Cold injuries are most likely to occur when an unprepared individual
is exposed to winter temperatures. They can occur even with proper
planning and equipment. The cold weather and the type of combat
operation in which the individual is involved impact on whether
he is likely to be injured and to what extent. His clothing, his
physical condition, and his mental makeup also are determining
factors. However cold injuries can usually be prevented. Well-disciplined
and well-trained individuals can be protected even in the most
adverse circumstances They and their leaders must know the hazards
of exposure to the cold. They must know the importance of personal
hygiene, exercise, care of the feet and hands, and the use of
a. Contributing Factors.
(1) Weather. Temperature, humidity, precipitation and
wind modify the loss of body heat. Low temperatures and low relative
humidity--dry cold--promote frostbite. Higher temperatures, together
with moisture, promote immersion syndrome. Windchill accelerates
the loss of body heat and may aggravate cold injuries. These principles
and risks apply equally to both men and women.
(2) Type of combat operation. Defense, delaying observation-post,
and sentinel duties do create to a greater extent--fear fatigue,
dehydration, and lack of nutrition. These factors further increase
the soldier's vulnerability to cold injury. Also, a soldier is
more likely to receive a cold injury if he is--
(3) Clothing. The soldier should wear several layers
of loose clothing. He should dress as lightly as possible consistent
with the weather to reduce the danger of excessive perspiration
and subsequent chilling. It is better for the body to be slightly
cold and generating heat than excessively warm and sweltering
toward dehydration. He should remove a layer or two of clothing
before doing any hard work. He should replace the clothing when
work is completed. Most cold injuries result from soldiers having
too few clothes available when the weather suddenly turns colder.
Wet gloves, shoes, socks, or any other wet clothing add to the
cold injury process.
- Often in contact with the ground.
- Immobile for long periods, such as while riding in a crowded
- Standing in water, such as in a foxhole.
- Out in the cold for days without being warmed.
- Deprived of an adequate diet and rest.
- Not able to take care of his personal hygiene.
In a chemical environment DO NOT take off protective chemical
(4) Physical makeup. Physical fatigue contributes to
apathy, which leads to inactivity, personal neglect, carelessness,
and reduced heat production. In turn, these increase the risk
of cold injury Soldiers with prior cold injuries have a higher-than-normal
risk of subsequent cold injury, not necessarily involving the
part previously injured.
(5) Psychological factor. Mental fatigue and fear reduces
the body's ability to rewarm itself and thus increases the incidence
of cold injury. The feelings of isolation imposed by the environment
are also stressful. Depressed and/or unresponsive soldiers are
also vulnerable because they are less active. These soldiers tend
to be careless about precautionary measures, especially warming
activities, when cold injury is a threat.
b. Signs/Symptoms. Once a soldier becomes familiar with
the factors that contribute to cold injury, he must learn to recognize
cold injury signs/symptoms.
(1) Many soldiers suffer cold injury without realizing what is
happening to them. They may be cold and generally uncomfortable
These soldiers often do not notice the injured part because
it is already numb from the cold.
(2) Superficial cold injury usually can be detected by numbness,
tingling, or "pins and needles" sensations. These signs/symptoms
often can be relieved simply by loosening boots or other clothing
and by exercising to improve circulation. In more serious cases
involving deep cold injury, the soldier often is not aware that
there is a problem until the affected part feels like
a stump or block of wood.
(3) Outward signs of cold injury include discoloration
of the skin at the site of injury. In light-skinned persons, the
skin first reddens and then becomes pale or waxy white. In dark-skinned
persons, grayness in the skin is usually evident. An injured foot
or hand feels cold to the touch. Swelling may
be an indication of deep injury. Also note that blisters may occur
after rewarming the affected parts. Soldiers should work
in pairs--buddy teams--to check each other for signs
of discoloration and other symptoms. Leaders should also be alert
for signs of cold injuries.
c. Treatment Considerations. First aid for cold injuries
depends on whether they are superficial or deep. Cases of superficial
cold injury can be adequately treated by warming the affected
part using body heat. For example, this can be done by
covering cheeks with hands, putting fingertips under armpits,
or placing feet under the clothing of a buddy next to his belly.
