First Aid and Emergency Information

1 Fundamental Criteria for First Aid
2 Basic Measures for First Aid
3 First Aid for Special Wounds
4 First Aid for Fractures
5 First Aid for Climatic Injuries
6 First Aid for Bites and Stings
7 First Aid in Toxic Environments
8 First Aid for Psychological Reactions

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Chapter 5 - First Aid for Climatic Injuries

It is desirable, but not always possible, for an individual’s body to become adjusted (acclimatized) to an environment. Physical condition determines the time adjustment, and trying to rush it is ineffective. Even those individuals in good physical condition need time before working or training in extremes of hot or cold weather. Climate-related injuries are usually preventable; prevention is both an individual and leadership responsibility. Several factors contribute to health and well-being in any environment: diet, sleep/rest, exercise, and suitable clothing. These factors are particularly important in extremes of weather. Diet, especially, should be suited to an individual’s needs in a particular climate. A special diet undertaken for any purpose should be done so with appropriate supervision. This will ensure that the individual is getting a properly balanced diet suited to both climate and personal needs,
whether for weight reduction or other purposes. The wearing of specialized protective gear or clothing will sometimes add to the problem of adjusting to a particular climate. Therefore, soldiers should exercise caution and judgment in adding or removing specialized protective gear or clothing.

5-1. Heat Injuries (081-831-1008)
Heat injuries are environmental injuries that may result when a soldier is exposed to extreme heat, such as from the sun or from high temperatures. Prevention depends on availability and consumption of adequate amounts of water. Prevention also depends on proper clothing and appropriate activity levels. Acclimatization and protection from undue heat exposure are also very important. Identification of high risk personnel (basic trainees, troops with previous history of heat injury, and overweight soldiers) helps both the leadership and the individual prevent and cope with climatic conditions. Instruction on living and working in hot climates also contributes toward prevention.

Salt tablets should not be used in the prevention of heat injury. Usually, eating field rations or liberal salting of the garrison diet will provide enough salt to replace what is lost through sweating in hot weather.

a. Diet. A balanced diet usually provides enough salt even in hot weather. But when people are on reducing or other diets, salt may need to come from other sources. DO NOT use salt tablets to supplement a diet. Anyone on a special diet (for whatever purpose) should obtain professional help to work out a properly balanced diet.
b. Clothing.
(1) The type and amount of clothing and equipment a soldier wears and the way he wears it also affect the body and its adjustment to the environment. Clothing protects the body from radiant heat. However, excessive or tight-fitting clothing, web equipment, and packs reduce ventilation needed to cool the body. During halts, rest stops, and other periods when such items are not needed, they should be removed, mission permitting.
(2) The individual protective equipment (IPE) protects the soldier from chemical and biological agents. The equipment provides a barrier between him and a toxic environment. However, a serious problem associated with the chemical overgarment is heat stress. The body normally maintains a heat balance, but when the overgarment is worn the body sometimes does not function properly. Overheating may occur rapidly. Therefore, strict adherence to mission oriented protective posture (MOPP) levels directed by your commander is important. This will keep those heat related injuries caused by wearing the IPE to a minimum. See FM 3-4 for further information on MOPP.
c. Prevention. The ideal fluid replacement is water. The availability of sufficient water during work or training in hot weather is very important. The body, which depends on water to help cool itself, can lose more than a quart of water per hour through sweat. Lost fluids must be replaced quickly. Therefore, during these work or training periods, you should drink at least one canteen full of water every hour. In extremely hot climates or extreme temperatures, drink at least a full canteen of water every half hour, if possible. In such hot climates, the body depends mainly upon sweating to keep it cool, and water intake must be maintained to allow sweating to continue. Also, keep in mind that a person who has suffered one heat injury is likely to suffer another. Before a heat injury casualty returns to work, he should have recovered well enough not to risk a recurrence. Other conditions which may increase heat stress and cause heat injury include infections, fever, recent illness or injury, overweight, dehydration, exertion, fatigue, heavy meals, and alcohol. In all this, note that salt tablets should not be used as a preventive measure.
d. Categories. Heat injury can be divided into three categories: heat cramps, heat exhaustion, and heatstroke.
e. First Aid. Recognize and give first aid for heat injuries.

Casualty should be continually monitored for development of conditions which may require the performance of necessary basic lifesaving measures, such as: clearing the airway, performing mouth-to-mouth resuscitation, preventing shock, and/or bleeding control.

DO NOT use salt solution in first aid procedures for heat injuries.

