Cold-Weather Operations:
Wounds, Disease, and Nonbattle Injuries

Cold weather seriously degrades medical operations in the field. Combat casualties are more susceptible to cold injuries, and the cold weather can constrain field medical treatment and evacuation. Furthermore, the incidence of disease and nonbattle injuries is increased during cold-weather operations.

Cold weather seriously affects care of battle casualties.

1. Medical equipment, medications and medication containers (e.g. IV containers, drug ampules) may freeze. Administration of intravenous medications or fluids is difficult in subfreezing temperatures due to freezing of solutions in lines or containers. Cold-weather clothing can make it more difficult to check the casualty for wounds and initiate treatment.

   a. Keep liquid medications and medical equipment from freezing. Store medications and medical equipment in heated areas of vehicles and shelters whenever possible to prevent freezing. Some liquid medications can be carried inside the clothing of medical personnel where body heat will prevent freezing. IV fluid bags (with required tubing attached by tape) can be distributed to individual Soldiers who can carry the bag inside their clothing.

   b. Extra clothing and blankets should be available for use by patients during treatment and evacuation, especially when their clothing has become torn or soaked in blood. Check patients awaiting treatment and evacuation for cold injuries frequently.

   
   

   
   

2. Shock may develop more rapidly and more severely when casualties are exposed to cold weather. Blood loss and shock increase susceptibility to frostbite and hypothermia. Sick or injured persons are often unable to sense the development of frostbite.
   

   TREATMENT FOR SHOCK: 1. KEEP WARM BY PLACING IN SLEEPING BAG OR SUBSTITUTE 2. RAISE LEGS ABOVE HEAD LEVEL, UNLESS PATIENT'S HEAD IS INJURED 3. LOOSEN CLOTHING WITHOUT COMPROMISING PROTECTION FROM COLD 4. IF CONSCIOUS, PROVIDE WARM DRINKING FLUIDS 5. MINIMIZE DISCOMFORT AND PROVIDE REASSURANCE

   
   

3. Evacuation procedures may require modification. Litter bearers fatigue quickly in snow, ice, or mud, slowing evacuation and putting the rescuers at risk of overexertion and cold injury. Mobile ground transport may be limited by road conditions. Air evacuation is limited by weather conditions. Open vehicles and aircraft can create tremendous windchill, requiring measures to protect patients from cold injury during transport.

The widespread use of stoves and heaters in tents, other types of shelters, and vehicles during cold weather operations pose a risk of burns and injuries from unventilated exhaust fumes.

1. Burns result from contacting hot surfaces, fires, or explosions of stoves and fuel sources. Improper fueling and lighting techniques or inadequate ventilation can result in the accumulation of flammable fumes into the tent or shelter. When ignited, these gases may cause potentially fatal fires.

   IMMEDIATE FIRST AID FOR BURNS: 1. MOVE CASUALTY AWAY FROM FIRE, REMOVE BURNING OR SMOLDERING CLOTHING 2. CUT AWAY CLOTHING OVER AND AROUND THE BURN UNLESS IT IS STUCK TO THE WOUND 3. COVER BURN WITH DRY, STERILE DRESSING, TIED AT EDGE OF (NOT OVER) THE BURN 4. DO NOT APPLY OINTMENTS, SNOW, OR ICE TO THE BURN, AND DO NOT BREAK BLISTERS

   
   

2. "Tent eye" is an inflammation and irritation of the eyes caused by exposure to fuel fumes which can accumulate in poorly ventilated shelters. Rubbing "itchy" eyes can subsequently lead to eye infection.

3. Carbon monoxide (CO) is a poisonous gas which cannot be seen or smelled, and is contained in exhaust from stoves and vehicles. CO can build up in closed spaces without being noticed. Soldiers seeking shelter from the cold in poorly ventilated shelters or vehicles with the engine idling often become victims of CO poisoning. Early signs of CO poisoning are headache, confusion, dizziness, or drowsiness. The lips and skin can become bright red. Victims will loose consciousness, and eventually die. Any person found unconscious in a closed tent or vehicle should be suspected of possible CO poisoning.
   

   FIRST AID FOR TENT EYE AND CARBON MONOXIDE POISONING: 1. MOVE CASUALTY TO FRESH AIR 2. ADMINISTER CPR IF NEEDED 3. REFER TO MEDICAL TREATMENT FACILITY FOR EVALUATION AND CARE

Accidents due to slipping, sliding, falling, and vehicular accidents will be more frequent during cold-weather operations.

1. Paths, walkways, and roads are frequently muddy or frozen. Heat escaping from the entrances of tents and buildings can cause cycles of thawing and freezing of the ground surface, which makes these areas particularly hazardous.

2. Fatigue, the hobbling effect of clothing, and the effect of hoods and hats on vision and hearing will also contribute to accidents and falls.

Source: SUSTAINING HEALTH & PERFORMANCE IN COLD WEATHER OPERATIONS