streets.
Izadpanah agrees.
“It’s really a social issue,” he said. “So I think having more support from the outside for this vulnerable population is really the key to reducing frostbite.”
