First Aid for Soldiers FM 21-11
FM 21-11 First Aid for Soldiers: Chapter 5
First Aid for Climatic Injuries
Headquarters, Department of the Army, Washington, D.C., October 27, 1988
INTRODUCTION
It is desirable, but not always possible, for an individual's body to become adjusted
(acclimatized) to an environment. Physical condition determines the time adjustment, and
trying to rush it is ineffective. Even those individuals in good physical condition need
time before working or training in extremes of hot or cold weather. Climate-related
injuries are usually preventable; prevention is both an individual and leadership
responsibility. Several factors contribute to health and well-being in any environment:
diet, sleep/rest, exercise, and suitable clothing. These factors are particularly
important in extremes of weather. Diet, especially, should be suited to an individual's
needs in a particular climate. A special diet undertaken for any purpose should be done so
with appropriate supervision. This will ensure that the individual is getting a properly
balanced diet suited to both climate and personal needs, whether for weight reduction or
other purposes. The wearing of specialized protective gear or clothing will sometimes add
to the problem of adjusting to a particular climate. Therefore, soldiers should exercise
caution and judgment in adding or removing specialized protective gear or clothing.
Heat injuries are environmental injuries that may result when a soldier is exposed to
extreme heat, such as from the sun or from high temperatures. Prevention depends on
availability and consumption of adequate amounts of water. Prevention also depends on
proper clothing and appropriate activity levels. Acclimatization and protection from undue
heat exposure are also very important. Identification of high risk personnel (basic
trainees, troops with previous history of heat injury, and overweight soldiers) helps both
the leadership and the individual prevent and cope with climatic conditions. Instruction
on living and working in hot climates also contributes toward prevention.
NOTE
Salt tablets should not be used in the prevention of heat injury. Usually, eating field
rations or liberal salting of the garrison diet will provide enough salt to replace what
is
lost through sweating in hot weather.
a. Diet. A balanced diet usually provides enough salt even in hot weather. But
when people are on reducing or other diets, salt may need to come from other sources. DO
NOT use salt tablets to supplement a diet. Anyone on a special diet (for
whatever purpose) should obtain professional help to work out a properly balanced diet.
b. Clothing
(1) The type and amount of clothing and equipment a soldier wears and the way he wears
it also affect the body and its adjustment to the environment. Clothing protects the body
from radiant heat. However, excessive or tight-fitting clothing, web equipment, and packs
reduce ventilation needed to cool the body. During halts, rest stops, and other periods
when such items are not needed, they should be removed, mission permitting.
(2) The individual protective equipment (IPE) protects the soldier from
chemical and biological agents. The equipment provides a barrier between him and a toxic
environment. However, a serious problem associated with the chemical overgarment is heat
stress. The body normally maintains a heat balance, but when the overgarment is worn
the body sometimes does not function properly. Overheating may occur rapidly. Therefore,
strict adherence to mission oriented protective posture (MOPP) levels directed by
your commander is important. This will keep those heat related injuries caused by wearing
the IPE to a minimum. See FM 3-4 for further information on MOPP.
c. Prevention. The ideal fluid replacement is water. The availability of
sufficient water during work or training in hot weather is very important. The
body, which depends on water to help cool itself, can lose more than a quart of water per
hour through sweat. Lost fluids must be replaced quickly. Therefore, during these work
or training periods, you should drink at least one canteen full of water every hour.
In extremely hot climates or extreme temperatures, drink at least a full canteen of water
every half hour, if possible. In such hot climates, the body depends mainly upon sweating
to keep it cool, and water intake must be maintained to allow sweating to continue. Also,
keep in mind that a person who has suffered one heat injury is likely to suffer another.
Before a heat injury casualty returns to work, he should have recovered well enough not to
risk a recurrence. Other conditions which may increase heat stress and cause heat injury
include infections, fever, recent illness or injury, overweight, dehydration, exertion,
fatigue, heavy meals, and alcohol. In all this, note that salt tablets should not be
used as a preventive measure.
d. Categories. Heat injury can be divided into three categories: heat cramps,
heat exhaustion, and heatstroke.
e. First Aid. Recognize and give first aid for heat injuries.
