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SECTION III

COLD WEATHER INJURIES

The primary injuries which threaten soldiers in cold weather are hypothermia, frostbite, chilblain, immersion syndrome, snowblindness, and sunburn. Any of these can cause debilitating injuries which diminish combat power for brief or extended periods. Hypothermia is the most dangerous because it may not be diagnosed early enough to reverse the condition. Hence, it can be fatal relatively quickly. Frostbite and immersion syndrome, while serious and which can result in the amputation of digits or extremities, are not normally fatal by themselves. However, soldiers suffering severe cases of frostbite or immersion syndrome which require hospitalization may be losses to their original unit. Snowblindness and sunburn injuries are normally debilitating only for brief periods; a soldier can usually return to duty in a few days.

COMBAT LIFESAVERS

As with other injuries that occur in the forward areas of the battlefield, cold injuries need immediate attention to save soldiers' lives. However, medical personnel may not be immediately available to apply life-saving measures. Because of this possibility, battalions, squadrons, and separate companies are required (by AR 350-41, Training in Units) ". . .to ensure that each squad, crew, or equivalent-sized unit has at least one member trained as a combat lifesaver." 1If wounded or injured soldiers cannot be turned over to medical personnel immediately, unit combat lifesavers should be called upon to identify cold injuries. They are authorized to apply certain field treatment measures "...to slow deterioration of a wounded soldier's condition until medical personnel arrive." 2Appropriate combat lifesaver actions are noted in the following discussions of cold injuries.

HYPOTHERMIA 3

Hypothermia is the condition of abnormally low core body temperature which results when heat loss exceeds the body's heat production. It occurs when body temperature drops to 95F or lower. Hypothermia is usually associated with cold climates, but it can occur even in warm climates during extended exposure in thunderstorms, hail, rain, and accompanying winds. When exposed, watch your soldiers carefully for signs of hypothermia.

Human cells, tissues, and organs operate efficiently only within narrow temperature limits. If our body temperature rises 2 degrees above the normal 98.6F, we may become ill. If it rises 7 degrees, we become critically ill. If our body temperature decreases 2 degrees, we feel cold. A 7-degree decrease puts our life in jeopardy. If it drops as low as 80F, death is likely.

We survive in cold environments because our intellectual responses enable us to deal effectively with environmental stress. We compensate for our physiological deficiencies with behavioral responses such as eating and drinking and creating microclimates through use of clothing, shelter, and the generation of heat. The diminished intellectual response evident in early stages of hypothermia (as well as altitude sickness, heat illness, and dehydration) dangerously impairs our ability to react to the stress of the extreme environment.

Hypothermia -- Signs and Symptoms 4

Signs and symptoms of hypothermia change as body temperature falls. Mental functions tend to decline first, and the soldier loses his ability to respond appropriately to the environment. Muscular functions deteriorate until he is too clumsy to walk or stand. Biochemical processes become slow and deficient as the body cools. Unfortunately, early signs and symptoms of hypothermia can be difficult to recognize and may easily go undetected. A victim may deny he is in trouble; believe the symptoms, not the victim.

• Mental signs. The soldier's decisionmaking ability deteriorates. His response to cold becomes slow, improper, or indifferent. His general state becomes apathetic and lethargic, and he expresses increased complaints. His cooperation in group activities decreases. He may also exhibit slurred speech, accompanied by disorientation progressing to incoherence, irrationality, and possible unconsciousness.

• Physical (muscular) signs. In the early and moderate stages of hypothermia, the soldier exhibits shivering. A hypothermic soldier loses fine motor ability, which may progress to stumbling, clumsiness, and falling. In severe cases, shivering ceases, and the soldier exhibits stiffness and inability to move.

Managing Hypothermia in the Field: Prevention, Detection, Evacuation 6

Leaders and soldiers should understand that prevention of hypothermia is vital to sustaining combat power. In the cold environment, leaders must be continually aware of the condition of their soldiers and be especially alert for signs and symptoms of cold injury. Prevention, early detection, and immediate evacuation are the leader initiatives through which hypothermia should be managed in the field.

