Cold weather injury awareness
According to the Military Health System website, 415 members of the active and reserve components suffered one or more cold weather injuries between July 2019 and June 2020. That statistic speaks volumes about the need for education and risk mitigation measures to protect the force. (Photo Credit: U.S Army Safety Center illustration) VIEW ORIGINAL

FORT LEE, Va. – 60 degrees.

Most people are surprised to learn that far-from-frosty temperature is the upper-level threshold for cold weather injuries.

It’s the point at which prolonged exposure to damp and cold conditions could result in complications such as trench foot – a skin reaction leading to blistering and dying tissue if ignored. It killed an estimated 2,000 Americans fighting in the trenches during World War II (hence, its name).

The list of common CWIs also includes Chilblain (similar to trench foot), hypothermia and frostbite, listed in the order of likelihood as temperatures creep toward freezing or absolute zero. A more detailed description of each condition appears later in this article.

According to the Military Health System website, 415 members of the active and reserve components suffered one or more CWIs between July 2019 and June 2020. A profile of the population most likely to incur such injuries appeared in a recent article published in the Army Safety Center’s Risk Management Magazine.

“When it comes to injury prevention, it often pays for leaders to target their efforts at the highest risk group,” read the opening paragraph. “While anyone can become a cold-weather casualty, the typical victim looks like this: male; about 20 years old; less than 18 months in service; from a warm climate; uses tobacco, alcohol and/or medications; and neglects proper foot care.”

Another category mentioned later in the article is individuals who have suffered a previous CWI. They may have nerve damage from a previous bout of serious frostbite, making skin in that area less resilient to freezing temperatures.

“Look around your squad, platoon, company, battery or troop and see if you have any Soldiers who fit [those descriptions] because they are at higher risk,” the write-up continued. “Identify and pay special attention to them now, before you go to the field or deploy.”

The Risk Management article also raised an important point about staying hydrated. People tend to drink far less water when it’s cold outside, and that can result in a decrease in blood flow, thus hindering the body’s heating mechanisms. Nutrition is a factor as well.

“When you’re in a cold environment, your body has a greater metabolic demand because you’re burning more calories to stay warm,” a portion of the article read. “If you need 3,000 calories per day in a controlled environment, you may need up to 4,500 calories in a cold environment just to maintain your body weight. Eating meals will also increase water consumption, which will be a hedge against dehydration.”

Training Circular 4-02.3 states every Soldier will “protect against cold injury in cold climates by wearing proper cold-weather clothing and frequently changing socks to keep feet dry, by careful handling of gasoline-type liquids, and by avoiding contact between skin and cold metal.”

It’s a simple matter of wearing protective gear that’s designed to reduce heat loss to the environment. Effective mitigation measures are best remembered by the acronym COLD: Keep it Clean; avoid Overheating; wear clothing Loose and in Layers; and keep Dry.

Multiple layers of clothing trap a greater amount of warmth for insulation. It also allows Soldiers to remove layers as needed based on their activity level and environmental conditions. The innermost layer in contact with the skin must have wicking properties that move water vapor outward for evaporation. Chose clothing made of polypropylene, fleece, a Gore-Tex shell or other equivalent synthetic materials.

Protect the feet by keeping boots and socks clean and dry and change them out if they become wet. Protect the hands by wearing gloves or mittens with the appropriate inserts/liners. Avoid contacting snow, fuel or bare metal with the hands. Be sure to wear a cap. The head can account for up to 50 percent of the body’s total heat loss.

An overview of cold weather injury symptoms and immediate first aid recommendations follows:

·        Hypothermia results from the body core temperature dropping below 95 degrees. Warning signs include profuse shivering, confusion, sleepiness, slurred speech, shallow breathing, weak pulse, low blood pressure, change in behavior and/or poor control over body movements/slow reactions. Hypothermia can be fatal without immediate treatment. For most cases, moving the individual to a warmer location, replacing wet clothing and movement/light exercise are sufficient to restore core temperature.

·        Frostbite is the freezing of the skin. Symptoms include loss of feeling or a tingling sensation in the affected area along with a white, gray, red, yellow or waxy-looking appearance of the affected area. The frozen tissue will feel solid to the touch. Treatment requires gradual rewarming of the affected area. Do not rub the wound, use hot water or place near a direct heat source that will cause further injury.

·        Chilblain can result from prolonged (1-5 hours) exposure to wet/cold conditions. Chilblain lesions are swollen, tender, itchy and painful. Similar to frostbite, treatment involves gradual rewarming of the skin and ensuring the individual has appropriate dry/insulated protective gear.

·        Trench or immersion foot is caused by prolonged skin exposure to wet and cold conditions. Symptoms include numbness in the feet accompanied by burning sensations and shooting pain. Severely affected tissue will appear pale and slightly blue. Trench foot can lead to gangrene. For treatment, remove wet or constrictive items; gently blot dry the affected extremities; elevate and cover with dry/warm material. Do not allow the individual to walk, which could increase tissue damage and worsen the injury. Evacuate for medical treatment.

Other types of common cold weather injuries include carbon monoxide poisoning, snow blindness, sunburn and slips, trips and falls on icy surfaces. All of the aforementioned maladies are preventable with forethought and proper preparation. The following articles are recommended for education and awareness:

·        Cold weather casualties and injuries: phc.amedd.army.mil/topics/discond/cip/Pages/Cold-Weather-Casualties-and-Injuries.aspx.

·        A look at cold-weather injuries and how to avoid them: www.dvidshub.net/news/411221.

Cold weather injuries, active and reserve components, July 2015-June 2020: www.health.mil/News/Articles/2020/11/01/Update-Cold-Weather-Injuries-MSMR-2020.