a person in most situations. DO NOT use salt tablets unless specified by a physician, DO NOT consume alcoholic beverages.
At the command level, prevention centers on an awareness of the environment. The Wet Bulb Globe Temperature (WGBT) must be monitored regularly, and the results interfaced with the Physiological Heat Exposure Limits (PHEL) chart and the work/rest chart before work assignments are made. In addition, unnecessary heat sources, especially steam leaks, must be eliminated, and vents and exhaust blowers must be checked for adequate circulation. The results will be a happier, healthier, and more productive crew.
When the body is subjected to extremely cold temperatures, blood vessels constrict, and body heat is gradually lost. As the body temperature drops, tissues are easily damaged or destroyed.
The cold injuries resulting from inadequate response to the cold in military situations have spelled disaster for many armies; for example, those of Napoleon and Hitler in their Russian campaigns. The weather (i.e., temperature, humidity, precipitation, and wind) is the predominant influence in the development of cold injuries. Falling temperature interacting with high humidity, a wet environment, and rising wind accelerates the loss of body heat. The other major causative factor is the type of mission. For example, riflemen involved in static defense or pinned down by enemy fire suffer from greater exposure to the elements and lack the opportunity to properly warm their bodies, change clothes, keep clean, or eat balanced meals. They may also suffer from fatigue and fear, which contribute to apathy and neglect. Other factors that influence the development of cold injuries are dehydration, the presence of other injuries (especially those causing a reduction in circulatory flow), and a previous cold injury (which increases susceptibility by lowering resistance). In addition, the use of any drug, including alcohol, that modifies autonomic nervous system response or alters judgment ability can drastically reduce an individuals chance for survival.
Like heat exposure injuries, cold exposure injuries are preventable. Acclimatization, the availability y of warm, layered clothing, and maintenance of good discipline and training standards are important factors. These are command, not medical, responsibilities, but the corpsman will have a crucial role as a monitor of nutritional intake and personal hygiene (with emphasis on foot care) and as an advisor to the commanding officer. A corpsman will also be responsible for acquainting the troops with the dangers of cold exposure and with prevention measures.
Two major points must be stressed in the management of all cold injuries: Rapid rewarming is of primary importance, and all unnecessary manipulations of affected areas must be avoided. More will be said about these points later. In military operations the treatment of cold injuries is influenced by (1) the tactical situation, (2) the facilities available for the evacuation of casualties, and (3) the fact that most cold injuries are encountered in large numbers during periods of intense combat when many other wounded casualties appear. Highly individualized treatment under these circumstances may be impossible because examination and treatment of more lifeendangering wounds must be given priority. In a high casualty situation, shelter cold injury victims, and try to protect them from further injury until there is sufficient time to treat them.
All cold injuries are similar, varying only in the degree of tissue damage. In general, the effects of cold are broken down into two types: general cooling of the entire body and local cooling of parts of the body, but cold injuries wilI seldom be totally of one type.
General cooling of the whole body is caused by continued exposure to low or rapidly falling temperatures, cold moisture, snow, or ice. Those exposed to low temperatures for extended periods may suffer ill effects, even if they are well protected by clothing, because cold affects the body systems slowly, almost without notice. As the body cools, there are several stages of progressive discomfort and disability. The first symptom is shivering, which is an attempt to generate heat by repeated contractions of surface muscles. This is followed by a feeling of listlessness, indifference, and drowsiness. Unconsciousness can follow quickly. Shock becomes evident as the victims eyes assume a glassy stare, respiration becomes slow and shallow, and the pulse is weak or absent. As the body temperature drops even lower, peripheral circulation decreases and the extremities become susceptible to freezing. Finally, death results as the core temperature of the body approaches 80°F.