Prevention involves the proper use of clothing and equipment by soldiers and continual interaction by leaders with their troops. If efforts to prevent hypothermia fail, the leader must be able to detect cold injuries at their onset. To do so, leaders must circulate among their soldiers and be alert for cold injury signs and symptoms, as noted in the table above. While taking body temperatures would not be practical (even if adequate thermometers were available), leaders should be able to detect signs and symptoms (see table above) which are either out of the ordinary for a particular soldier or which point to hypothermia or other cold injury.

When hypothermia is detected in its early stage, a soldier may respond well to the removal of the cold stress. In the absence of a serious underlying medical condition, the chances for successful rewarming are good. While we cannot change the air temperature, we can replace wet clothing with dry, protect the soldier from the wind, add layers of insulation, and apply heat. 7Keep in mind that a rewarmed soldier should not return to the cold until his energy and fluid reserves have been replenished. After rewarming from the early stage of hypothermia, the soldier should be given a good hot meal, several quarts of liquids, and adequate rest before returning to duty. A fatigued or dehydrated soldier is a strong candidate for another episode of hypothermia. 8

If a chilled or cold soldier does not respond immediately to basic rewarming efforts, or if he continues to exhibit symptoms of hypothermia, the soldier may be in a more advanced stage of hypothermia than initially thought, and the leader should immediately initiate action to evacuate the soldier to a medical facility.

In severe cases of hypothermia, the patient produces little or no heat and, in the absence of external heat sources, may cool further. Immediate evacuation is the preferred action for casualties suffering severe hypothermia. If immediate evacuation is possible, treatment should not be undertaken in the field. Do not delay evacuation to attempt rewarming. Rapid rewarming may lead to "rewarming shock."

A cold heart is also susceptible to abnormal rhythms such as ventricular fibrillation -- random quivering of the heart that fails to pump blood. Jarring or bouncing, almost inevitable in transporting a patient on the battlefield, can trigger this rhythm. 9There may also be complications from an underlying medical condition, wound trauma, and complex disturbances in the body's biochemical balance. 10

During evacuation, the soldier should be insulated from the cold surfaces of a vehicle or sled. A windproof outer layer will reduce the patient's convective and evaporative heat loss. Wet clothing must be replaced with dry. 11If the patient is conscious and alert, he can be given warm liquids to drink (being careful not to burn him) and simple, sweetened foods to eat, including candy bars. Carbohydrates are the fuel most quickly transformed into heat and energy. However, hot liquids should not be given by mouth to a severely hypothermic soldier. 12If the patient is semiconscious, try to keep him awake.

COMBAT LIFESAVER TREATMENT FOR HYPOTHERMIC CASUALTIES 13

The preferred field management practice is to immediately evacuate the hypothermic casualty. If immediate evacuation is not possible, a unit combat lifesaver should proceed with the following measures to slow further deterioration of the hypothermic soldier's condition.

Moderate Hypothermia

Move the casualty out of the wind to a sheltered environment. Replace wet clothing with dry clothing or sleeping bags. Cover the casualty with blankets or other insulating material. Apply heating pads (if available) wrapped in towels to the casualty's armpits, groin, and abdomen. Give the casualty warm, nutritious fluids to drink. Do not give alcoholic beverages or tobacco products to the casualty. Wrap the casualty from head to toe and evacuate to a medical treatment facility in a recumbent (lying down) position.

Severe Hypothermia

Cut away wet clothing and replace with dry clothing. Ensure that the casualty's airway remains open, but do not use an oropharyngeal airway (J-tube). Perform mouth-to-mouth resuscitation if the casualty's breathing rate drops below five respirations per minute.

Apply an additional heat source. The casualty's body is not able to generate sufficient body heat and must receive warmth from another source. One method is to place the casualty in a sleeping bag with his outer clothing removed and have another soldier remove his outer clothing and get into the sleeping bag also. Cover both soldiers with additional clothing. The casualty's body will absorb the heat given off by the second soldier's body.

Evacuate the casualty to a medical treatment facility as soon as possible. Evacuate the casualty even if you cannot detect respiration or a heartbeat. Handle the casualty gently.

