U.S. ARMY RANGER SCHOOL
Fort Benning, Georgia
Warm, sunny weather is what most folks think about when it comes to the southern United States. It’s not just warm, but downright hot several months of the year. But the other extreme is also true. Winters can be brutal, even if we don’t have a lot of snow. Believe it or not, we’ve seen cold injuries here at the U.S. Army Ranger School, Fort Benning, Georgia, which is well below the Mason-Dixon Line.
Soldiers falling victim to cold injuries usually end up much worse off because they and their leaders aren’t trained to identify the early signs and symptoms of these afflictions. The Ranger School has an internal standing operating procedure in accordance with Army Regulation 350-1, Army Training and Education, and it’s designed to mitigate the risks our students will face in extreme weather conditions. However, the three phases of Ranger training occur in different geographical locations: Fort Benning; Dahlonega, Georgia; and Eglin Air Force Base, Florida. Although these locations are relatively close, there’s enough distance to create a unique set of environmental concerns for the training battalions in each area. And, despite our precautions, we had a student suffer a cold weather injury that should’ve been avoided.
The student started complaining of pain in his right big toe on the fourth day of a field training exercise. The unit medics conducted foot checks in accordance with AR 350-1 and noted mild swelling and a ruptured, healing blister on top of the student’s toe, but no accompanying redness or warmth. They diagnosed a likely sprain aggravated by a bunion.
During the second FTX four days later, the student complained the pain in his toe was worse, but he didn’t attend sick call on change-of-mission day. Although the student limped when he saw the medics, he didn’t do so while being observed earlier in the day. The senior medic discussed this fact with the Ranger instructors and told them to watch the student, whose original diagnosis remained unchanged.
The senior medic evaluated the student again the next day in the field during sick call. The student’s toe was red and tender around the old blister, so the medic administered an oral antibiotic to combat the inflammation, which he assessed as cellulitis, a bacterial skin infection. The student was seen again the following day at the troop medical clinic. The TMC medics saw the student’s condition was worsening and administered intramuscular antibiotics in addition to the oral medication he was already taking. The student continued taking the medicine until the FTX was over, at which time he returned to Fort Benning to begin processing for leave.
Upon his return, the student was evaluated by a physician’s assistant who told him to finish the oral antibiotics and seek additional treatment at his leave location if the condition worsened. While on leave a few days later, both the student’s big toes swelled and, in his own words, “hurt like hell.” The tips of his big toes became discolored a couple of days later, so he visited a civilian doctor who changed the antibiotics and told the student to follow up with medical personnel when he returned to Fort Benning.
Back at Fort Benning, the battalion PA evaluated the student before his scheduled departure to Eglin and noticed the discolored areas. He referred the student to the brigade PA, who then diagnosed the student with second-degree frostbite on both toes. The podiatry department at the post hospital confirmed the PA’s diagnosis the following day. The student received a medical drop and was given a six-month profile. He was instructed to contact the TMC at his home station for follow-up care.
The investigation into the incident revealed that the underlying soft tissue infection and resultant swelling decreased circulation in the student’s toes, greatly increasing the risk for a cold-weather injury. This infection, coupled with repeated exposure to the cold, resulted in the student’s frostbite injury. The student also didn’t take responsibility for his own foot care, exacerbating the damage caused by the frostbite. He said the frostbite symptoms, including the discolorations, didn’t develop until he was several days into his leave, and he didn’t mention the symptoms during his multiple on-duty evaluations. No other students in the class reported similar symptoms.
The Ranger School learned several lessons from this incident. First, distal extremities, such as fingers and toes, areas of limited circulation and exposed body parts, including the hands and feet, are much more prone to cold-weather injury than the more insulated body areas. Likewise, Soldiers with underlying infections on those extremities are at even higher risk, as our student found out.
Our cadre are now more suspicious and thorough in their foot checks, especially during sustained training in inclement weather. They’re also enforcing the students’ sock and footgear changes to a higher degree. Hydration is another key issue our cadre is tackling in cold-weather injury prevention. Our students and all Soldiers operating in extreme environments must continue to hydrate even when they don’t feel like it.
Remember, cold-weather injuries can happen even in the sunniest of places to the most hooah of Soldiers. Our student spent six months on profile for a preventable injury when he could’ve been doing his duty as a Ranger instead. No one can change the weather, but we can adapt our behavior to beat it and fight another day.
FYI
For more information about preventing, identifying and treating cold weather injuries, visit the U.S. Army Public Health Command website at http://phc.amedd.army.mil/topics/discond/cip/Pages/ColdCasualtiesInjuries.aspx