LESSON 15
PERFORM FIRST AID FOR COLD INJURIES
(TASK 081-831-1045)
TASK:
Identify the type of cold injury and the treatment for each.
CONDITIONS:
Given multiple-choice examination items pertaining to cold injuries.
STANDARD:
Score 70 or more points on a 100-point comprehensive examination.
REFERENCES:
STP
21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.
FM
21-11, First Aid for Soldiers.
NOTE:Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.
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. The extent of the cold injury depends upon duration of exposure and adequacy of protection. Individuals with a history of cold injury are more likely to suffer cold injuries. 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.
15-2. IDENTIFY SIGNS AND SYMPTOMS OF CHILBLAIN/FROSTNIP
Chilblain is caused by repeated prolonged exposure of bare skin at temperature from 60°F to 32°F, or 20°F for acclimated, dry, unwashed skin. Signs and symptoms are the following:
a. Redness or pallor of affected areas (fingers, nose, ears).
b. Hot, tender, itching skin.
c. Absence of pain (numb).
d. May have ulcerated or bleeding lesions.
15-3. IDENTIFY SIGNS AND SYMPTOMS OF 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. Frostbite usually occurs in the cheeks, nose, ears, chin, forehead, fingers, hands, wrists, toes, or feet. These areas are more likely to be exposed to cold conditions. These areas also have poorer blood circulation than other parts of the body, and blood carries warmth as well as nutrients.
Superficial frostbite primarily involves injury to the skin and the tissue just beneath the skin. Signs and symptoms of superficial frostbite, listed in the order in which they would appear with increased exposure and time, include:
A tingling sensation, followed by numbness.
A sudden blanching (whitening) of the affected area.
A reddish (in light-skinned individuals) or grayish (in dark-skinned individuals) area on the skin. If the temperature is above freezing, this condition is called chilblain.
Deep frostbite
Blisters and sloughing (flaking in large sheets) of affected skin (may occur 24 to 36 hours after exposure).
Swelling or tender areas.
Loss of previous feeling of pain in the affected area.
Pale, yellowish, waxy-looking skin.
Frozen area feels solid or wooden to the touch.
The above frostbite signs and symptoms are applicable to the face, hands, and feet. Deep frostbite is a very serious injury that requires immediate first aid and subsequent medical treatment to avoid or minimize loss of body parts.
15-4. IDENTIFY SIGNS AND SYMPTOMS OF 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°F 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. Trench foot occurred frequently during WWI. Soldiers stood in cold, wet, muddy trenches for extended periods of time awaiting the order to move. Signs and symptoms are as follows:
Early stages/first phase of immersion foot
The affected area feels cold.
The affected area feels numb and painless.
The pulse is diminished/absent in the affected area.
Later stages/advanced immersion foot
The limbs feel hot and burning.
There are shooting pains in the affected area.
The affected area is pale with a bluish cast.
The pulse strength is decreased.
Some other signs that may follow are: blisters, swelling, redness, heat hemorrhages, and gangrene.
15-5. IDENTIFY SIGNS AND SYMPTOMS OF SNOWBLINDNESS
Snowblindness is the effect that glare from an ice field or snow field 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 normally cause an individual to instinctively protect his eyes. Signs and symptoms are as follows:
Scratchy feeling in the eyes, as if from sand or dirt.
Watery eyes.
Redness in the eyes.
The casualty may have a headache.
Increased pain with exposure to light.
15-6. IDENTIFY SIGNS AND SYMPTOMS OF HYPOTHERMIA
The destructive influence of cold on the body is called hypothermia (general cooling). This means the body loses heat faster than it can produce it. Hypothermia and frostbite may occur at the same time with exposure to below-freezing temperatures. 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. Signs and symptoms are given below.
| WARNING | |
| With generalized hypothermia, the entire body has cooled with the core temperature below 95°F. This is a medical emergency. | |
Mild hypothermia (body temperature 90°to 95°F).
(NOTE: Reference to temperatures is made to give you an idea of what is taking place in the body of the casualty.)
Hypothermia should be suspected in any chronically ill person who is found in an environment of less then 50°F.
The casualty is conscious, but usually apathetic or lethargic.
The casualty is shivering.
The skin is pale, cold.
The casualty speaks with slurred speech.
The casualty has poor muscle coordination.
There is a faint pulse.
Severe hypothermia (body temperature 90°F or lower).
The casualty's breathing is slow and shallow.
There is irregular heart action.
The pulse is weaker or even absent.
The casualty appears to be in a stupor or is unconscious.
The skin is ice cold.
The casualty's muscles are rigid.
The eyes are glassy.
15-7. IDENTIFY SIGNS AND SYMPTOMS OF DEHYDRATION (COLD WEATHER)
Dehydration (cold weather) 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 that it 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. Signs and symptoms the casualty may exhibit are given below.
The mouth, tongue, and throat are parched and dry.
Swallowing is difficult.
Nausea and dizziness may be present.
The casualty may faint.
There is a feeling of being tired and weak.
There may be muscle cramps, especially in the legs.