The injured part should NOT be massaged, exposed to a fire or
stove, rubbed with snow, slapped, chafed, or soaked in cold water.
Walking on injured feet should be avoided. Deep cold injury (frostbite)
is very serious and requires more aggressive first aid to avoid
or to minimize the loss of parts of the fingers, toes, hands,
or feet. The sequence for treating cold injuries depends on whether
the condition is life-threatening. That is, PRIORITY
is given to removing the casualty from the cold. Other-than-cold
injuries are treated either simultaneously while waiting for evacuation
to a medical treatment facility or while en route to the facility.
The injured soldier should be evacuated at once to a place
where the affected part can
be rewarmed under medical supervision.
d. Conditions Caused by Cold. Conditions caused by cold
are chilblain, immersion syndrome (immersion foot/trench foot),
frostbite snow blindness, dehydration, and hypothermia.
(2) Immersion syndrome (immersion foot/trench foot).
Immersion foot and trench foot are injuries that result from fairly
long exposure of the feet to wet conditions at temperatures from
approximately 50 to 32F. Inactive feet in damp
or wet socks and boots or tightly laced boots which impair circulation
are even more susceptible to injury. This injury can be very serious;
it can lead to loss of toes or parts of the feet. If exposure
of the feet has been prolonged and severe, the feet may swell
so much that pressure closes the blood vessels and cuts off circulation.
Should an immersion injury occur, dry the feet thoroughly; and
evacuate the casualty to a medical treatment facility by the fastest
- Signs/Symptoms. Chilblain is caused by repeated prolonged
exposure of bare skin at temperatures from 60F, to 32F,
or 20F for acclimated, dry, unwashed skin. The area may
be acutely swollen, red, tender, and hot with itchy skin. There
may be no loss of skin tissue in untreated cases but continued
exposure may lead to infected, ulcerated, or bleeding lesions.
- Treatment. Within minutes, the area usually responds
to locally applied body heat. Rewarm the affected part by applying
firm steady pressure with your hands, or placing the affected
part under your arms or against the stomach of a buddy. DO NOT
rub or massage affected areas. Medical personnel should evaluate
the injury, because signs and symptoms of tissue damage may be
slow to appear.
- Prevention. Prevention of chilblain depends on basic
cold injury prevention methods. Caring for and wearing the uniform
properly and staying dry (as far as conditions permit) are of
(3) Frostbite. Frostbite is the injury of tissue caused
from exposure to cold, usually below 32F depending on
the windchill factor, duration of exposure, and adequacy of protection.
Individuals with a history of cold injury are likely to be more
easily affected for an indefinite period. The body parts most
easily frostbitten are the cheeks, nose, ears, chin, forehead,
wrists, hands, and feet. Proper treatment and management depend
upon accurate diagnosis. Frostbite may involve only the skin (superficial),
or it may extend to a depth below the skin (deep). Deep frostbite
is very serious and requires more aggressive first aid to avoid
or to minimize the loss of parts of the fingers, toes, hands,
- Signs/Symptoms. At first, the parts of the affected
foot are cold and painless, the pulse is weak, and numbness may
be present. Second, the parts may feel hot, and burning and shooting
pains may begin. In later stages, the skin is pale with a bluish
cast and the pulse decreases. Other signs/symptoms that may follow
are blistering swelling, redness, heat, hemorrhages (bleeding),
- Treatment. Treatment is required for all stages of
immersion syndrome injury. Rewarm the injured part gradually by
exposing it to warm air. DO NOT massage it. DO NOT moisten the
skin and DO NOT apply heat or ice. Protect it from trauma and
secondary infections. Dry, loose clothing or several layers of
warm coverings are preferable to extreme heat. Under no circumstances
should the injured part be exposed to an open fire. Elevate the
injured part to relieve the swelling. Evacuate the casualty to
a medical treatment facility as soon as possible. When the part
is rewarmed, the casualty often feels a burning sensation and
pain. Symptoms may persist for days or weeks even after rewarming.
