Cold Injury Prevention
Cold Weather Casualties and Injuries 

Images of Soldiers in cold weather environment

Cold Weather Injuries: Prevention, Identification, and Treatment - Key information from this website has been placed in this slide deck for field use to create annual training and predeployment medical briefings. (Note: When selecting "Open" file, some users may receive a Windows Security pop-up message; please select "Cancel" and the presentation should load.)

If you have additional questions, please contact the USAPHC Injury Prevention Program at:

Email Address: usarmy.apg.medcom-phc.mbx.injuryprevention@mail.mil
Telephone: 410-436-4655
DSN: 584-4655


Commanders, leaders and medical advisors should use TB MED 508 Prevention and Management of Cold Weather Injuries to develop their cold weather injury (CWI) prevention program. This technical bulletin provides guidance on all aspects of CWI prevention. A CWI prevention program should be complemented by Army Risk Management doctrine, as detailed in FM 5-19 Composite Risk Management. A variety of resources and training aids are available at the bottom of this page.

Classroom training on cold injuries and avoidance is not sufficient to prepare troops for operating in cold weather.  Opportunities to learn through experience in controlled situations are invaluable. Gradually increasing exposure and training time in the cold will give troops the confidence and ability to recognize potential risks early enough to appropriately employ countermeasures with little mission impact from injuries.

To prevent CWIs, Leaders at all levels must ensure that Service Members receive adequate food, water, and rest; that they implement training on wearing the appropriate cold weather gear, and that they avoid the use of alcohol and tobacco. Pre-mission planning, knowing the weather forecast, and application of the Composite Risk Management process are integral to preventing CWI. Soldiers must use the buddy system to monitor health and performance and report to the unit medic/medical officer any signs or symptoms of CWI. Soldiers should not sleep in vehicles that are running due to the risk of carbon monoxide poisoning.

Cold Weather Clothing

It is important to use cold weather clothing properly, maintain adequate hydration and ensure nutritional requirements to ward off cold weather injuries. When wearing clothing in cold weather, remember the acronym C-O-L-D.

C: Keep it Clean; O: Avoid Overheating; L: Wear clothing Loose and in layers; D: Keep clothing Dry



COLD WEATHER INJURIES                                                                           

Cold weather-related injuries include: injuries due to decreased temperature (hypothermia, frostbite, nonfreezing cold injury), injuries due to heaters, carbon monoxide poisoning, and accidents due to impaired physical and/or mental function resulting from cold stress. Cold weather injuries can also occur in warmer ambient temperatures when an individual is wet due to rain or water immersion.

HYPOTHERMIA                                                                                                                                           

Hypothermia is defined as a body core temperature below 95°F/35°C. Hypothermia is usually characterized as mild, moderate, or severe, based on body core temperature. In order to properly diagnose hypothermia, core temperature must be measured rectally with a thermometer with an extended low range scale. Oral and tympanic temperatures will not yield accurate results in a cold environment, even when care is taken to use the best technique.

Cause

    • Hypothermia occurs when heat loss is greater than heat production. This can occur suddenly, such as during partial or total immersion in cold water, or over hours or days, such as during extended operations or survival situations.
    • Hypothermia may occur at temperatures above freezing, especially when a person’s skin or clothing is wet.

 Symptoms

    • Vigorous shivering is typically present. Shivering may decrease or cease as core temperature continues to fall.
    • Onset of hypothermia is typically associated with the so-called “umbles”, the grumbles, mumbles, stumbles and fumbles that increase as cold affects muscle and nerve function.
    • Symptoms of hypothermia consist of confusion, sleepiness, slurred speech, shallow breathing, weak pulse, low blood pressure, change in behavior and/or poor control over body movements/slow reactions.

Prevention

    • The keys to preventing hypothermia are layering clothing and staying dry. Remember the acronym COLD:
  • Keep it Clean
  • Avoid   Overheating
  • Wear it Loose and in Layers
  • Keep it Dry
      • Layers can be removed as ambient temperature or physical activity increases, which can reduce sweating and moisture build-up within clothing.

    Treatment

      • The goals for field management of hypothermia are to rescue, examine, insulate, and rapidly transport. If untreated, hypothermia is a true medical emergency and requires evacuation.
      • Rewarming techniques include: Soldiers generating their own heat via shivering or exercise, insulating against further heat losses, use of heat on the skin and direct delivery of heat to the core. The latter can only be performed in a hospital setting.
      • The use of heat on the skin (radiant heat, hot water bottles, electric blankets) should only be applied to individuals who have ceased shivering or have a traumatic vasodilation that increases heat loss.  Patients must be reassessed frequently to prevent burns.
      • For most cases, moving the individual to a warmer location, replacing wet clothing and movement/light exercise are sufficient to restore core temperature.

    FROSTBITE                                                                                                                                                  

    Frostbite accounts for the largest number of CWI each year and occurs when tissue temperature falls below ~28-30°F. Frostbite can occur suddenly due to contact to cold metal or super-cooled liquids such as alcohol, fuel or antifreeze or can develop over time due to prolonged cold exposure. Frostbite is most common in exposed skin such as the nose, ears, cheeks, but can also occur in the hands and feet due to reduced skin blood flow.

