Identify proper procedures for treating a cold injury casualty.

Given written items pertaining to the identification and treatment of cold injuries.

Score 75 or more points on the 100 point written examination.

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.

FM 21-11, First Aid for Soldiers.

STP 8-91-SM, Soldier's Manual: CMF 91 General Medical Tasks.

Cold weather operations can cause serious injury to a combat soldier. Exposure for prolonged periods to temperature at or below freezing may cause tissue damage or a general body cooling that can lead to death. Soldiers, however, may be in danger of cold injury even when the temperature is above freezing. The seriousness of the injury depends upon the weather (temperature and moisture), clothing, type of combat operation, and the physical and mental makeup of the individual soldier. Soldiers who have had a previous cold injury should take extra precautions against cold injury.

Preventive measures were discussed in Lesson 1, Take Preventive Measures Against Disease and Environmental Conditions, of Subcourse IS0824. The memory device COLD (keep clothing Clean, avoid Overheating your body, wear clothing in Layers, keep clothing Dry) can help in reminding soldiers to take preventive measures.

Chilblain is caused by prolonged exposure of bare skin to cool or cold temperatures [50^oF (10^oC) or lower). Signs and symptoms of chilblain include:

Acutely red, swollen, hot, tender, and/or itching skin.

Open sores or bleeding lesions from continued exposure.

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, etc.).

Do not rub or massage the affected area. Rubbing or massaging the area may cause tissue damage.

Apply a field dressing to lesions (sores).

Have medical personnel evaluate the casualty as soon as practical. Signs and symptoms of tissue damage may be slow to appear.

Immersion syndrome is caused by prolonged exposure (hours to days) to wet conditions at temperatures from 50^oF to 32^oF (10^oC to 0^oC). Immersion foot, trench foot, and trench hand are types of immersion syndrome injuries.

Signs of immersion syndrome include blisters, swelling, redness, skin hot to the touch, and bleeding. 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 (bluish coloring) around the nailbeds and lips, and decreased pulse strength.

Dry the affected part immediately.

Rewarm the affected area gradually in warm air. Do not massage the area. The area will probably become swollen, red, and hot to the touch after it has been rewarmed. Blisters may form also.

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.

Frostbite is caused by the freezing of water in the skin and other tissues. Frostbite occurs only when the flesh is exposed to freezing temperatures [below 32ºF (0ºC)]. Frostbite usually occurs in areas most likely to be exposed to cold conditions such as the cheeks, nose, ears, chin, forehead, fingers, hands, wrists, toes, and feet. The depth and the severity of the injury depend upon the temperature and the duration of exposure. The lower the temperature, the shorter the time required to produce the injury. Frostbite is generally divided into two categories--superficial and deep.

Superficial frostbite primarily involves injury to the skin and the subcutaneous tissues just beneath the skin. Signs and symptoms of superficial frostbite include:

A reddish (in light-skinned individuals) or grayish (in dark-skinned individuals) area on the skin. (This condition is usually the first indication that frostbite is developing.)

A sudden blanching (whitening) of the affected area.

A tingling sensation, followed by numbness.

Blisters (normally filled with clear or serous fluid) and sloughing (flaking in large sheets) of affected skin. (This sign may occur 24 to 36 hours after exposure.)

Deep frostbite occurs when not only the skin and subcutaneous tissue freeze but also the fat, muscle and bone tissue freeze as well. The blanching and numbness of superficial frostbite always precede the development of deep frostbite. Signs and symptoms of deep frostbite include:

Lack of feeling in the affected (frozen) tissue.

Pale, yellowish, waxy-looking skin.

Solid flesh (feels wooden to the touch).

Blisters (may occur 12 to 36 hours after freezing) normally filled with bloody fluid.

Red-violet discoloration, usually appearing 1 to 5 days after the injury occurs if the injury is not treated properly.

If not properly treated, frostbite can result in the loss of fingers, toes, hands, or feet. Frostbite can also result in gangrene, a life threatening condition.

Move the casualty to a sheltered area.

Loosen constricting clothing.

Remove jewelry.

If available the area should be rapidly rewarmed using warm water (between 100 and 104 degrees F). This is not prolonged soaking used only until the area is rewarmed.

If warm water not available gradually warm the exposed area. (If possible, have the casualty warm himself. Apply local warming by putting bare hands over the affected area on 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 (other than as discussed above) the frostbitten area.

Do 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.

Generalized hypothermia (low body temperature) occurs when the entire body is cooling with a core temperature (measured rectally) below 95^oF. It is caused by continued exposure to low or rapidly dropping temperatures, cold moisture, snow, or ice. Generalized hypothermia is a medical emergency that will result in death if not treated promptly.

Signs and symptoms of mild hypothermia include:

Apathetic, lethargic behavior.

Pale, cold skin.

Acetone (sweet, fruity) breath odor.

Shivering, which soon stops.

Slurred speech

Poor muscle coordination

Faint pulse.

Low body temperature (around 90^oF to 95^oF).

Signs and symptoms of severe hypothermia include:

Skin ice cold.

Slow, shallow respirations.

Faint, irregular pulse or lack of detectable pulse.

Glassy eyes.

Mental confusion.

Unconsciousness.

Rigid muscles

Very low body temperature (below 85^oF).

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.

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.

Snow blindness is a temporary loss of sight caused by ultraviolet rays from the sun reflecting off snow or ice. The condition is similar to a welding flash burn and is caused by damage to the cells covering the cornea (clear portion of the eye). Snow blindness is more likely to occur in hazy, cloudy weather than when the sun is shinning. Cloudy weather reduces the amount of visible light reaching the eyes; therefore, soldiers are less likely to take proper preventive measures such as wearing sunglasses. Ultraviolet rays, however, are not visible and are not reduced by the haze or clouds. Signs and symptoms of snow blindness include:

Scratchy feeling in the eyes as though dirt or sand were present in the eyes.

Decreased vision.

Eyes watering.

Reluctance or inability to open eyes.

Headache.

Pain as late as 3 to 5 hours later.

Snow blindness can usually be prevented by wearing regular or improvised sunglasses.

To treat a casualty with snow blindness:

Cover the casualty's eyes with a dark cloth to protect his eyes from the light if the mission permits.

Reassure the casualty. (The condition usually heals within a few days with no permanent damage.)

Evacuate him to a medical treatment facility as soon as possible.