RETIRED COL. JOSEPH MCKEON, M.D.
Keller Army Community Hospital
West Point, New York
During World War II and Korea, the number of Soldiers incapacitated due to cold weather injuries was staggering. Lt. Col. (Dr.) Kenneth Orr reported in 1954 that the number of hospitalization days due to cold injuries in those two conflicts was more than 3 million! Imagine our entire Army being hospitalized for more than a week. This stands as a stark reminder of how poorly trained and equipped Soldiers can rapidly become compromised, especially in the absence of meticulous supervision by caring leaders.
As a Soldier today, you are neither poorly trained nor poorly equipped, nor are you lacking caring leaders. So why bother writing about cold injuries? Unfortunately, it’s because they continue to happen, even though they are preventable. The equipment issued to you, when used and maintained properly, will allow you to fight and win in even the most austere environments.
I know this because when I was building my little shelter in the snow near Fairbanks, Alaska, it was minus 20 F and my gear protected me. And then there was the time I spent the night unexpectedly on a hilltop at the National Training Center at Fort Irwin, California. I was with a light infantry battalion and had nothing but the BDUs I was wearing and my TA-50. Even though the temperature was only in the 40s, I endured the coldest night of my life. But this article isn’t about war stories, it’s about protecting yourself and the Soldiers you work with.
As leaders, it is your responsibility to ensure your Soldiers are properly trained and equipped. As individuals, it is you responsibility to ensure you use your training and equipment properly. That means anticipating being colder and staying longer than originally planned. Those who grew up in cold environments have learned how to respect the weather and dress for it. Few residents of Fairbanks or Watertown, New York, would walk out to the mailbox in a T-shirt and shorts in February, or drive to the store without a coat and gloves in the car. If the door accidentally locked behind you or the car broke down, you could freeze to death. So what was I thinking, ending up with my hooah medical team stuck on a hilltop at NTC with no snivel gear? The fact is, I wasn’t thinking, and I set us up for cold injuries. Life is too short to make all the mistakes yourself, so learn from others!
The typical victim
When considering injury prevention, it often pays to target your efforts at the highest risk group. So what does the typical cold injury patient look like? He is young, from a warm climate, has less than 18 months in the service and doesn’t yet know how important it is to take care of his feet. Just so you know, I’m not using your usual sexist male pronoun in that profile; the typical cold injury victim is male, usually about 20 years old and, because he is from a warm climate, hasn’t learned you don’t walk to your mailbox in February in a T-shirt. In addition, he is likely to use alcohol, tobacco and, possibly, medications. Look around your squad, platoon, company, battery or troop and see if you have Soldiers that fit that description because they are at risk. Identify and pay special attention to them now, before you go to the field or deploy.
Some chilling information
Now that we have an idea of who is most likely to get hurt, let’s briefly discuss cold injuries and what we can do to prevent them. The human body is indeed fearfully and wonderfully made. I’m sure you’ve noticed how some folks get very red in the face when they exercise. That’s the body’s cooling mechanism shunting blood to your skin so the blood can be readily cooled. But did you know the shunting process also works the opposite way? In cold environments, as much as 99 percent of the surface blood flow can be shifted back inside you to keep your vital organs warm. Amazing, isn’t it?
However, this protective mechanism that has been engineered into our bodies can be defeated by what we do. For instance, dehydration decreases the amount of blood that is circulating, thus hindering the body’s heating mechanisms. That’s why it’s so important to ensure we stay hydrated. Pushing fluids can be forgotten in a cold environment. This is especially true if you have to get out of a warm tent when it’s below zero, trudge through the snow and “drop trou” to go to the latrine.
In cold weather, you may be tempted to drink less to reduce your need to leave your nice, warm tent. However, this can set you up for dehydration and even a heat injury. That’s right, a heat injury! When you are performing hard physical work in a cold environment and wearing all of your protective equipment, it’s easy for you to start sweating and become overheated. You can end up exhausted and sweaty, and then rapidly cool off in the cold. It’s no wonder the typical cold injury victim is a young, first-term, male Soldier. Who usually gets detailed to put up the GP mediums?
In addition to the demographics listed above (young, first-term males), there are other significant risk factors. If you have a previous history of cold injuries, you are obviously at risk because you’ve already shown you are susceptible. In addition, if you are not physically fit, you are more likely to be injured; thus the Army’s emphasis on physical fitness.
Poor or inadequate nutrition also can quickly take its toll. When you’re in a cold environment, your body has a greater metabolic demand because you’re burning more calories trying to stay warm. If you need 3,000 calories per day in a controlled environment, you may need up to 4,500 calories in a cold environment just to maintain your body weight. Eating meals will also increase water consumption, which will be a hedge against dehydration.
Too little activity also can be a risk factor. While overheating is a risk when you are working hard, lack of activity can cause you to have cold injuries because of poor circulation in the extremities. Using those large muscle groups will ensure good circulation and heating, so get up and do 20 side-straddle hops (when not in contact with the enemy!).
Alcohol and tobacco, as well as caffeine, can also make it harder for you to stay warm. These substances all affect your body’s ability to dilate and constrict the blood vessels, which can defeat your body’s built-in heating and cooling mechanisms. Prescription and over-the-counter medications can also adversely affect your body’s heating and cooling, so it is important to let your doctor know if you will be exposed to cold weather. If you are a leader, you need to create a healthy work environment where Soldiers are steered away from behaviors such as tobacco use and excessive alcohol consumption.
Keep the following tips in mind to avoid becoming a cold-weather casualty.
• Dress in layers and avoid tight-fitting clothing. This will improve your circulation and provide layers of air between layers of clothing to help insulate you.
• Change your socks frequently to ensure your feet stay dry. This is going to require that you actually take off your boots and socks and change the latter, maybe even the former. If you are a squad leader, you may have to closely observe your Soldiers to ensure compliance.
• Beware of the wind. Wind chill can cause skin to freeze at temperatures that would be much less dangerous were there no wind. This is especially important when you are working around helicopters or in open areas where trees or man-made features are not available for wind protection.
• Protect your face and ears; these areas often suffer frostbite because of exposure and decreased blood flow. Wear the appropriate gloves, especially when you’re handling petroleum, oil and lubricant products, and avoid touching cold metal or fuel.
• Eat often and drink warm, non-caffeinated beverages. Soup is super! Use the buddy system. Seek medical attention for yourself and your buddy before symptoms become severe. As cold skin gets numb, subtle damage can progress and become a severe injury.
Don’t be like those thousands of Soldiers that spent weeks convalescing during World War II and Korea. This Army needs every Soldier, every day, so take care of your body.
The following cold injuries require immediate medical attention, so don’t delay if you or your buddy exhibits any of the following symptoms:
. Shivering, an altered sense of consciousness and uncoordinated movements. Hypothermia can be fatal if treatment is not given immediately.
. Loss of feeling or a tingling sensation in the affected area along with white, gray, red, yellow or waxy-looking skin. The frozen tissue will feel solid to the touch.
• Trench foot
. Numbness in the feet accompanied by burning sensations and shooting pain. Severely affected tissue will appear pale and slightly blue. Trench foot can lead to gangrene.
. Reddened, slightly swollen skin accompanied by a prickly or burning sensation. Left untreated, chilblain can lead to more severe cold injuries.