    Cause

      • Exposure to below freezing temperatures (<32°F) causing freezing of skin, fingers, toes, ears and facial parts.
      • Exposure of skin to metal, super cold fuel and POL (petroleum, oil, lubricants), wind chill, and tight clothing, particularly boots.
      • Riding in open vehicles, exposure to propeller/rotor-generated wind, running or skiing, and altitude exposure where there is little tree cover can all contribute to greater windchill.

    Symptoms

      • Numbness in affected area.
      • Tingling, blistered, swollen, or tender areas.
      • Pale, yellowish, waxy-looking skin (grayish in dark-skinned soldiers).
      • Frozen tissue that feels wooden to the touch.
      • Significant pain after rewarming

    Prevention

      • Monitoring air temperature and wind speed and using the windchill index is the only way to determine the relative risk of frostbite.
      • Use contact gloves to handle all equipment; never use bare hands.
      • Use approved gloves to handle all fuel and POL (petroleum, oil, lubricants) products.
      • Avoid cotton clothing, which holds perspiration in cold-weather environments.
      • Keep face and ears covered and dry.
      • Keep socks clean and dry.
      • Avoid tight socks and boots.

    Treatment

      • Immersion of the affected part in a warm (98-104°F) water is very effective, however most minor cases of frostbite can be re-warmed at room temperature or against a buddy’s skin.
      • Once a tissue is thawed, it must not freeze again. If there is the possibility of tissue refreezing, it is better not to thaw it in order to avoid damaging tissue further.
      • Avoid exposure to excessive heat (open flame, stove tops, steam, heat packs) or rubbing affected tissue.
      • All Soldiers with a peripheral freezing injury must be suspected of being hypothermic and treated appropriately. During field management, it is more important to prevent hypothermia than to rewarm frostbite rapidly

    NON-FREEZING COLD INJURY                                                                                                                   

    The most common non-freezing cold injuries are chilblain and trenchfoot. Trench foot occurs when tissues are exposed to temperatures from 32-60°F for prolonged periods of time (>12 hrs), whereas chilblains, which is a more superficial injury, can occur after just a few hours of exposure. A non-freezing cold injury is classified by the symptoms and stages of recovery.

    CHILBLAIN

    Chilblain is a non-freezing CWI that can occur after 1-5 hours in cold-wet conditions when skin temperature is > 32°F/0°C. The most commonly affected areas are the dorsal surface of the fingers, but the ears, face, and other exposed skin are also areas of occurrence. There are no lasting effects from chilblains.

    Cause

      • Continuous or repeated exposure of skin to cold/wet weather conditions at temperatures below 50 °F for more than 1-5 hours.

    Symptoms

      • Chilblain lesions are swollen, tender, itchy and painful.
      • With re-warming, the skin becomes swollen, red (or darkening of the skin in dark-skinned soldiers) and hot to the touch. An itching or burning sensation may continue for several hours after exposure.
      • Early diagnosis of chilblains becomes evident when symptoms do not resolve with re-warming. 

    Prevention

      • Use contact gloves to handle all equipment; never use bare hands.
      • Use approved gloves to handle all fuel and POL (petroleum, oil, lubricants) products.
      • In extreme cold environments, do not remove clothing immediately after heavy exertion (PT); wait until you are in a warmer location.
      • Avoid cotton clothing, which holds perspiration, in cold-weather environments.

    Treatment

      • Re-warm affected area, keep warm and dry.

    IMMERSION FOOT (TRENCH FOOT)                                                                                                          

    Cause

      • Prolonged (>12 hrs) exposure of tissue, especially the feet, to wet cold and conditions at 32°F to 60°F. Inactivity and damp socks and boots (or tightly laced boots that impair circulation) speed onset and severity.

    Symptoms

      • Cold, numb feet that may progress to hot with shooting pains.
      • Swelling, redness, and bleeding may become pale and blue.
      • Accompanied by aches, increased pain sensitivity and infection.

    Prevention

      • Keep feet clean and dry; change wet or damp socks as soon as possible.
      • Wipe dry the inside of Vapor Barrier boots dry at least once per day, or more often as feet sweat.
      • Dry leather boots by stuffing with paper towels.

    Treatment

      • Remove wet or constrictive clothing, gentle wash and dry affected extremities.
      • Elevate affected limbs and cover with layers of loose, warm, dry clothing.
      • Do not pop blisters, apply lotions or creams, massage, expose to extreme heat or permit Soldiers to walk, which can increase tissue damage and worsen the injury.
      • Evacuate for medical treatment.

     

    References

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    Army Policy

    OTSG Technical Reference

    Other Regulations

    Cold Injury Prevention Products

    Fact Sheets

  • USAPHC Fact Sheet: Wearing Army Combat Boots in Cold Weather
  • USAPHC Fact Sheet: Guidance on the Use of Heaters Inside Tents and Other Enclosed Shelters (2005)
  • Field Manuals and Technical Manuals

     
     Risk Management

    USARIEM References

    Training Aids

    Additional Information