Temperature (WBGT) must be monitored regularly,and the results interpreted with the Physiological HeatExposure Limit (PHEL) chart before work assign-ments are made. In addition, unnecessary heat sources,especially steam leaks, must be eliminated, and ventsand exhaust blowers must be checked for adequatecirculation. The results will be a happier, healthier, andmore productive crew.COLD EXPOSURE INJURIESLEARNING OBJECTIVE: Identify thesigns, symptoms, and emergency treatmentof each type of cold exposure injury.When the body is subjected to extremely coldtemperatures, blood vessels constrict, and body heat isgradually lost. As the body temperature drops, tissuesare easily damaged or destroyed.The cold injuries resulting from inadequateresponse to the cold in military situations have spelleddisaster for many armiesthose of Napoleon andHitler in their Russian campaigns, for example. Theweather (i.e., temperature, humidity, precipitation, andwind) is the predominant influence in the developmentof cold injuries. Falling temperature interacting withhigh humidity, a wet environment, and rising windaccelerates the loss of body heat.Other factors that influence the development of coldinjuries are the individual's level of dehydration, thepresence of other injuries (especially those causing areduction in circulatory flow), and a previous cold injury(which increases susceptibility by lowering resistance).In addition, the use of any drug (including alcohol) thatmodifies autonomic nervous system response or altersjudgment ability can drastically reduce an individual’schance for survival in a cold environment.Like heat exposure injuries, cold exposure injuries arepreventable. Acclimatization, the availability of warm,layered clothing, and maintenance of good discipline andtraining standards are important factors. These arecommandnot medicalresponsibilities, but theCorpsman plays a crucial role as a monitor of nutritionalintake and personal hygiene (with emphasis on foot care)and as an advisor to the commanding officer. ACorpsmanis also responsible for acquainting the troops with thedangers of cold exposure and with preventive measures.Two major points must be stressed in themanagement of all cold injuries: Rapid rewarming isof primary importance, and all unnecessary manipula-tions of affected areas must be avoided. More will besaid about these points later.In military operations the treatment of cold injuries isinfluenced by the tactical situation, the facilities availablefor the evacuation of casualties, and the fact that mostcold injuries are encountered in large numbers duringperiods of intense combat when many other woundedcasualties appear. Highly individualized treatment underthese circumstances may be impossible becauseexamination and treatment of more life-endangeringwounds must be given priority. In a high-casualtysituation, shelter cold-injury victims, and try to protectthem from further injury until there is sufficient time totreat them.All cold injuries are similar, varying only in thedegree of tissue damage. Although the effects of coldcan, in general, be divided into two types—generalcooling of the entire body and local cooling of parts of thebodycold injuries are seldom strictly of one type or theother; rather, these injuries tend to be a combination ofboth types. Each type of cooling, however, will bediscussed separately in the sections that follow.General Cooling (Hypothermia)General cooling of the whole body is caused bycontinued exposure to low or rapidly fallingtemperatures, cold moisture, snow, or ice. Thoseexposed to low temperatures for extended periods maysuffer ill effects, even if they are well protected byclothing, because cold affects the body systems slowly,almost without notice. As the body cools, there areseveral stages of progressive discomfort and disability.The first symptom is shivering, which is an attempt togenerate heat by repeated contractions of surfacemuscles. This is followed by a feeling of listlessness,indifference, and drowsiness. Unconsciousness canfollow quickly. Shock becomes evident as the victim’seyes assume a glassy stare, respiration becomes slowand shallow, and the pulse is weak or absent. As thebody temperature drops even lower, peripheralcirculation decreases and the extremities becomesusceptible to freezing. Finally, death results as thecore temperature of the body approaches 80F.The steps for treatment of hypothermia are asfollows:1. Carefully observe respiratory effort and heartbeat; CPR may be required while the warmingprocess is underway.4-62
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