The casualty may have difficulty focusing his eyes.
15-8. TREAT CHILBLAIN/FROSTNIP
Chilblain is treated by warming the injured body part. Blow warm air on the part or place the body part in contact with a warm object, such as a caregiver's hands or the casualty's body. If the hands are affected, the casualty can cross his arms and place his hands under his armpits.
Once the body part is rewarmed, protect it from further cold exposure.
Frostbite is treated by rewarming the affected area slowly and protecting the affected area from refreezing. Move the casualty to the most protected area available and perform the following warming procedures.
(NOTE: These rewarming procedures can also be used to treat yourself if you begin to develop cold injury.)
Face
Cover the frostbitten area on the casualty's face with your bare hands. Leave your hands in place until the pain in the frostbitten area stops and the color returns to the area.
Cover the casualty with blankets or other dry material to keep him warm and to avoid additional injuries from the cold. Give him warm, nonalcoholic liquids to drink, if available.
Have the casualty seek medical personnel for further evaluation when the opportunity presents itself.
Hand
Remove jewelry from the affected hand and put it in the casualty's pocket. Loosen constricting clothing to help restore circulation.
Open the casualty's field jacket and shirt.
Place the casualty's frostbitten hand(s) under the armpits (right hand under left armpit; left hand under right armpit).
Close the casualty's clothing to prevent additional exposure to the cold.
Cover the casualty with blankets or other dry material to keep him warm and to avoid additional injuries from the cold.
Give the casualty warm, nonalcoholic liquids to drink, if available.
Tell the casualty to seek medical aid for further evaluation.
Feet
Loosen constricting clothing to help restore circulation.
Remove the boot and sock from the frostbitten foot.
Place the casualty's frostbitten foot (or feet) against the abdomen of the second soldier.
Close the second soldier's clothing as much as possible in order to provide additional warmth to the foot (feet) and to protect the second soldier's body from the cold.
Cover the casualty with blankets or other dry material to keep him warm and to avoid additional injuries from the cold.
Give him warm, nonalcoholic liquids to drink, if available.
The casualty should exercise as much as possible while avoiding trauma to the injured part.
Evacuate the casualty to a medical treatment facility if deep frostbite has occurred. If possible, use a litter or other means to evacuate the casualty that will not require him to stand or walk. Any frostbite should be evaluated by medical personnel as soon as practical.
Actions to avoid in treating frostbite.
A well-meaning person can perform certain procedures which can result in harming the person he is trying to help. You should be familiar with these rules.
Snow. Do not rub the frostbitten area with snow or ice. Snow or ice will increase heat loss.
Soaking. Do not soak the frostbitten area. Hot or cold soaks can damage tissue.
Extreme Heat. Do not expose the frostbitten area to extreme heat, such as a fire. Burns can result since the casualty will not be able to judge heat accurately.
Massaging. Do not rub or massage the frostbitten area. Manipulation can cause damage to the tissue.
Alcohol. Do not give the casualty alcoholic beverages. Alcohol causes the blood vessels near the surface to enlarge which results in heat loss.
Tobacco. Do not give the casualty tobacco products. Tobacco promotes heat loss.
Ointments. Do not apply ointment to the affected area. The moisture in the ointment can freeze and cause additional damage to the affected area.
15-10. TREAT IMMERSION FOOT/TRENCH FOOT
Gradually rewarm by exposing to warm air. Do not apply heat or ice. Do not moisten or massage the foot.
Protect affected parts from trauma.
Dry the feet thoroughly and avoid walking.
Elevate the affected part.
Seek medical treatment (evacuate the casualty).
Cover the casualty's eyes with a dark cloth.
Seek medical treatment (evacuate the casualty).
| WARNING | |
| Hypothermia is a medical emergency. Prompt medical treatment is necessary. The casualty should be evacuated to a medical treatment facility immediately. | |
Mild hypothermia.
Rewarm the body evenly using a heat source such as a campfire or another soldier's body. Merely placing the casualty in a sleeping bag or covering with a blanket is not enough since the casualty is unable to generate sufficient body heat on his own.
Keep the casualty dry and protected from the elements.
Have a conscious casualty drink warm liquids gradually.
Seek medical treatment immediately.
Severe hypothermia.
Stabilize the temperature by using heat sources such as: camp fire, electric blankets, hot water bottle, etc. The object is to warm the body evenly and quickly.
| CAUTION: 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. |
Attempt to avoid further heat loss by using blankets, sleeping bags, etc. Remove wet clothing before covering the soldier with blankets or using a sleeping bag. Move the casualty to a place of warmth, if possible.
Evacuate the casualty to the nearest medical treatment facility as soon as possible.
| CAUTION:Continue to monitor the casualty for life-threatening conditions. |
15-13. TREAT DEHYDRATION (COLD WEATHER)
Keep the casualty warm.
Loosen the casualty's clothes to improve circulation.
Give the casualty fluids for fluid replacement. (Medical personnel will determine the need for salt replacement.)
Have the casualty rest.
Seek medical assistance.