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MEDICAL ASPECTS OF COLD WEATHER OPERATIONS: A Handbook for Medical Officers U S ARMY RESEARCH INSTITUTE OF REPORT NO TN93-4
MEDICAL ASPECTS OF COLD
WEATHER OPERATIONS:
A Handbook for Medical Officers
U S ARMY RESEARCH INSTITUTE
OF
ENVIRONMENTAL MEDICINE
Natick, Massachusetts
01760-5007
Approved for public release distribution unlimited
UNITED STATES ARMY
MEDICAL RESEARCH & DEVELOPMENT COMMAND
AD A263 559 The findings in this report are not to be construed as an official Department of the
Army position, unless so designated by other authorized documents.
DTIC AVAILABILITY NOTICE
Qualified requestors may obtain copies of this document from Commander
Defense Technical Information Center (DTIC), Cameron Station, Alexandria, VA 22314.
DISTRIBUTION UNLIMITED
DISPOSITION INSTRUCTIONS
Destroy this report when no longer needed.
Do not return to the originator. i
Table of Contents
Page
Acknowledgements 1
Preface 2
Introduction 3
Section 1. Physiologic Effects of Cold Exposure 4
1.1 Heat Balance and Cora Temperature 5
1.2 The Acute Response to Cold Exposure 6
1.3 Cold-Introduced Vasodilatation (CIVD) 7
1.4 Human Adaptation to Cold 7
Section 2. Prevention of Illness and Injury in the Cold 8
2.1 Preventing Cold Injuries: Role of the Medical Officer 8
2.2 Advice for the Commander 8
2.2.1 Soldier-Related Risk Factors 8
2.2.2 Environmental Risk Factors 9
2.2.3 Mission-Related Risk Factors 10
2.3 Training 11
2.4 Medical Surveillance 12
2.5 Sustaining Health and Performance 13
2.5.1 Medical Predeployment Preparation 13
2.5.2 Nutrition 14
2.5.3 Hydration 14
2.6 Medical Soldiers Are Role Models 15 ii
2.7 Prevention of Illness and Injury from Other Hazards 15
2.7.1 Traumatic Injury and Falls 15
2.7.2 Carbon Monoxide, Fires and Fumes 15
2.7.3 Crowding and Infection 16
2.7.4 Sun Exposure 16
2.7.5 Contact Freezing Injuries 16
2.7.6 Alcohol 17
2.8
Be Alert 17
Section 3.
Illness and Injury Due to Cold 18
3.1 Introduction 18
3.2 Freezing Injury (Frostbite) 18
3.2.1 Pathogenesis of Freezing Injuries 19
3.2.2 Clinical Manifestations and Classification 19
3.2.3 First Aid and Field Management 21
3.2.4 Hospital Management 22
3.2.5 Return to Duty and Physical Profiling 25
3.3 Non-Freezing Cold Injury (NFCI) 25
3.3.1 Pathogenesis 26
3.3.2 Clinical Manifestations 26
3.3.3 Classification 27
3.3.4 First Aid and Field Management 28
3.3.5 Hospital Management 29
3.3.6 Return to Duty and Physical Profiling 30 iii
3.4 Accidental Hypothermia 30
3.4.1 Pathophysiology of Hypothermia 30
3.4.2 Accidental Hypothermia 31
3.4.3 Clinical Manifestations of Hypothermia 33
3.4.4 First Aid and Field Management of Accidental Hypothermia 33
3.4.5 Cardiopulmonary Resuscitation (CPR) 34
3.4.6 Sudden Death in Accidental Hypothermia 36
3.4.7 Hospital Management 37
3.4.8 Return to Duty and Physical Profiling 40
3.5 Other Medical Problems in Cold Environments 41
3.5.1 Carbon Monoxide (CO) Poisoning 41
3.5.2 Respiratory Tract Conditions 42
3.5.3 Cold Urticaria 42
3.5.4 Chilblains (Pernio) 43
3.5.5 Solar Keratitis (Snow Blindness) and Sunburn 43
3.5.6 Eczema (Winter Itch, Eczema Craquele) 44
3.5.7 Lacerations 44
3.5.8 Intolerance of Cold Exposure 44
Section 4 Key Points and Reminders 45
4.1 Useful points to remember. 45
4.2 Prevention 45
4.3 Rescue and Evacuation 46
4.4 Medical Operations in the Cold 47 iv
1
Appendices 49
Appendix A: Wind Chill Chart 50
Appendix B: Cold Weather Training Guidelines 52
Appendix C: Clinical Manifestations of Hypothermia 54
References 55
Bibliography 56 1
Acknowledgements
In the preparation of this handbook, the author has had the benefit of the
unstinting help of a number of individuals.
First and foremost, COL Gerald Krueger, the USARIEM Commander who
originated the concept of an environmental medicine handbook series has given
continuous support careful an