FROSTBITE 14

Frostbite is the freezing or crystallization of living tissues. Exposure time can be minutes or instantaneous if skin is directly exposed to extreme cold or high winds. Heat loss occurs faster than it can be replaced by blood circulation, and is compounded by intense cold and inactivity. The extremities (fingers, toes, and ears) and face are affected first. Damp hands and feet may freeze quickly since moisture conducts heat away from the body and destroys the insulating value of clothing. The extent of frostbite depends on temperature and duration of exposure. Frostbite is one of the major nonfatal cold-weather injuries encountered in military operations. With proper clothing and equipment, properly maintained and used, frostbite can be prevented.

Categories of Frostbite 15

• Superficial Frostbite (mild). This category of frostbite involves only the skin. The skin usually appears white to grayish. The surface will feel very stiff or hard, but the underlying tissue will be soft.

• Deep Frostbite (severe). Deep frostbite extends beyond the first layer of skin and may include the bone. Joint movement may be absent or restricted depending on the extent of the injury. Discoloration is the same as for superficial frostbite, but the underlying tissue is hard. If a large area is frostbitten, such as an entire foot or hand, tissues may appear purple as the result of sludging of blood within the vessels. (A blackened appearance will be noticed after the injury has thawed.) This category of frostbite requires immediate evacuation to a medical facility.

Contributing Factors 16

• Dehydration.

• Below-freezing temperatures and wind chill.

• Skin contact with super-cooled metals or liquids.

• Use of caffeine, tobacco, or alcohol.

• Constriction of an extremity, which may be caused by tight boots, gloves, gaiters, watchbands, or confinement in a cramped position, may reduce blood flow and increase the likelihood of frostbite. 17

• Neglect.

Signs of Frostbite Injury 18

Signs of frostbite vary and may include a cold feeling, pain, burning, followed by numbness as it progresses in severity. The skin turns pale or grayish, appearing frosty or waxy white. The skin may feel hard, may not be movable over the joints and bony prominence, or may be frozen. The level of deep frostbite cannot be determined in the field. The extent of injury may not be fully realized until the frozen part has been thawed at a medical facility. It may then take three to seven days (or longer) for medical personnel to ascertain the extent of injury. Blisters, swelling, and pain may occur after thawing.

Field Management of Frostbite Injuries 19

The buddy system is one of the prime preventative measures of frostbite. Buddies must watch each other for signs of frostbite and provide mutual aid if frostbite occurs. Frostbite should be identified early -- with prompt first-aid care applied to prevent further damage.

Early signs of superficial frostbite may respond to simple rewarming using skin-to-skin contact or by sheltering the body part under the clothing next to the body. However, if tissues freeze, evacuate the victim immediately, before the frozen area begins to thaw.

Thawing of a frostbitten victim is a medical procedure. Field thawing should not be attempted by nonmedical personnel. If the victim has frozen extremities, apply first aid, protect the frozen areas and evacuate as a litter casualty. Give the casualty liquids and keep him comfortable during evacuation.

If frostbite is not recognized before it thaws, do not let the area refreeze since this causes more damage and may require amputation. The most often affected body parts are the hands, fingers, toes, feet, ears, chin, and nose. Apply first aid, protect the injured area, and evacuate.

If evacuation of the victim as a litter case is not possible and the body part has not yet thawed, self-evacuation may be tactically necessary. It is better to walk out on frozen feet than to have them thaw and refreeze. If required, the soldier can walk many miles on frozen feet. It is impossible to walk far on thawed feet. When medical evacuation is not possible, walking evacuation may be the only course of action available to save the life of the injured soldier. Walking on frozen feet does less harm than walking on thawed feet.

Do not rub frostbitten parts -- the crystallized tissues may break internally and cause more damage. Do not lance blisters; cover them with a sterile dressing. Apply first aid and protect the affected area.

COMBAT LIFESAVER TREATMENT FOR FROSTBITE 21

Move the casualty to a sheltered area. Loosen constricting clothing. Remove jewelry. Gradually warm the casualty. (If possible, have the casualty warm himself. Apply local warming by putting bare hands over the affected area of the face or putting affected hands inside the uniform under the armpits. If a casualty has a frostbitten foot, have him remove his boot and sock from affected foot, have another soldier open his clothing to expose his abdomen, have the casualty put his foot against the soldier's abdomen, and have the soldier close his clothing over his abdomen and the casualty's foot.)

