1. Identify the type of cold injury.

a. Chilblain/frostnip. If the signs and symptoms are as follows go to step 2a.

(1) Prolonged exposure of bare skin at temperatures of 60?F, to 32?F.

(2) Redness or pallor of affected areas.

(3) Absence of pain (numb).

(4) May have ulcerated bleeding skin lesions.

 

NOTE: Freezing of superficial skin tissue may occur with frostnip - however, there is no freezing of the deeper tissues.

b. Frostbite. If the signs and symptoms are as follows go to step 2b.

(1) Superficial.

(a) Loss of sensation or numb feeling in any part of the body.

(b) Sudden whitening of the skin in the affected area followed by momentary tingling feeling.

(c) Redness of skin in light-skinned soldiers, grayish coloring in dark-skinned soldiers.

(2) Deep.

(a) Blisters.

(b) Swelling or tender areas.

(c) Loss of previous feeling of pain in the affected area.

(d) Pale, yellowish, waxy-looking skin.

(e) Frozen area feels solid or wooden to the touch.

c. Immersion foot/trench foot. If the signs and symptoms are as follows go to step 2c.

(1) Long exposure of feet to wet conditions at temperatures from 50?F down to 32?F.

(2) Early stage/first phase.

(a) Affected area feels cold.

(b) Number and painless.

(3) Later stage/advanced phase.

(a) Limbs feel hot and burning.

(b) Shooting pains.

(c) Affected area is pale with bluish cast.

(d) Pulse strength decreased.

(e) Other signs that may follow: Blisters, swelling, redness, heat, hemorrhages or gangrene.

d. Snow blindness. If the signs and symptoms are as follows go to step 2d.

(1) Scratchy feeling in eyes, as if from sand or dirt.

(2) Watery eyes.

(3) Redness.

(4) Headache.

(5) Increased pain with exposure to light.

e. Hypothermia. If the signs and symptoms are as follows go to step 2e.

(1) Mild.

 

NOTE: This condition should be suspected in any chronically ill person who is found in an environment of less then 50?F. CAUTION With generalized hypothermia the entire body has cooled with the core temperature below 95?F. (Temperature is provided as a guide; the common soldier probably would not have a thermometer to use.) This is a medical emergency.

(a) Body is cold (temperature 90-95?F.)

(b) Intense shivering.

(c) Difficulty speaking.

(d) Cold pale skin.

(e) Poor muscle coordination.

(f) Faint pulse.

(2) Moderate.

(a) Body temperature 85-90?F.

(b) Stops shivering.

(c) Dilated pupils.

(d) Loss of voluntary movement.

(e) Loss of consciousness.

(f) Lethargy.

(g) Slow pulse.

 

CAUTION

Hypothermia is a medical emergency. Prompt medical treatment is necessary. Casualty should be evacuated to medical treatment facility immediately.

(3) Severe.

(a) Decrease pulse, respirations.

(b) Lost contact with environment.

(c) Erratic or no heartbeat.

(d) Stupor or unconsciousness.

(e) Ice cold skin.

(f) Rigid muscles.

(g) Eyes become glassy.

 

CAUTION

HYPOTHERMIA IS A MEDICAL EMERGENCY. PROMPT MEDICAL TREATMENT IS NECESSARY. CASUALTY SHOULD BE EVACUATED TO MEDICAL TREATMENT FACILITY IMMEDIATELY.

f. Dehydration (cold weather). If the signs and symptoms are as follows go to step 2f.

(1) Mouth, tongue, and throat are parched and dry.

(2) Swallowing is difficult.

(3) Nausea and dizziness.

(4) Fainting.

(5) Tired and weak.

(6) Muscle cramps especially in the legs.

(7) Focusing eyes may be difficult.

2. Perform first aid for the cold injury.

a. Chilblain/frostnip.

(1) Apply rewarming (body heat).

(a) Apply warmth with casualties bare hands.

(b) Blow warm air on the affected area.

(c) For hands and fingertips place hands in armpits.

(2) Protect lesions (if present) with dry sterile dressing.

(3) Seek medical aid.