(1) Check the casualty for signs and symptoms of heat cramps (081-831-1008).
• Signs/Symptoms. Heat cramps are caused by an imbalance of chemicals (called electrolytes) in the body as a result of excessive sweating. This condition causes the casualty to exhibit:
o Muscle cramps in the extremities (arms and legs).
o Muscle cramps of the abdomen.
o Heavy (excessive) sweating (wet skin).
o Thirst.
• Treatment.
o Move the casualty to a cool or shady area (or improvise shade).
o Loosen his clothing (if not in a chemical environment).
o Have him slowly drink at least one canteen full of cool water.
o Seek medical aid should cramps continue.

DO NOT loosen the casualty’s clothing if in a chemical environment.

(2) Check the casualty for signs and symptoms of heat exhaustion (081-831-1008).
• Signs/Symptoms which occur often. Heat exhaustion is caused by loss of water through sweating without adequate fluid replacement. It can occur in an otherwise fit individual who is involved in tremendous physical exertion in any hot environment. The signs and symptoms are similar to those which develop when a person goes into a state of shock.
o Heavy (excessive) sweating with pale, moist, cool skin.
o Headache.
o Weakness.
o Dizziness.
o Loss of appetite.
• Signs/Symptoms which occur sometimes.
o Heat cramps.
o Nausea—with or without vomiting.
o Urge to defecate.
o Chills (gooseflesh).
o Rapid breathing.
o Tingling of hands and/or feet.
o Confusion.
• Treatment.
o Move the casualty to a cool or shady area (or improvise shade).
o Loosen or remove his clothing and boots (unless in a chemical environment). Pour water on him and fan him (unless in a chemical environment).
o Have him slowly drink at least one canteen full of cool water.
o Elevate his legs.
o If possible, the casualty should not participate in strenuous activity for the remainder of the day.
o Monitor the casualty until the symptoms are gone, or medical aid arrives.
(3) Check the casualty for signs and symptoms of heatstroke (sometimes called “sunstroke") (081-831-1008).

Heatstroke must be considered a medical emergency which may result in death if treatment is delayed.

• Signs/Symptoms. A casualty suffering from heatstroke has usually worked in a very hot, humid environment for a prolonged time. It is caused by failure of the body’s cooling mechanisms. Inadequate sweating is a factor. The casualty’s skin is red (flushed), hot, and dry. He may experience weakness, dizziness, confusion, headaches, seizures, nausea (stomach pains), and his respiration and pulse may be rapid and weak. Unconsciousness and collapse may occur suddenly.
• Treatment. Cool casualty immediately by—
o Moving him to a cool or shaded area (or improvise shade).
o Loosening or removing his clothing (except in a chemical environment).
* o Spraying or pouring water on him; fanning him to permit a coolant effect of evaporation.
o Massaging his extremities and skin which increases the blood flow to those body areas, thus aiding the cooling process.
o Elevating his legs.
o Having him slowly drink at least one canteen full of water if he is conscious.

Start cooling casualty immediately. Continue cooling while awaiting transportation and during the evacuation.

• Medical aid. Seek medical aid because the casualty should be transported to a medical treatment facility as soon as possible. Do not interrupt cooling process or lifesaving measures to seek help.
• Casualty should be continually monitored for development of conditions which may require the performance of necessary basic lifesaving measures, such as clearing the airway, mouth-to-mouth resuscitation, preventing shock, and/or bleeding control.
f. Table. See Table 5-1 for further information.
Table 5-1 Table 5-1 (con't)

5-2. Cold Injuries (081-831-1009)
Cold injuries are most likely to occur when an unprepared individual is exposed to winter temperatures. They can occur even with proper planning and equipment. The cold weather and the type of combat operation in which the individual is involved impact on whether he is likely to be injured and to what extent. His clothing, his physical condition, and his mental makeup also are determining factors. However, cold injuries can usually be prevented. Well-disciplined and well-trained individuals can be protected even in the most adverse circumstances. They and their leaders must know the hazards of exposure to the cold. They must know the importance of personal hygiene, exercise, care of the feet and hands, and the use of protective clothing.
a. Contributing Factors.
(1) Weather. Temperature, humidity, precipitation, and wind modify the loss of body heat. Low temperatures and low relative humidity-dry cold—promote frostbite. Higher temperatures, together with moisture, promote immersion syndrome. Wind-chill accelerates the loss of body heat and may aggravate cold injuries. These principles and risks apply equally to both men and women.
(2) Type of combat operation. Defense, delaying, observation-post, and sentinel duties do create to a greater extent—fear, fatigue, dehydration, and lack of nutrition. These factors further increase the soldier’s vulnerability to cold injury. Also, a soldier is more likely to receive a cold injury if he is—
• Often in contact with the ground.
• Immobile for long periods, such as while riding in a crowded vehicle.
• Standing in water, such as in a foxhole.
• Out in the cold for days without being warmed.
• Deprived of an adequate diet and rest.
• Not able to take care of his personal hygiene.
(3) Clothing. The soldier should wear several layers of loose clothing. He should dress as lightly as possible consistent with the weather to reduce the danger of excessive perspiration and subsequent chilling. It is better for the body to be slightly cold and generating heat than excessively warm and sweltering toward dehydration. He should remove a layer or two of clothing before doing any hard work. He should replace the clothing when work is completed. Most cold injuries result from soldiers having too few clothes available when the weather suddenly turns colder. Wet gloves, shoes, socks, or any other wet clothing add to the cold injury process.