• DO NOT expose the frostbitten area to extreme heat which could result in burns.

• DO NOT apply ointments or medications to the frostbitten area.

• DO NOT rub, massage, or soak the frostbitten area.

• DO NOT not give alcoholic beverages or tobacco products to the casualty.

• Give the casualty something warm to drink.

• Protect the frostbitten area from cold and additional injury.

• Evacuate the casualty to a medical treatment facility as soon as possible.

CHILBLAIN 22

Chilblain is caused by prolonged exposure of bare skin to cool or cold temperatures (50F (10C) or lower). Signs and symptoms of chilblain include acutely red, swollen, hot, tender, and/or itching skin. Open sores or bleeding lesions may result from continued exposure.

COMBAT LIFESAVER TREATMENT FOR CHILBLAIN 23

Apply local warming (putting bare hands over the affected area on the face; putting affected hands inside the uniform under the armpits; putting bare feet against the abdomen of another soldier). Do not rub or massage the affected area. Rubbing or massaging the area may cause tissue damage. Signs and symptoms of tissue damage may be slow to appear. Apply a field dressing to lesions. Have medical personnel evaluate the casualty when practical.

IMMERSION SYNDROME 24

Immersion syndrome results from prolonged exposure (hours to days) to wet conditions at temperatures from 50F to 32F. Immersion syndrome occurs when cold, wet conditions constrict blood vessels. Immersion foot, trench foot, and trench hand are types of immersion syndrome injuries. Reduced blood flow to the extremity deprives cells of needed oxygen and nutrients. 25Permanent muscle and nerve damage may result if this cold injury is allowed to develop. For the soldier, regular attention to his feet -- drying them and changing to clean dry socks once a day, or more often if his feet get wet -- is all that is needed to prevent immersion foot or trench foot.

Signs and Symptoms of Immersion Syndrome

The extremity appears cold, swollen, and mottled. Cyanosis, a blueness of the skin resulting from imperfectly oxygenated blood, is usually present. Tactile sensitivity is reduced, as is capillary refill time. The extrimity may look shiny. The patient may describe the affected area as feeling wooden. 26

Immersion syndrome usually occurs in three stages. In the first phase, the affected part is cold and without pain. There is a weak pulse at the site. In the second phase, the affected limb feels hot, as though burning, and has shooting pains. In the third phase, the casualty has pale skin, cyanosis around the nailbeds and lips, and decreased pulse strength. 27

When the extremity rewarms, the skin becomes warm, dry, and red. The pulse bounds and the injury is painful. The injured area may itch, tingle, and exhibit increased sensitivity to cold, possibly permanently. Recovery can last weeks. Nerve damage may be permanent. The development of blisters, ulcers, and gangrene is possible. Amputation may also be necessary. 28

Field Management of Immersion Syndrome 29

Areas affected by immersion syndrome should be warmed slowly at room temperature. In serious cases, swelling, pain, and blisters will prevent walking. In most cases, the extremity will be sore. Soldiers should avoid walking on injured feet, and the feet should be elevated to reduce swelling. Bed rest and avoidance of trauma are necessary until the injury heals. Soldiers who suffer severe immersion syndrome may be cold-weather casualties for an extended period.

COMBAT LIFESAVER TREATMENT FOR IMMERSION SYNDROME 30

Dry the affected part immediately. Rewarm the affected area gradually in warm air. Do not massage the extremity. The affected area will probably become swollen, red, and hot to the touch after it has been rewarmed. Blisters may form. Remove wet clothing and replace with dry, warm clothing. Protect the casualty from injury and infection. Elevate the affected part to reduce edema (swelling). Evacuate to a medical treatment facility as soon as practical.