WARNING
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
control.
*CAUTION
DO NOT use salt solution in first aid procedures for heat injuries.
WARNING
DO NOT loosen the casualty's clothing if in a chemical environment.
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(3) Check the casualty for signs and symptoms of heatstroke (sometimes
called "sunstroke") (081-831-1008).
WARNING
Heatstroke must be considered a medical emergency which may result in death if
treatment is delayed.
-
Signs/Symptoms. A casualty suffering from heatstroke has usually worked in a
very hot, humid environment for a prolonged time. It is caused by failure of the body's
cooling mechanisms. Inadequate sweating is a factor. The casualty's skin is red (flushed),
hot and dry. He may experience weakness, dizziness, confusion, headaches seizures, nausea
(stomach pains), and his respiration and pulse may be rapid and weak. Unconsciousness and
collapse may occur suddenly.
-
Treatment. Cool casualty immediately by--
o Moving him to a cool or shaded
area (or improvise shade).
o Loosening or removing his clothing (except in a chemical environment).
*o Spraying or pouring water on him; fanning
him to permit a coolant effect of evaporation.
o Massaging his extremities and skin which increases the blood flow to those body
areas, thus aiding the cooling process.
o Elevating his legs.
o Having him slowly drink at least one canteen full of water if he is conscious.
NOTE
Start cooling casualty immediately. Continue cooling while awaiting
transportation
and during the evacuation.
-
Medical aid. Seek medical aid because the casualty should be transported to a
medical treatment facility as soon as possible. Do not interrupt cooling process or
lifesaving measures to seek help.
-
Casualty should be continually monitored for development of conditions which may require
the performance of necessary basic lifesaving measures, such as clearing the airway,
mouth-to-mouth resuscitation, preventing shock, and/or bleeding control.
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f. Table. See Table 5-1 for further
information.
Table 5-1 Sun or Heat Injuries (081-831-1008)
INJURIES |
SIGNS/SYMPTONS |
FIRST AID*
|
Heat cramps |
The casualty experiences muscle cramps of arms, legs, and/or stomach. The
casualty may also have heavy sweating (wet skin) and extreme thirst. |
1. Move the casualty to a shady area or improvise shade and loosen his clothing.+
2. Give him large amounts of cool water slowly.
3. Monitor the casualty and give him more water as tolerated.
4. Seek medical aid if the cramps continue. |
Heat exhaustion |
The casualty often experiences profuse (heavy) sweating with
pale, moist, cool skin; headache, weakness, dizziness, and/or loss of appetite.
The casualty sometimes experiences heat cramps, nausea (with or without
vomiting), urge to defecate, chills (gooseflesh), rapid breathing, confusion, and tingling
of the hands and/or feet |
1. Move the casualty to a cool, shady area or improvise shade and loosen/remove his
clothing.+
2. Pour water on him and fan him to permit coolant effect of evaporation.
3. Have him slowly drink at least one canteen full of water.
4. Elevate the casualty's legs.
5. Seek medical aid if symptoms continue; monitor the casualty until the symptoms are gone
or medical aid arrives. |
Heatstroke#
(sunstroke) |
The casualty stops sweating (red [flushed] hot, dry skin). He first may
experience headache, dizziness, nausea, fast pulse and respiration, seizures, and mental
confusion. He may collapse and suddenly become unconscious.
THIS IS A MEDICAL
EMERGENCY. |
1. Move the casualty to a cool, shady area or improvise shade and loosen or remove the
outer garments and protective clothing if the situation permits.+
*2. Start cooling the casualty immediately. Spray
or pour water on him. Fan him. Massage his extremities and skin.
3. Elevate his legs.
4. If conscious, have him slowly drink at least one canteen full of water.
5. SEEK MEDICAL AID. CONTINUE COOLING WHILE AWAITING TRANSPORT AND DURING EVACUATION.
EVACUATE AS SOON AS POSSIBLE. PERFORM ANY NECESSARY LIFESAVING MEASURES.
