JSP 539 Climatic Injury The Prevention and Recognition of Cold Injury

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

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

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

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

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”

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

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

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

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

Summary Cold Injuries can and will occur in UK

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

Questions?