SNOWBLINDNESS 31

Snowblindness is a temporary, but often painful, condition caused by inadequate eye protection when operating in brilliant sunshine reflecting off snow or light-colored rock. The eyes become bloodshot, feel irritated and "full of sand." The proper field management technique is to apply clean, cool, wet compresses to the eyes. The patient should then wear dark, UV-protective glasses. Aspirin can be used to control the pain. Occasionally, it may be necessary to cover the patient's eyes and lead him by the hand to an area where treatment can be administered. Recovery may take two or three days.

SUNBURN 32

Sunburn, often associated with a summer day at the beach, can also become a debilitating cold weather injury. Both first and second degree burns are possible in cold weather operations. First degree burns involve reddening of the skin; second degree burns are characterized by the formation of blisters. Mountain climbers are especially vulnerable to sunburn because they often operate at high altitude environments covered with highly reflective snow fields. The relatively thinner air allows more of the burning rays of the sun to penetrate the atmosphere and reflect off of the snow. Because the air temperature seems relatively cold, soldiers may miscalculate the intensity of the sun or simply be too weary to take preventive action.

Clothing provides adequate coverage of the skin; however, exposed areas, such as the face, lips, neck, ears, and bare hands, are susceptible to sunburn. In addition, reflection from snow can cause burns in areas not ordinarily affected, such as under the chin, around the eyes, inside the nostrils and ears, and even on the roof of the mouth. Lack of a hat, where hair is short, thin, or absent, may result in scalp burns. As with any burn -- from sun, rope, or fire -- if the affected area is large, toxic substances absorbed by the body can cause generalized illness.

Sunburn usually is treated on first notice by further applications of sunburn preventive. Sun screens/blocks should be used rather than the more common cosmetic suntan preparations. In mild cases, sunburned soldiers can continue their duties even though they may suffer significant discomfort for a few days. In more severe cases, such as second degree sunburn (with blister formation), soldiers should be treated by medical personnel who can assess the impact of their injuries on their assigned duties. If there is much swelling, cold compresses should be applied.

Aspirin may be taken for pain, and warm liquids should be administered to replenish body fluids. (Salty liquids can be administered if prescribed by medical personnel. If sunburned soldiers drink salt solutions without medical monitoring, they may become nauseated and vomit, thus compounding their dehydrated state.33)

OTHER CONDITIONS RELATED TO COLD WEATHER OPERATIONS

In addition to the injuries directly related to exposure to the cold environment, other physiological conditions can develop which impair soldier performance. These include dehydration, constipation, carbon monoxide poisoning, and tent eye.

DEHYDRATION

Dehydration is a deficiency in body fluids that inhibits body functions. 34It adversely affects the body's resistance to cold injury. It can cause serious physical problems and make the soldier more susceptible to other problems, such as frostbite and hypothermia. 35Proper hydration is essential to supplying fuel and energy to body parts to facilitate heat production. Dehydration contributes to poor soldier performance in physical activities, even more so than lack of food. 36It also adversely affects soldiers' mental attitudes; irritability is an early sign.

Cold weather requirements for water are no different than in the desert and may, in fact, exceed desert requirements because of the increased energy expended in operating with additional layers of clothing and trudging through the snow. At high altitudes, the air is very dry; when combined with a rapid rate of respiration, as much as two quarts of fluid per day may be lost just in breathing. Soldiers need approximately four to six quarts of water per day to prevent dehydration when living and performing tasks in cold environments or mountainous regions.

Factors Contributing to Dehydration 37

The thirst mechanism does not function properly in cold weather. Soldiers tend to not feel as thirsty as they do when operating in warmer climates. In cold weather operations, water is often inconvenient to obtain and purify. It may take 45-60 minutes to melt and purify enough snow to sustain body hydration. (The contact time for water purification tablets in water is 30 minutes before drinking.38) There also tends to be a lack of moisture in the air in cold environments, especially at high altitudes. Cold also causes more frequent urination.

Signs of Dehydration 39

In addition to irritability, other signs of dehydration include darkening urine, decreased amounts of urine being produced, dry mouth, tiredness, mental sluggishness, lack of appetite, increased or rapid heartbeat, dizziness, and even unconsciousness.