- Prevention. Immersion syndrome can be prevented by
good hygienic care of the feet and avoiding moist conditions for
prolonged periods. Changing socks at least daily (depending on
environmental conditions) is also a preventive measure. Wet socks
can be air dried, then can be placed inside the shirt to warm
them prior to putting them on.
Casualty should be continually monitored for development of
conditions which may
require the performance of necessary basic
lifesaving measures, such as clearing the
airway, performing mouth-to-mouth
resuscitation, preventing shock, and/or bleeding
- Progressive signs/symptoms (081-831-1009).
- Loss of sensation, or numb feeling in any part of
- Sudden blanching (whitening) of the skin of the affected
part, followed by a momentary "tingling" sensation.
- Redness of skin in light-skinned soldiers grayish
coloring in dark-skinned individuals.
- Swelling or tender areas.
- Loss of previous sensation of pain in affected area.
- Pale, yellowish, waxy-looking skin.
- Frozen tissue that feels solid (or wooden) to the
Deep frostbite is a very serious injury and requires immediate first
aid and subsequent
medical treatment to avoid or minimize loss
of body parts.
- Treatment (O81-831-1009).
- Face, ears, and nose. Cover the casualty affected
area with his and/or your bare hands until sensation and color
- Hands. Open the casualty's field jacket and shirt.
(In a chemical environment never remove the clothing.) Place the
affected hands under the casualty's armpits. Close the field jacket
and shirt to prevent additional exposure.
- Feet. Remove the casualty's boots and socks if he
does not need to walk any further to receive additional treatment.
(Thawing the casualty's feet and forcing him to walk on them will
cause additional pain/ injury.) Place the affected feet under
clothing and against the body of another soldier.
DO NOT attempt to thaw the casualty's feet or other seriously
frozen areas if he will
be required to walk or travel to receive
further treatment. The casualty should avoid
walking if possible,
because there is less danger in walking while the feet are frozen
than after they have been thawed. Thawing in the field increases
the possibilities of
infection, gangrene, or other injury.
Thawing may occur spontaneously during transportation to the
medical facility; this
cannot be avoided since the body in general
must be kept warm.
In all of the above areas, ensure that the casualty is kept warm
and that he is covered (to avoid further injury). Seek medical
treatment as soon as possible. Reassure the casualty, protect
the affected area from further injury by covering it lightly with
a blanket or any dry clothing, and seek shelter out of the wind.
Remove/minimize constricting clothing and increase insulation.
Ensure that the casualty exercises as much as possible, avoiding
trauma to the injured part, and is prepared for pain when thawing
occurs. Protect the frostbitten part from additional injury. DO
NOT rub the injured part with snow or apply cold water soaks.
DO NOT warm the part by massage or exposure to open fire because
the frozen part may be burned due to the lack of feeling. DO NOT
use ointments or other medications. DO NOT manipulate the part
in any way to increase circulation. DO NOT allow the casualty
to use alcohol or tobacco because this reduces the body's resistance
to cold. Remember when freezing extends to a depth below the skin,
it involves a much more serious injury. Extra care is required
to reduce or avoid the chances of losing all or part of the toes
or feet. This also applies to the fingers and hands.
(4) Snow blindness. Snow blindness is the effect that
glare from an ice field or snowfield has on the eyes. It is more
likely to occur in hazy, cloudy weather than when the sun is shining.
Glare from the sun will cause an individual to instinctively protect
his eyes. However, in cloudy weather, he may be overconfident
and expose his eyes longer than when the threat is more obvious.