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* The first aid procedure for heat
related injuries caused by wearing individual protective equipment is to move the
casualty to a clean area and give him water to drink.
+ When in a chemical environment, DO NOT loosen/remove the
casualty's clothing.
# Can be fatal if not treated promptly and correctly.
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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 protective clothing.
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--
-
Often in contact with the ground.
-
Immobile for long periods, such as while riding in a crowded vehicle.
-
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.
(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.
CAUTION
In a chemical environment DO NOT take off protective chemical gear.
(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.
NOTE
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.
(1) Chilblain.
-
Signs/Symptoms. Chilblain is caused by repeated prolonged exposure of bare skin
at temperatures from 60¡F, to 32¡F, or 20¡F 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 immediate importance.
(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 32¡F. 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 means possible.
-
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), and gangrene.
-
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.
(3) Frostbite. Frostbite is the injury of tissue caused from exposure to cold,
usually below 32¡F 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, or feet.
WARNING
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
control.
-
Progressive signs/symptoms (081-831-1009).
o Loss of sensation, or
numb feeling in any part of the body.
o Sudden blanching (whitening) of the skin of the affected part, followed by a
momentary "tingling" sensation.
o Redness of skin in light-skinned soldiers grayish coloring in dark-skinned
individuals.
o Blister.
o Swelling or tender areas.
o Loss of previous sensation of pain in affected area.
o Pale, yellowish, waxy-looking skin.
o Frozen tissue that feels solid (or wooden) to the touch.
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CAUTION
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).
o Face, ears, and nose. Cover the
casualty affected area with his and/or your bare hands until sensation and color return.
o 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.
o 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.
WARNING (081-831-1009)
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.
NOTE
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. |
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Prevention. Prevention of frostbite or any cold injury depends on adequate
nutrition, hot meals and warm fluids. Other cold injury preventive factors are proper
clothing and maintenance of general body temperature. Fatigue, dehydration, tobacco, and
alcoholic beverages should be avoided.
o Sufficient clothing must be worn for
protection against cold and wind. Layers of clothing that can be removed and replaced as
needed are the most effective. Every effort must be made to keep clothing and body as dry
as possible. This includes avoiding any excessive perspiration by removing and replacing
layers of clothing. Socks should be changed whenever the feet become moist or wet.
Clothing and equipment should be properly fitted to avoid any interference with blood
circulation. Improper blood circulation reduces the amount of heat that reaches the
extremities. Tight fitting socks, shoes, and hand wear are especially hazardous in very
cold climates. The face needs extra protection against high winds, and the ears need
massaging from time to time to maintain circulation. Hands may be used to massage and warm
the face. By using the buddy system, individuals can watch each other's face for signs of
frostbite to detect it early and keep tissue damage to a minimum. A mask or headgear
tunneled in front of the face guards against direct wind injury. Fingers and toes should
be exercised to keep them warm and to detect any numbness. Wearing windproof leather
gloves or mittens and avoiding kerosene, gasoline, or alcohol on the skin are also
preventive measures. Cold metal should not be touched with bare skin; doing so could
result in severe skin damage.
o Adequate clothing and shelter are also necessary during periods of inactivity.
(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.
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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 medical facility.
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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.
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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.
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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.
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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
95¡F 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.
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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 90¡F 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 85¡F)
increases the risk o irregular heart action. This irregular heart action or heart
standstill can result in sudden death.
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Treatment. Except in cases of the most severe hypothermia (marked by coma or
unconsciousness, a weak pulse, and a body temperature of approximately 90¡F 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.
*CAUTION
Hypothermia is a MEDICAL EMERGENCY! Prompt medical treatment is necessary.
Casualties with hypothermic complications should be transported to a medical treatment
facility immediately.
CAUTION
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)
INJURIES |
SIGNS/SYMPTOMS |
FIRST AID |
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. |
Immersion foot/
Trench foot |
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!
Severe Hypothermia
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.
|
*CAUTION: Hypothermia is a MEDICAL EMERGENCY! Prompt medical
treatment is necessary.
|