Alleviating Dehydration 40

The most important consideration is prevention. Leaders should ensure that soldiers consume four to six quarts of fluid per day. Coffee and liquids containing caffeine (tea, cocoa, soft drinks) should not be considered adequate sources for replenishing body fluids because they act as a diuretic, removing fluids from the body. Drinks containing caffeine should only be consumed in moderation -- not as the primary means of hydration. Alcoholic beverages also contribute to dehydration and should never be consumed during operations.

If the soldier is conscious, administer fluids by mouth. If improvement is not obvious in an hour, evacuate the patient to a medical facility. In advanced stages of dehydration, as in the case of an unconscious soldier, immediately evacuate the patient to a medical treatment facility.

CONSTIPATION 41

Constipation is the difficulty in passing feces caused by a deficiency in body fluids (dehydration), improper nutrition, infrequent or irregular defecation, or ignoring nature's call altogether for extended periods.

Factors Contributing to Constipation 42

Contributing factors include the unavailability of water, lack of sites protected from the elements to facilitate normal body functions, and not eating the food provided. Symptoms of constipation include loss of appetite, headache, cramping, and painful defecation.

Alleviating Constipation 43

Treatment involves the consumption of adequate amounts and variety of foods and water (four to six quarts per day), and responding to nature's call to rid the body of waste. High fiber foods, especially fruits, vegetables, and whole grain breads, are effective in combating constipation if accompanied by regular and adequate amounts of water. If constipation is allowed to progress beyond the self-care stage, medical treatment is necessary.

CARBON MONOXIDE POISONING 44

Carbon monoxide poisoning occurs when oxygen in the body is replaced by carbon monoxide. For soldiers, the main contributing factor is inhalation of fumes produced by fires in areas that lack proper ventilation. Stoves and heaters in tents, and running vehicle engines in which fumes leak into the cab or cargo areas, are primary sources of carbon monoxide poisoning.

Signs and Symptoms of Carbon Monoxide Poisoning 45

Signs and symptoms of carbon monoxide poisoning progress slowly. At the onset, they may go unnoticed because carbon monoxide is colorless, tasteless, and odorless. Many of the signs and symptoms are similar to other common illnesses: headache, tiredness, excessive yawning, confusion, followed by unconsciousness and, eventually, death. A cherry-red coloring to the tissues of the lips, mouth, and inside the eyelids occurs very late in carbon monoxide poisoning -- when the patient is very near death. If this condition occurs, it may be too late to save the soldier. Action must be taken when earlier signs and symptoms appear.

First Aid for Carbon Monoxide Poisoning 46

Immediately remove the victim from the source of contamination. If the soldier is not breathing on his own, administer rescue breathing. If available, give the soldier oxygen. Then, immediately evacuate the soldier to a medical facility; severe complications can develop, even in casualties who appear to have recovered perfectly.

Prevention is the key. Carbon monoxide poisoning can be prevented if unit leaders enforce a few simple rules:

• Don't permit soldiers to sleep in vehicles while engines are operating.

• Ensure tent stoves and heaters are regularly serviced and inspected to confirm safe operation; ensure that sleeping tents have proper ventilation.

TENT EYE 47

Tent eye is caused by fumes emanating from stoves and lanterns operated in a poorly ventilated shelter. It can be prevented by using properly functioning stoves and lanterns, and adequately ventilating the shelter. First aid for tent eye is fresh air.

CASUALTY EVACUATION 48

Helicopters, if available, are the preferred method of evacuation for injured or wounded soldiers; however, ground evacuation should always be planned. Cold injuries, as with all serious wounds and injuries, need prompt medical intervention. Helicopters provide rapid, direct transport of casualties to medical facilities. Generally, they also provide a smoother, less intrusive ride for the patient. However, helicopter operations are somewhat more affected by weather phenomena than are other means of patient transport. In the winter, other forms of transportation can also be affected by adverse weather conditions which can make ground transport treacherous. Helicopters, weather and tactical conditions permitting, can also get to areas that are inaccessible to ground vehicles.

Ground ambulance is the second choice for patient evacuation -- but it should always be the planned method of evacuation. Units should plan on using ground transportation and regard helicopter evacuation as a bonus if it becomes available. Units operating in snowy terrain should have small unit support vehicles (SUSVs) available for medical evacuation. In wintry conditions, these tracked vehicles are preferred over wheeled vehicles, especially if the casualty is located in a remote, roadless area.