He may also neglect precautions such as the use of protective
eyewear. Waiting until discomfort (pain) is felt before using
protective eyewear is dangerous because a deep burn of the eyes
may already have occurred.
- Signs/Symptoms. Symptoms of snow blindness are a
sensation of grit in the eyes with pain in and over the eyes,
made worse by eyeball movement. Other signs/symptoms are watering,
redness, headache, and increased pain on exposure to light. The
same condition that causes snow blindness can cause snowburn of
skin, lips, and eyelids. If a snowburn is neglected, the result
is the same as a sunburn.
- Treatment. First aid measures consist of blindfolding
or covering the eyes with a dark cloth which stops painful eye
movement. Complete rest is desirable. If further exposure to light
is not preventable, the eyes should be protected with dark bandages
or the darkest glasses available. Once unprotected exposure to
sunlight stops the condition usually heals in a few days without
permanent damage. The casualty should be evacuated to the nearest
- Prevention. Putting on protective eye wear is essential
not only to prevent injury, but to prevent further injury
if any has occurred. When protective eye wear is not available,
an emergency pair can be made from a piece of wood or cardboard
cut and shaped to the width of the face. Cut slits for the eyes
and attach strings to hold the improvised glasses in place. Slits
are made at the point of vision to allow just enough space to
see and reduce the risk of injury. Blackening the eyelids and
face around the eyes absorbs some of the harmful rays.
(5) Dehydration. Dehydration occurs when the body loses
too much fluid, salt, and minerals. A certain amount of body fluidis lost through normal body processes. A normal daily intake of
food and liquids replaces these losses. When individuals are engaged
in any strenuous exercises or activities, an excessive amount
of fluid and salt is lost through sweat. This excessive loss creates
an imbalance of fluids, and dehydration occurs when fluid and
salt are not replaced. It is very important to know that it can
be prevented if troops are instructed in its causes, symptoms,
and preventive measures. The danger of dehydration is as prevalent
in cold regions as it is in hot regions. In hot weather
the individual is aware of his body losing fluids and salt. He
can see, taste, and feel the sweat as it runs down his face, gets
into his eyes, and on his lips and tongue, and drips from his
body. In cold weather, however, it is extremely difficult
to realize that this condition exists. The danger of dehydration
in cold weather operations is a serious problem. In cold climates,
sweat evaporates so rapidly or is absorbed so thoroughly by layers
of heavy clothing that it is rarely visible on the skin. Dehydration
also occurs during cold weather operations because drinking is
inconvenient. Dehydration will weaken or incapacitate a casualty
for a few hours, or sometimes, several days. Because rest is an
important part of the recovery process, casualties must take care
that limited movement during their recuperative period does not
enhance the risk of becoming a cold weather casualty.
- Signs/Symptoms. The symptoms of cold weather dehydration
are similar to those encountered in heat exhaustion. The mouth,
tongue, and throat become parched and dry, and swallowing becomes
difficult. The casualty may have nausea with or without vomiting
along with extreme dizziness and fainting. The casualty may also
feel generally tired and weak and may experience muscle cramps
(especially in the legs). Focusing eyes may also become difficult.
- Treatment. The casualty should be kept warm and his
clothes should be loosened to allow proper circulation. Shelter
from wind and cold will aid in this treatment. Fluid replacement,
rest, and prompt medical treatment are critical. Medical personnel
will determine the need for salt replacement.
- Prevention. These general preventive measures apply
for both hot and cold weather. Sufficient additional liquids should
be consumed to offset excessive body losses of these elements.
The amount should vary according to the individual and the type
of work he is doing (light, heavy, or very strenuous). Rest is
equally important as a preventive measure. Each individual must
realize that any work that must be done while bundled in several
layers of clothing is extremely exhausting. This is especially
true of any movement by foot, regardless of the distance.
(6) Hypothermia (general cooling). In intense cold a
soldier may become both mentally and physically numb, thus neglecting
essential tasks or requiring more time and effort to achieve them.
