Emergency War Surgery NATO Handbook: Part I: Types of Wounds
and Injuries: Chapter IV: Cold Injury
Prophylaxis
United States Department of Defense
Peer Review Status: Internally Peer
Reviewed
The successful prevention and control of cold injuries depend,
first of all, upon vigorous command interest, the provision of
adequate clothing, and a number of individual and group measures.
These measures include:
- A thorough appreciation and comprehension by command, staff,
technical personnel, and all combat components regarding the
potential losses that may occur from cold injury, both in winter
combat and in other circumstances in which cold injury has been
known to occur.
- There should be full command support, by echelon, of a
comprehensive and practical cold injury prevention and control
program. It should be emphasized again that this is a command, not
a medical, responsibility.
- Indoctrination of all personnel in the prevention of cold
injuries individually and by units.
- The provision of adequate supplies of clothing and footgear
and their correct utilization to avoid exposure to cold. The
program of supply must provide adequate dry clothing for the daily
needs of the soldier who is farthest forward in combat; it must
also provide for the correct fitting of clothing and boots. All
articles of clothing must be sized and fitted to avoid
constriction of the extremities and tightness over the back,
buttocks, and thighs.
Clothing for cold weather, based on the layering principle, is
now designed as an assembly for protection of the head, torso, and
extremities. The clothing is worn in loose layers, with air spaces
between the layers, under an outer wind-resistant and
water-resistant garment. Body heat is thus conserved. The garment
is flexible, and inner layers can be removed for comfort and
efficiency in higher ambient temperatures or during strenuous
physical exertion. Prevention of loss of body heat by the proper
protection of the body is as important as the efficient use of
appropriate dry footgear and warm dry gloves. Finally, the most
efficient clothing is of no value unless a high level of
individual and unit clothing discipline are maintained through
training.
- Special protection for certain groups who may be especially
susceptible to cold injury, together with the regular rotation of
all troops. It should be remembered that casualties with exposed
wounds and injuries are particularly liable to cold injury because
blood and transudate from their wounds will freeze from the
clothing inward.
- Effective policies of sorting in forward areas, with provision
for early evacuation and treatment of casualties actually
suffering from cold trauma.
- The identification of factors responsible for cold injury in
special situations, which is a command responsibility. Significant
numbers of cases occur as a result of barehanded contact with cold
metal or gasoline; as a result of rapid deployment of troops
seated in unheated vehicles, without interruptions for short
rewarming marches every few hours; as a result of airdrops of
troops into cold areas without adequate-protective equipment and
training; or as a result of several hours' confinement of
artic-equipped airborne troops in heated aircraft, followed by a
drop into a subzero environment after their insulating clothing
has been saturated with perspiration. Only by the evaluation of
these factors can the specific measures necessary in particular
units or groups be put into effect.
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