Slide Set for Unit/Installation Training Applications* Cold Weather

Slide Set for Unit/Installation Training Applications* Cold Weather

Slide Set for Unit/Installation Training Applications* Cold Weather Injuries: Prevention, Identification, and Treatment * This slide deck was prepared for adaption and local use by units/installation personnel when conducting cold injury prevention training. The information presented in these slides and notes sections (as posted) has been approved by the Disease Epidemiology Program (DEP) of the U.S. Army Public Health Center (APHC) as of February 2019. The DEP can be contacted at 410-436-9286 for technical consultation regarding cold injury prevention. The requirement for Army Cold Weather Injury Prevention training is established by the Army Medical Command the current (2013) policy memorandum is at https:// This presentation material includes images from Defense Imagery Management Operations Center, and slides from U.S. Army Safety Center, Additional information links and resources may be obtained from APHC at: UNCLASSIFIED 1

Cold Weather Injuries: Prevention, Identification, and Treatment Presenters Name Presenters Command Local Contact Information insert date UNCLASSIFIED 2 Introduction Prevention of cold injuries is a Command and Individual Responsibility ALL COLD WEATHER INJURIES ARE PREVENTABLE!!! UNCLASSIFIED

3 Outline Susceptibility Factors Cold Weather Injuries Description Identification Treatment Prevention Conclusion UNCLASSIFIED 4 Typical Victim of a Cold Weather Injury

Male E-4 or below Around 20 years old From a warm climate Less than 18 months time in service Uses tobacco, alcohol, and/or medications Neglects proper foot care However, ANYONE can become a cold weather casualty! UNCLASSIFIED 5 Susceptibility Factors Previous cold weather injury Inadequate nutrition

Alcohol or nicotine use Dehydration Over-activity Under-activity Long exposure to the cold Sick or injured Ethnic/geographic origin Wind, cold, rain Age Discipline and morale Physical stamina Inadequate training Poor clothing and equipment UNCLASSIFIED 6 Body Temperature Regulation

Heat Production Heat Loss Metabolism Exercise Shivering Convection Conduction Radiation Evaporation Respiration

When heat loss and production are in balance, body temperature is stable When heat loss is greater, either in an area of the body (finger, toes) or in the body core, cooling occurs When cooling is too great, cold weather injury can occur UNCLASSIFIED 7 Types of Cold Injuries Hypothermia Frostbite Non-freezing cold injuries Chilblains Immersion/Trench Foot Injuries related to cold exposure

Dehydration Sunburn Snow Blindness Carbon Monoxide Poisoning UNCLASSIFIED 8 Hypothermia MEDICAL EMERGENCY; life threatening condition Severe body heat loss-body temp falls below 95oF Occurs when: cold conditions are severe conditions are windy, clothing is wet, and/or the individual is inactive extended water exposure or immersion 1 hour or less when water temp is below 45oF prolonged exposure in slightly cool water (e.g. 60oF)

thunderstorms, hail, rain and accompanying winds UNCLASSIFIED 9 Hypothermia Initial Symptoms The umblesstumbles, mumbles, fumbles, and grumbles Severe Stages

shivering dizzy, drowsy withdrawn behavior irritability confusion slowed, slurred speech altered vision stumbling UNCLASSIFIED stops shivering desire to lie down and sleep heartbeat and breathing are faint or undetectable unconsciousness followed by DEATH

10 Hypothermia Treatment prevent further cold exposure evacuate immediately if severe hypothermia remove wet clothing rewarm with body-to-body contact or in a warmed sleeping bag warm, sweet liquids if conscious give CPR if needed UNCLASSIFIED 11

Hypothermia Prevention wear uniform properly (layers worn loosely) stay dry keep active eat properly and often warm liquids and water warming tents get plenty of rest buddy watch/observation/NCO checks