Under some conditions (particularly cold water immersion), even
a soldier in excellent physical condition may die in a matter
of minutes. The destructive influence of cold on the body is called
hypothermia. This means bodies lose heat faster than
they can produce it. Frostbite may occur without hypothermia when
extremities do not receive sufficient heat from central body stores.
The reason for this is inadequate circulation and/or inadequate
insulation. Nonetheless, hypothermia and frostbite may occur at
the same time with exposure to below-freezing temperatures. An
example of this is an avalanche accident. Hypothermia may occur
from exposure to temperatures above freezing, especially from
immersion in cold water, wet-cold conditions, or from the effect
of wind. Physical exhaustion and insufficient food intake may
also increase the risk of hypothermia. Excessive use of alcohol
leading to unconsciousness in a cold environment can also result
in hypothermia. General cooling of the entire body to a temperature
below 95F is caused by continued exposure to low or rapidly
dropping temperatures, cold moisture, snow or ice. Fatigue, poor
physical condition, dehydration, faulty blood circulation, alcohol
or other drug intoxication, trauma, and immersion can cause hypothermia.
Remember, cold affects the body systems slowly and almost without
notice. Soldiers exposed to low temperatures for extended periods
may suffer ill effects even if they are well protected by clothing.
- Signs/Symptoms. As the body cools, there are several
stages of progressive discomfort and impairment. A sign/symptom
that is noticed immediately is shivering. Shivering is an attempt
by the body to generate heat. The pulse is faint or very difficult
to detect. People with temperatures around 90F may be
drowsy and mentally slow. Their ability to move may be hampered,
stiff, and uncoordinated, but they may be able to function minimally.
Their speech may be slurred. As the body temperature drops further,
shock becomes evident as the person's eyes assume a glassy state,
breathing becomes slow and shallow, and the pulse becomes weaker
or absent. The person becomes very stiff and uncoordinated. Unconsciousness
may follow quickly. As the body temperature drops even lower,
the extremities freeze, and a deep (or core) body temperature
(below 85F) increases the risk o irregular heart action.
This irregular heart action or heart standstill can result in
- Treatment. Except in cases of the most severe hypothermia
(marked by coma or unconsciousness, a weak pulse, and a body temperature
of approximately 90F or below), the treatment for hypothermia
is directed towards rewarming the body evenly and without
delay. Provide heat by using a hot water bottle, electric
blanket, campfire, or another soldier's body heat. Always call
or send for help as soon as possible and protect the casualty
immediately with dry clothing or a sleeping bag. Then, move him
to a warm place. Evaluate other injuries and treat them. Treatment
can be given while the casualty is waiting evacuation or while
he is en route. In the case of an accidental breakthrough into
ice water, or other hypothermic accident, strip the casualty of
wet clothing immediately and bundle him into a sleeping bag. Mouth-to-mouth
resuscitation should be started at once if the casualty's breathing
has stopped or is irregular or shallow. Warm liquids may be given
gradually but must not be forced on an unconscious or semiconscious
person because he may choke. The casualty should be transported
on a litter because the exertion of walking may aggravate circulation
problems. A physician should immediately treat any hypothermia
casualty. Hypothermia is life-threatening until normal
body temperature has been restored. The treatment of a casualty
with severe hypothermia is based upon the following principles:
stabilize the temperature, attempt to avoid further heat loss,
handle the casualty gently, and evacuate as soon as possible
to the nearest medical treatment facility! Rewarming a severely
hypothermic casualty is extremely dangerous in the field due to
the great possibility of such complications as rewarming shock
and disturbances in the rhythm of the heartbeat.
Hypothermia is a MEDICAL EMERGENCY! Prompt medical treatment is necessary. Casualties with hypothermic complications should be transported to a medical treatment facility immediately.
The casualty is unable to generate his own body heat. Therefore,
merely placing him in a blanket or sleeping bag is not sufficient.
