Treat a Casualty with a Cold Injury

INTRODUCTION

Cold injuries are most likely to occur when an unprepared individual is exposed to winter temperatures. The cold weather and the type of combat operation in which the individual is involved impact on whether he or she is likely to be injured and to what extent. Clothing, physical condition and 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 and how to provide first aid for the cold injuries. The extent of the cold injury depends upon 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 affected by cold are the cheeks, nose, ears, chin, forehead, wrists, hands, and feet. Proper treatment and management depend upon accurate diagnosis.

Recognize an Environmental Emergency

Environmental Emergency

Medical condition caused or exacerbated by the weather, terrain, atmospheric pressure, or other local factors

(1) Instances of environmental emergencies

(2) Environmental impact on morbidity and mortality

(3) Environmental factors that induce or exacerbate other medical or traumatic conditions

Risk Factors

(1) Age

(2) General health

(3) Fatigue

(4) Predisposing medical conditions

(5) Medications

(a) Peripheral vasodilator medications

(b) Diuretics

Environmental Factors

(1) Climate

(2) Season

(3) Weather

(4) Atmospheric (barometric) pressure - the pressure exerted by the weight of the air. An increase in altitude decreases pressure.

(5) Terrain

Types of Environmental Injuries

(1) Heat injury (SEE C191W056, Treat a Casualty with a Heat Injury)

(2) Cold injuries

(a) Chilblains

(b) Frostbite

(d) Snow Blindness

(e) Hypothermia (general cooling)

(f) Dehydration (cold weather)

(3) Localized injuries

(a) Frostbite

(b) Radiation burns, e.g., sunburn

Perform General Assessment and Prevention of Cold Injuries

Temperature Evaluation

(1) Oral

(2) Axillary

(3) Tympanic

(4) Rectal-only accurate method for determining core body temp

(5) Tactile

(a) Core temp is higher than preipherial temp (skin)

(b) When core temp drops to the level of peripherial temp (homeostasis) - this becomes a medical emergency

Mechanisms of heat loss

(1) Physiological

(a) Conduction - transfer of heat from one substance to another due to difference in temperature

(b) Convection - transfer of heat through gas or liquid by circulated heat particles

(2) Environmental

(a) Weather

(b) Altitude

Predisposing factors

(1) Previous cold injury

(2) Discipline, training, experience

(3) Race/geographic origin

(4) General health and medications

(a) Hypothyroidism

(b) Malnutrition, dehydration

(d) Medications

(5) Fatigue and exhaustion

(6) Length and intensity of exposure

(7) Climate factors

(a) Temperature

(b) Wind

(d) Humidity

(8) Activity factors

(a) Type of combat

(b) Mobility

(9) Tobacco Usage

Cold Injury preventative measures

(1) Dress

(2) Rest

(3) Food

(4) Limit exposure

(5) Injury control officer/NCO

(6) Plan operations around weather

(7) Provide rewarming tents and hot liquids

(8) Carbon monoxide precautions

(9) Frequent rotations

(10) Use buddy system

Perform specific assessment and management for cold injuries

Chilblains

Cause by repeated prolonged exposure of bare skin at temperature from 60F to 32F, or 20F for acclimated, dry unwashed skin

(1) Signs and symptoms are the following:

(a) Redness or pallor of affected areas, (fingers, nose, ears)

(b) Hot, tender, itching skin

(d) May have ulcerated or bleeding lesions

(2) Emergency care for Chilblains

(a) Warm the injured body part

(i) Elevate the affected body part

(ii) Place the injured body part in contact with a warm object, such as a rescuer’s hands or the casualty’s body. Instruct the casualty to cross arms and place the hands under armpits.

(iii) DO NOT RUB TISSUE. Do not apply heat or ice.

(b) Protect the rewarmed injury from further cold exposure or trauma

Frostbite

An injury of tissue caused from exposure to cold, usually below 32 F depending on the wind-chill factor, duration of exposure, and adequacy of protection. The body parts most easily frostbitten are the cheeks, nose, ears, chin, forehead, wrists, hands, and feet. Signs and symptoms are the following:

NOTE: Signs and symptoms are listed in the order in which they would appear with increased exposure and time.

(1) Superficial

(a) Loss of sensation or numb feeling in any part of the body

(b) Sudden whitening of the skin in the affected area followed by momentary tingling feeling

(2) Deep frostbite is a very serious injury that requires immediate first aid and subsequent medical treatment to avoid or minimize loss of body parts

(a) Blisters

(b) Swelling or tender areas

(d) Pale, yellowish, waxy-looking skin

(e) Frozen area feels solid or wooden to the touch

(3) Emergency care for Frostbite

WARNING: DO NOT attempt to thaw the casualty’s feet or other seriously frozen areas if the casualty will be required to walk or travel to receive further treatment. Thawing in the field increases the possibilities of infection, gangrene, or other injury.

(a) Warm the area at the first sign of frostbite using firm, steady pressure of the hand, underarm, or abdomen (aid giver or buddy’s) depending on the area affected.

(i) Face, ears, nose. Cover the area with the casualty's or a buddy's hands until sensation and color return.

