1. JSP 539
Climatic Injury
The Prevention and Recognition of Cold Injury

2. Outline of Presentation
Background
Types of Cold Injury
Description, Signs and Prevention
Additional Risks
General Advice
Summary

3. Background Cold Injuries DO occur in the UK
Prevention is better than cure
Early recognition and action is vital

4. Why? A cold injury could happen to YOU!
YOU have a responsibility to reduce the risk
Cold injury can be prevented by following simple rules and looking after yourself and your mates

5. Cold Injuries Non-freezing Cold Injury (NFCI) - Trench Foot
- Jungle Foot
- Paddy Foot
Hypothermia (general cold)
Freezing Cold Injury (FCI)
- Frost Nip
- Frost Bite

6. Non-Freezing Cold Injury - Description
Can cause disability
Most common type of Cold Injury in UK
Usually affects the feet and may be called ‘trench foot’, ‘jungle foot’ or ‘paddy foot’
Numbness of the affected area
Caused by periods of not moving around and spending a long time in damp and cold weather, it does not have to be freezing

7. Non-Freezing Cold Injury - Signs
Stage 1
Tissue is not swollen, but is white, numb and cold
Feels like “wearing someone else’s feet”
There may be a history of waterlogged boots and socks

8. Non-Freezing Cold Injury - Signs
Stage 2
With gentle early re-warming there will be slight swelling and blotchy skin
Pain – often like “pins and needles” lasting for up to 24 hours

9. Non-Freezing Cold Injury - Signs
Stage 3
Limb(s) swollen, red and very painful, especially at night
Pain will not respond to normal pain killers and may last for some weeks

10. Non-Freezing Cold Injury - Signs
In the early stages, the signs can be difficult to identify and the injured person will often try to continue training for a number of reasons:
They do not recognise the signs
Fear of being removed from training
They do not know damage is being caused
Reporting these signs early may prevent permanent damage and possible medical discharge

11. Non-Freezing Cold Injury - Prevention
Be prepared for the risk
Correct use of equipment
Self and buddy checks
Recognise the signs
Act and report them

12. Non-Freezing Cold Injury – First Aid
Keep casualty warm
Insulate
DO NOT rapidly re-warm
Evacuate

13. Non-Freezing Cold Injury - What to do next
Stay sheltered until evacuation can take place
Dry the feet if wet, change socks and footwear
If the limb has been re-warmed, it should not be used e.g. NFCI of the foot – do not walk / ski
Evacuate by stretcher

14. Hypothermia - Description
Can be a killer
Definition: Drop of a body temp below 35oC (normal 37oC)
A fall below 32oC is a life-threatening emergency

15. Hypothermia - Signs Initial Later: Severe Hypothermia
- Feels very cold (maybe thirsty)
- Stiffness, tiredness
- Violent shivering
- Increased heart rate
Later: Severe Hypothermia
(Body temperature less than 32oC)
- Probably not shivering
- Stiff limbs – muscles and joints rigid
- Confusion or loss of consciousness
(could appear to be dead)

16. Hypothermia - Prevention
Be prepared even in fairly cool weather
(particularly if cold and wet)
Recognise the signs
Act on them and report immediately

17. Hypothermia – First Aid
Stop the casualty getting colder
Get them under cover then start to slowly re-warm them
Cover them, use the “buddy system” to swap warmth, add layers – even plastic sacks are good
Replace wet clothing with dry
Give them warm food and drink (not alcohol)
Urgent evacuation is necessary

18. Freezing Cold Injury - Description
Can cause disability
Face, fingers, toes, the soles of the feet and the heels are more prone to freezing
Frost Nip → Frost Bite
FROST NIP: a freezing cold injury which fully recovers within 30 minutes once re- warming of the injured part has started
FROST BITE: the flesh freezes, the longer in the cold and the colder the temperature, the deeper the damage

19. Freezing Cold Injury - Signs
Early – FROST NIP:
The affected part will feel very cold and may be painful
If freezing continues a tingling may be felt followed by numbness
There may be a total loss of feeling when the affected part is moved
Skin is white and blotchy

20. Freezing Cold Injury - Signs
Later – FROST BITE:
Loss of feeling
The skin tissue becomes very white and wax-like and there is usually a clear line between white and pink skin
Later (usually after re-warming) the skin may appear bruised and blistered
Important – The full extent of the damage is not always clear until a few days after the injury

21. Freezing Cold Injury - Prevention
Be prepared for the risk
Correct use of equipment
Recognise the signs
Regular self and buddy checks
Act and report them immediately

22. Freezing Cold Injury – First Aid
Do not re-warm if there is any danger of re-freezing
Shelter the casualty and protect the affected part
Do not apply direct heat or rub the frozen part in an attempt to thaw
Smoking can delay or even prevent recovery and must not be allowed
Do not use protective creams e.g. “Deep Heat”

23. Freezing Cold Injury - What to do next
Stay sheltered until evacuation can take place
Evacuate by stretcher
If the limb has been re-warmed, it should not be used e.g. FCI of the foot – do not walk / ski

24. Additional Risks Individual risk is increased if: Unwell Unfit Hungry
Previous history of cold injury
Ethnic background
Work load
High e.g. fire and movement – likely to sweat and then get cold when activity stops
Low e.g. lying/standing still for long periods of time

25. General Prevention Advice
Clothing
Clothing and equipment – get to know how to use kit and clothing properly
Wear many layers of clothing rather than one thick layer
Always have spare socks and boots and change them when wet
Use gloves
Remove damp/wet clothing before getting into your sleeping bag and put on dry clothing

26. Off Duty
Wear the correct level of cold and wet weather clothing, to prevent the onset of NFCI/FCI

27. Summary
Cold Injuries can and will occur in UK

28. Impact
Since 1998, over 800 servicemen and women have suffered with cold injury
Every year about 20 personnel are medically discharged and many others will remain permanently downgraded
It could be the difference between a career in the Armed Forces or NO career in the Armed Forces

29. Questions?