UNCLASSIFIED 12 Hypothermia Symptoms BODY TEMP (Early Stage) 98.6 95.0 SYMPTOMS Intense and uncontrollable shivering; ability to perform complex tasks impaired. (Moderate Stage) Violent shivering persists, difficulty in 95.0 91.4 speaking, sluggish thinking, amnesia begins to appear. (Severe Stages) Shivering decreases; replaced by 91.4 87.8 muscular rigidity and erratic, jerky

movements; thinking not clear but maintains posture. OBSERVABLE IN OTHERS Slowing of pace. Intense shivering. Poor coordination. Stumbling, lunching gait. Thickness of speech. Poor judgment. Irrationality, incoherence. Memory lapses, amnesia. Hallucinations. Loss of contact with environment. 87.8 85.2 Victim becomes irrational, loses contact with environment, drifts into stupor; muscular rigidity continues;

pulse and respiration slowed. Blueness of skin. Decreased heart and respiratory rate. Dilation of pupils. Weak or irregular pulse. Stupor. 85.2 78.8 Unconsciousness; does not respond to spoken words; most reflexes cease to function; heartbeat becomes erratic. Failure of cardiac and respiratory control centers in brain; cardiac fibrillation; probable edema and hemorrhage in lungs; apparent death. Unconsciousness. 78.8

UNCLASSIFIED FELT BY YOURSELF Fatigue. Uncontrollable fits of shivering. Immobile, fumbling hands. Stumbling. Poor articulation. Feeling of deep cold or numbness. Disorientation. Decrease in shivering. Stiffening of muscles. Exhaustion, inability to get up after a rest. Blueness of skin. Slow, irregular, or weak pulse. Drowsiness. 13

Frostbite Air temps below 32oF skin freezes at 28oF Superficial frostbite (mild) freezing of skin surface Deep frostbite (severe) freezing of skin and flesh, may include bone Hands, fingers, feet, toes, ears, chin, nose, groin area UNCLASSIFIED 14 Frostbite Symptoms

initially redness in light skin or grayish in dark skin tingling, stinging sensation turns numb, yellowish, waxy or gray color feels cold, stiff, woody blisters may develop UNCLASSIFIED 15 Frostbite Treatment remove from cold and prevent further heat loss remove constricting clothing and jewelry rewarm affected area evenly with body heat until pain returns when skin thaws it hurts!!

do not rewarm a frostbite injury if it could refreeze during evacuation or if victim must walk for medical treatment do not massage affected parts or rub with snow evacuate for medical treatment UNCLASSIFIED 16 Frostbite Prevention wear uniform properly (layers and loosely) keep socks and clothing dry (use poly pro/thermax liner socks and foot powder/ change insoles also) protect yourself from wind

drink hot fluids and eat often keep active insulate yourself from the ground (sleeping pad/tree branches, etc.) Buddy System warm with body heat avoid skin contact with super-cooled metals or fuel seek medical aid for all suspected cases UNCLASSIFIED 17 Chilblains

Nonfreezing cold injury Cold, wet conditions (between 32-60oF, high humidity) Repeated, prolonged exposure of bare skin Can develop in only a few hours Ears, nose, cheeks, fingers, and toes UNCLASSIFIED 18 Chilblains Symptoms: initially pale and colorless worsens to achy, prickly sensation then numbness red, swollen, hot, itchy, tender skin upon rewarming

blistering in severe cases UNCLASSIFIED 19 Chilblains Treatment prevent further exposure wash, dry gently rewarm (apply body heat) dont massage or rub dry sterile dressing

seek medical aid UNCLASSIFIED 20 Chilblains Prevention keep dry and warm cover exposed skin wear uniform properly use the Buddy System UNCLASSIFIED

21 Trench/Immersion Foot Potentially crippling, nonfreezing injury (temps from 32oF50oF) Prolonged exposure of skin to moisture (12 or more hours, days) High risk during wet weather, in wet areas, or when sweat accumulates in boots or gloves UNCLASSIFIED 22 Trench/Immersion Foot Symptoms initially appears wet, soggy, white, shriveled sensations of pins and needles, tingling, numbness, and then pain

skin discoloration-red, bluish, or black becomes cold, swollen, and waxy in appearance may develop blisters, open weeping, or bleeding in extreme cases, flesh dies UNCLASSIFIED 23 Trench/Immersion Foot Treatment prevent further exposure dry carefully DO NOT break blisters, apply lotions, massage, expose to heat, or allow to walk on injury rewarm with body heat clean and wrap loosely elevate feet to reduce swelling evacuate for medical treatment