 

CAUTION

DO NOT RUB OR MASSAGE AREA. NOTE: If the condition does not respond to simple care begin first aid for frostbite.

b. Frostbite.

 

CAUTION

DO NOT: RUB SNOW ON THE FROSTBITTEN PART; MASSAGE OR RUB THE FROSTBITTEN PART; USE DRY OR RADIANT HEAT TO REWARM; RUPTURE BLISTER; USE OINTMENTS OR OTHER MEDICATIONS ON THE PART; HANDLE A FROSTBITTEN EXTREMITY ROUGHLY; ALLOW A THAWED EXTREMITY TO REFREEZE; OR ALLOW THE CASUALTY TO USE ALCOHOL OR TOBACCO PRODUCTS.

(1) Warm the area using firm, steady pressure of hands, underarm or abdomen.

(2) Face, ears, nose--cover with hands (casualty's or a buddy's).

(3) Hands--open casualty's field jacket an place against the body (under armpits if possible), then close the jacket.

(4) Feet--remove boots, socks, and place feet under clothing and against the body of another soldier.

 

CAUTION

DO NOT REMOVE CLOTHING IN A CHEMICAL ENVIRONMENT. WARNING: DO NOT ATTEMPT TO THAW THE CASUALTY'S FEET OR OTHER SERIOUSLY FROZEN AREAS IF THE SOLDIER WILL BE REQUIRED TO WALK OR TRAVEL TO A MEDICAL CENTER IN ORDER TO RECEIVE MEDICAL TREATMENT. THE POSSIBILITY OF INJURY FROM WALKING IS LESS WHEN THE FEET ARE FROZE THAN AFTER THEY HAVE BEEN THAWED (IF POSSIBLE, AVOID WALKING). THAWING IN THE FIELD INCREASES THE POSSIBILITY OF INFECTION, GANGRENE, OR INJURY.

(5) Loosen or remove constricting clothing and remove any jewelry.

(6) Increase insulation (cover with blanket or something similar and dry).

(7) Have the casualty exercise as much as possible, avoiding trauma to injured part(s).

(8) Seek medical aid (Evacuate the casualty).

 

WARNING

MONITOR THE CASUALTY FOR LIFE THREATENING CONDITIONS AND APPLY APPROPRIATE FIRST AID AS NECESSARY.

c. Immersion foot/trench foot.

(1) Gradually rewarm by exposing to warm air.

(2) Protect affected parts from trauma.

(3) Dry feet thoroughly and avoid walking.

(4) Elevate the affected part.

(5) Seek medical treatment (evacuate casualty).

d. Snow Blindness.

(1) Cover the eyes with a dark cloth.

(2) Seek medical treatment (evacuate casualty).

e. Hypothermia.

 

CAUTION

THIS IS A MEDICAL EMERGENCY! PROMPT MEDICAL TREATMENT IS NECESSARY.

(1) Mild.

(a) Rewarm body evenly. (Must provide heat source--campfire or other soldiers body.)

 

NOTE: Merely placing the casualty in a sleeping bag or covering with a blanket is not enough since the casualty is unable to generate his or her own body heat.

(b) Keep dry and protect from the elements.

(c) Give warm liquids gradually if the casualty is conscious.

(d) Seek medical treatment immediately.

(2) Severe.

(a) Stabilize the temperature.

(b) Attempt to avoid further heat loss.

(c) Evacuate to the nearest medical treatment facility as soon as possible.

 

NOTE: 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. WARNING: MONITOR THE CASUALTY FOR LIFE THREATENING CONDITIONS.

f. Dehydration.

(1) Keep warm.

(2) Loosen clothes to improve circulation.

(3) Give fluids for fluid replacement.

 

NOTE: Medical personnel will determine the need for salt replacement.

(4) Rest.

(5) Seek medical assistance.

(5) Seek medical assistance.

 

Brief Soldier: Tell the soldier being evaluated to determine what cold injury the casualty has. After the cold injury has been identified, ask the soldier to describe the proper treatment.

Score the soldier GO if all the steps are passed. Score the soldier NO GO if any of the steps are failed. If the soldier scores NO GO, show what was done wrong and how to do it correctly.