- Prevention. Prevention of hypothermia consists of
all actions that will avoid rapid and uncontrollable loss of body
heat. Individuals should be properly equipped and properly dressed
(as appropriate for conditions and exposure). Proper diet, sufficient
rest, and general principles apply. Ice thickness must be tested
before river or lake crossings. Anyone departing a fixed base
by aircraft, ground vehicle, or foot must carry sufficient protective
clothing and food reserves to survive during unexpected weather
changes or other unforeseen emergencies. Traveling alone is never
safe. Expected itinerary and arrival time should be left with
responsible parties before any departure in severe weather. Anyone
living in cold regions should learn how to build expedient shelters
from available materials including snow.
e. Table. See Table 5-2 for further information.
Table 5-2. Cold and Wet Injuries (081-831-1009)
*CAUTION: Hypothermia is a MEDICAL EMERGENCY! Prompt medical treatment is necessary.
|Chilblain||Red, swollen, hot, tender, itching skin. Continued exposure may lead to infected (ulcerated or bleeding) skin lesions.||1. Area usually responds to locally applied rewarming (body heat).|
2. DO NOT rub or massage area.
3. Seek medical treatment.
|Affected parts are cold, numb, and painless. Parts may then be hot, with burning and shooting pains. Advanced stage: skin pale with bluish cast; pulse decrease; blistering, swelling, heat, hemorrhages, and gangrene may follow.||1. Gradual rewarming by exposure to warm air.|
2. DO NOT massage or moisten skin.
3. Protect affected parts from trauma.
4. Dry feet thoroughly, avoid walking.
5. Seek medical treatment.
|Frostbite||Loss of sensation, or numb feeling in any part of the body. Sudden blanching (whitening) of the skin of the affected part, followed by a momentary "tingling" sensation. Redness of skin in light-skinned soldiers; grayish coloring in dark-skinned individuals. Blisters. Swelling or tender areas. Loss of previous sensation of pain in affected area. Pale yellowish, waxy-looking skin. Frozen tissue that feels solid (or wooden) to the touch.||1. Warm the area at the first sign of frostbite, using firm, steady pressure of hand, underarm or abdomen.|
2. Face, ears, nose--cover area with hands (casualty's own or buddy's).
3. Hand(s)--open field jacket and place casualty's hand(s) against body, then close jacket to prevent heat loss.
4. Feet--casualty's boots/socks removed and exposed feet placed under clothing and against body of another soldier.
5. Warning: Do not attempt to thaw the casualty's feet or other seriously frozen areas if he will be required to walk or travel to a medical center in order to receive additional treatment. The possibility of injury from walking is less when the feet are frozen than after they have been thawed. (However, if possible, avoid walking.) Thawing in the field increases the possibility of infection, gangrene, or injury.
6. Loosen or remove constricting clothing and remove any jewelry.
7. Increase insulation (cover with blanket or other dry material). Ensure casualty exercises as much as possible, avoiding trauma to injured part.
|Snow Blindness||Eyes may feel scratchy. Watering, redness, headache, and increased pain with exposure to light can occur.||1. Cover eyes with a dark cloth.|
2. Seek medical treatment.
|Dehydration||Similar to heat exhaustion. See Table 5-1.||1. Keep warm, loosen clothes.|
2. Casualty needs fluid replacement, rest and prompt medical treatment.
|Hypothermia||Casualty is cold. Shivering stops. Core temperature is low. Consciousness may be altered. Uncoordinated movements may occur. Shock and coma may result as body temperature drops.||Mild Hypothermia|
1. Rewarm body evenly and without delay. (Need to provide heat source; casualty's body unable to generate heat).
2. Keep dry, protect from elements.
3. Warm liquids may be given gradually (to conscious casualties only).
*4. Seek medical treatment immediately!
1. Stabilize the temperature.
2. Attempt to avoid further heat loss.
3. Handle the casualty gently.
4. Evacuate to the nearest medical treatment facility as soon as possible.
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