The least preferred method of casualty transport is by sled. However, terrain and weather conditions can prevent a vehicle from reaching the casualty's position. The decision, then, is whether to risk further injury to the patient and possible injury to a sled team by attempting an evacuation on foot. Keeping the casualty where he is and obtaining medical advice by radio until an evacuation vehicle can reach the patient may be the only option.

SUMMING UP COLD WEATHER INJURIES: PREVENTION IS THE KEY

Cold injuries are always a possibility in cold environments. If allowed to develop, they can be debilitating to soldiers, diminishing a unit's combat power. However, leaders and soldiers can successfully avoid hypothermia, frostbite, and other adverse cold weather-related conditions 24 hours a day by practicing prevention.

Attentive leadership is essential to ensure soldiers have, and are using, available cold weather clothing and equipment. A buddy system reinforces attentive leadership and helps the soldier monitor the fitness of a fellow soldier to ensure the buddy is eating properly, drinking adequate amounts of water, dressing warmly, and that individual and unit equipment is maintained and functional. During cold weather operations, leaders must continually check the fitness of their soldiers as well as the adequacy and condition of their clothing and equipment.

Rapid evacuation of cold weather casualties is essential to minimize long-term effects of cold injuries and to save lives. Helicopter evacuation is the preferred method of transport; however, ground evacuation should always be planned. Risks to the patient, the unit, and the mission must be assessed.

______________

1Chapter 12, AR 350-41, Training in Units, 19 April 1993, p. 22.

2 Ibid., p. 22.

3Tod Schimelpfenig and Linda Lindsey, NOLS Wilderness First Aid, 2d edition (1993), published by the National Outdoor Leadership School and Stackpole Books, pp. 160-165.

4Ibid., pp. 161-163.

5Adapted from MOUNTAINEERING, The Freedom of the Hills, edited by Ed Peters, p. 436.

6 Schimelpfenig and Lindsey, pp. 164-165.

7 Ibid., pp. 164-165.

8 Ibid., p. 167.

9 Ibid., pp. 164-165.

10 Ibid., p. 165.

11Ibid., p. 168.

12Peters, p. 438.

13Medical Tasks, Combat Lifesaver Course, Subcourse IS 0825, Edition A, The Army Institute for Professional Development, Army Correspondence Course Program, pp. 81-82.

14Adapted from TC 90-6-1, pp. 1-46 to 1-48.

15 Ibid., p. 1-46.

16Ibid., p. 1-46.

17 Schimelphenig and Lindsey, p. 170.

18 TC 90-6-1, p. 1-46.

19Ibid., p. 1-47.

20Schimelphenig and Lindsey, p. 170.

21Medical Tasks, pp. 80-81.

22Ibid., p. 78.

23 Ibid., p. 78.

24Ibid., p. 78.

25Schimelphenig and Lindsey, p. 173.

26Ibid., p. 175.

27 Medical Tasks, p. 78.

28Schimelphenig and Lindsey, p. 175.

29 Ibid., p. 176.

30Medical Tasks, p. 79.

31Peters, p. 443.

32Ibid., p. 443.

33 USAMEDDC&S comment to coordinating draft, on file at CALL.

34Winter Operations Manual, p. 7-2.

35TC 21-3, Soldier's Handbook for Individual Operations and Survival in Cold-Weather Areas, May 1986, p. 86.

36Winter Operations Manual, p. 7-2.

37Ibid., p. 7-5.

38USAMEDDC&S comment to coordinating draft, on file at CALL.

39 Winter Operations Manual, p. 7-5.

40Ibid., p. 7-5.

41Ibid., p. 7-5.

42 Ibid., p. 7-5.

43 Ibid., p. 7-5.

44Ibid., pp. 7-5 to 7-6.

45 Ibid., p. 7-5.

46Ibid., p. 7-6.

47Ibid., p. 7-7.

48Ibid., p. 7-11.

Section II: Combating the Cold

Section IV: Leadership in Cold Weather Operations