In a chemical environment DO NOT take off protective chemical gear.

(4) Physical makeup. Physical fatigue contributes to apathy, which leads to inactivity, personal neglect, carelessness, and reduced heat production. In turn, these increase the risk of cold injury. Soldiers with prior cold injuries have a higher-than-normal risk of subsequent cold injury, not necessarily involving the part previously injured.
(5) Psychological factor. Mental fatigue and fear reduces the body’s ability to rewarm itself and thus increases the incidence of cold injury. The feelings of isolation imposed by the environment are also stressful. Depressed and/or unresponsive soldiers are also vulnerable because they are less active. These soldiers tend to be careless about precautionary measures, especially warming activities, when cold injury is a threat.
b. Signs/Symptoms. Once a soldier becomes familiar with the factors that contribute to cold injury, he must learn to recognize cold injury signs/symptoms.
(1) Many soldiers suffer cold injury without realizing what is happening to them. They may be cold and generally uncomfortable. These soldiers often do not notice the injured part because it is already numb from the cold.
(2) Superficial cold injury usually can be detected by numbness, tingling, or “pins and needles” sensations. These signs/symptoms often can be relieved simply by loosening boots or other clothing and by exercising to improve circulation. In more serious cases involving deep cold injury, the soldier often is not aware that there is a problem until the affected part feels like a stump or block of wood.
(3) Outward signs of cold injury include discoloration of the skin at the site of injury. In light-skinned persons, the skin first reddens and then becomes pale or waxy white. In dark-skinned persons, grayness in the skin is usually evident. An injured foot or hand feels cold to the touch. Swelling may be an indication of deep injury. Also note that blisters may occur after rewarming the affected parts. Soldiers should work in pairs—buddy teams—to check each other for signs of discoloration and other symptoms. Leaders should also be alert for signs of cold injuries.
c. Treatment Considerations. First aid for cold injuries depends on whether they are superficial or deep. Cases of superficial cold injury can be adequately treated by warming the affected part using body heat. For example, this can be done by covering cheeks with hands, putting fingertips under armpits, or placing feet under the clothing of a buddy next to his belly. The injured part should NOT be massaged, exposed to a fire or stove, rubbed with snow, slapped, chafed, or soaked in cold water. Walking on injured feet should be avoided. Deep cold injury (frostbite) is very serious and requires more aggressive first aid to avoid or to minimize the loss of parts of the fingers, toes, hands, or feet. The sequence for treating cold injuries depends on whether the condition is life-threatening. That is, PRIORITY is given to removing the casualty from the cold. Other-than-cold injuries are treated either simultaneously while waiting for evacuation to a medical treatment facility or while en route to the facility.

The injured soldier should be evacuated at once to a place where the affected part can be rewarmed under medical supervision.

d. Conditions Caused by Cold. Conditions caused by cold are chilblain, immersion syndrome (immersion foot/trench foot), frostbite, snow blindness, dehydration, and hypothermia.
(1) Chilblain.
• Signs/Symptoms. Chilblain is caused by repeated prolonged exposure of bare skin at temperatures from 60°F, to 32°F, or 200F for acclimated, dry, unwashed skin. The area may be acutely swollen, red, tender, and hot with itchy skin. There may be no loss of skin tissue in untreated cases but continued exposure may lead to infected, ulcerated, or bleeding lesions.
• Treatment. Within minutes, the area usually responds to locally applied body heat. Rewarm the affected part by applying firm steady pressure with your hands, or placing the affected part under your arms or against the stomach of a buddy. DO NOT rub or massage affected areas. Medical personnel should evaluate the injury, because signs and symptoms of tissue damage may be slow to appear.
• Prevention. Prevention of chilblain depends on basic cold injury prevention methods. Caring for and wearing the uniform properly and staying dry (as far as conditions permit) are of immediate importance.

Continue to Immersion Syndrome


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