(ii) Hands. Place the casualty's hands inside his or her clothing against the body and close the clothing. Place the affected hands under the casualty's armpits.

(iii) Feet Loosen and remove footgear. Place the casualty's bare feet under the clothing and against the body of another soldier.

(b) Loosen or remove tight clothing and watches

(d) Do not cause further injury. Observe the following procedures:

(i) Do not soak the frostbitten part

(ii) Do not rub it with snow

(iii) Do not expose it to any extreme heat source

(iv) Do not rub or move the part in any way to increase circulation

(v) Do not allow the casualty to smoke or drink alcohol

(vi) Do not treat seriously frostbitten parts if the casualty must walk or travel to receive further treatment

(vii) Exposing the frozen part to an open fire could cause burns because of the lack of feeling in the area

(viii) Alcohol and tobacco reduce the body's resistance to cold

(ix) The casualty should be prepared for pain when thawing occurs

(e) Evacuate patient to appropriate facility

Immersion Syndrome (Immersion foot/Trench foot)

Injuries that result from fairly long exposure of the feet to cool or cold water or mud. Inactive feet in damp or wet socks and boots, or tightly laced boots that impair circulation are even more susceptible to injury.

NOTE: Trench foot occurred frequently during WWI. Soldiers stood in cold, wet, muddy trenches for extended periods of time awaiting the order to move. During Vietnam, soldiers were also faced with the similar environmental conditions as in WWI. Paddy foot was a condition that frequently occurred during this period.

(1) Signs and symptoms of Immersion Syndrome

(a) Early Stages/First phase

(i) Affected area feels cold

(ii) Numb and painless

(iii) Pulses diminished/absent

(b) Later Stages/Advanced

(i) Limbs feel hot and burning

(ii) Shooting pains

(iii) Affected area is pale

(iv) Blisters, swelling, redness, ulceration

(v) Complications-infection, gangrene

(2) Treatment for Immersion Syndrome

(a) Immediate treatment consists of protecting the extremity from trauma and infection

(b) Gradually rewarm by exposing to warm air. Do not apply heat, ice, moisten or massage it.

(d) Elevate the affected part

(f) Seek medical treatment (Evacuate casualty)

Snow Blindness

A burn to the eye from UV radiation. The damage is to the cornea and similar to a welding flash burn to the eye. It is more likely to occur in hazy, cloudy weather than in sunny weather.

(1) Signs and symptoms of Snow Blindness

(a) Scratchy feeling in eyes, as if from sand or dirt

(b) Watery eyes

(2) Emergency treatment for Snow Blindness

(a) Perform visual acuity

(b) Cover the eyes with a dark cloth

Hypothermia

A systemic cold injury. Hypothermia is the decrease of body temperature below 95 degrees and generally occurs from prolonged 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. Hypothermia is a medical emergency.

(1) Signs and symptoms of Hypothermia

(a) Mild hypothermia (Core Body temperature 90º-95ºF)

(i) Conscious, but usually apathetic or lethargic

(ii) Shivering

(iii) Pale, cold skin

(iv) Slurred speech

(v) Poor muscle coordination

(vi) Faint pulse

(b) Severe hypothermia (Core Body temperature 90ºF or lower)

(i) Breathing is slow and shallow

(ii) Irregular heart action

(iii) Pulse weaker or absent

(iv) Stupor or unconsciousness

(v) Ice cold skin

(vi) Rigid muscles

(vii) Glassy eyes

(2) Emergency care for Hypothermia

(a) Mild

(i) Rewarm the body evenly. (Must provide heat source, a campfire, or another soldiers body.)

(ii) Keep the casualty dry and protected from the elements

(iii) Give warm liquids

(iv) Evacuate patient to the nearest treatment facility immediately

(b) Severe

(i) Gentle handling of patient

NOTE: A cold heart is more prone to V-Fib. if handled roughly.

(ii) Avoid further heat loss

(iii) Initiate IV

(iv) Place on cardiac monitor, if available

(v) Evacuate the casualty to the nearest medical treatment facility as soon as possible. Continuous monitoring of vital signs and level of consciousness while in route.

NOTE: Rewarming a severely hypothermic casualty is extremely dangerous in the field due to the great possibility of such complications as rewarming shock and disturbance in the rhythm of the heartbeat.

Dehydration

Occurs when the body loses too much fluid, salt, and minerals. When individuals engage in any strenuous exercises or activities, an excessive amount of fluid and salt is lost through sweat. The danger of dehydration is as prevalent in cold regions as it is in hot regions. In cold weather, it is extremely difficult to realize that this condition exists.

(1) Signs and symptoms of Dehydration

(a) Mouth, tongue, and throat are parched and dry

(b) Swallowing is difficult

(d) Fainting

(e) Tired and weak

(f) Muscle cramps especially in the legs

(g) Focusing eyes may be difficult

(2) Emergency care for Dehydration

(a) Keep warm

(b) Loosen clothes to improve circulation

(d) Rest

(e) Seek medical assistance

SUMMARY

Always be prepared for extreme weather conditions. Once a cold injury has occurred, you are more susceptible to it occurring again. Prevention is critical and may save someone's life. Don't let the weather become your worst enemy.