UNCLASSIFIED 24 Trench/Immersion Foot Prevention keep feet dry change socks and apply foot powder at least every 8 hours or whenever wet bring extra boots to field no blousing bands report all suspected cases to leadership UNCLASSIFIED 25 Dehydration

A condition caused by the excessive loss of water from the body May increase the risk of hypothermia due to impaired ability to keep active and generate body heat UNCLASSIFIED 26 Dehydration Symptoms irritability decreased amount of urine being produced mental sluggishness increased or rapid heartbeat lethargy

dark urine headache dizziness, nausea weakness dry mouth, tongue, throat, lips lack of appetite stomach cramps or vomiting UNCLASSIFIED 27 Dehydration

Treatment drink WATER or other warm liquids do not eat snow rest UNCLASSIFIED 28 Dehydration Prevention drink minimum of 3 canteens of water daily if inactive and 5-6 quarts if active monitor urine color do not wait until you are thirsty drink hot liquids for warmth UNCLASSIFIED 29

Sunburn Burning of the skin due to overexposure to the sun and UV light Contributing factors fair skin, light hair exposed skin reflective qualities of the snow high altitudes Symptoms UNCLASSIFIED redness of skin, slight swelling (1st degree) prolonged exposure (2nd degree)

pain and blistering chills, fever, headache 30 Sunburn Treatment Prevention soothing skin creams in mild cases in severe cases, seek medical attention aspirin for pain UNCLASSIFIED cover exposed skin

with clothing sunscreen, lip balm limit exposure of skin to the environment 31 Carbon Monoxide Poisoning When oxygen in the body is replaced by carbon monoxide colorless, odorless, tasteless gas resulting from incomplete combustion Inadequate ventilation from engines, stoves, heaters UNCLASSIFIED 32

Carbon Monoxide Poisoning Symptoms headache dizziness weakness excessive yawning ringing in ears confusion

UNCLASSIFIED nausea bright red lips, eyelids drowsiness unconsciousness possibly death 33 Carbon Monoxide Poisoning Treatment move to fresh air immediately seek medical aid promptly provide mouth-to-mouth resuscitation if victim is not breathing

UNCLASSIFIED 34 Carbon Monoxide Poisoning Prevention ensure proper ventilation dont use unvented heaters or engines ensure heaters are regularly serviced turn heaters off when not needed (during sleep) never sleep in vehicle with engine running never wrap poncho around vehicle exhaust to collect heat

UNCLASSIFIED 35 Snow Blindness Inflammation and sensitivity Symptoms of the eyes caused by ultraviolet rays of the sun reflected by the snow or ice UNCLASSIFIED gritty feeling in eyes redness and tearing eye movement will cause pain

headache 36 Snow Blindness Treatment Prevention remove from sunlight blindfold both eyes or cover with cool, wet bandages seek medical attention recovery may take 2-3 days UNCLASSIFIED eye protection

dark, UV protective glasses field expedient-cut narrow slits in MRE cardboard and tie around head do not wait for discomfort to begin 37 Conclusion Dress properly Drink plenty of fluids Eat right Keep in shape Get plenty of rest Minimize periods of inactivity Maintain a positive attitude

UNCLASSIFIED 38 References and Resources TB MED 508 Prevention and Management of Cold Weather Injuries TC 21-3 Soldiers Handbook for Individual Operations and Survival in Cold-Weather Areas FM 21-10 Field Hygiene and Sanitation FM 4-25.11 First Aid U.S. Army Public Health Center Cold Weather Injury Prevention webpage: https

:// lties-and-Injuries.aspx U.S. Army Research Institute of Environmental Medicine Guidance downloads: http:// UNCLASSIFIED 39 References and Resources Individuals interested in heat illness and CWI on-line training that produces a certificate: Central Army Registry (CAR) Virtual Mission Preparation Course (Hot/Cold Weather Injury) Go to: Log in with CAC In the Search the CAR field in the upper left, paste 553G D01 Virtual Mission Preparation Course (Hot/Cold Weather Injury

Prevention) Click on the blue hyperlink EAMS-A may be required, which should lead to a page describing the training Scroll down and click on the View button at the bottom UNCLASSIFIED 40 Questions? UNCLASSIFIED 41

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