Part C Acclimatization And Conditioning

1. General.

Before undertaking extensive military operations in high mountainous elevations, as a soldier, you require a period of acclimatization. It is unrealistic to think that a freshly deployed, unacclimatized unit can perform well in action. This could be disastrous if the opposing force is acclimatized. Even the physically fit soldier experiences physiological and psychological degradation when thrust into high elevations.

Time must be allocated to allow for acclimatization, conditioning and training. Training in mountains of low or medium elevation (1,500 to 2,500 meters) does not require special conditioning and acclimatization procedures, however, impairment of operating efficiency on some soldiers may occur.

Above 3,000 meters (high elevation), most unacclimatized soldiers may be expected to display some altitude effects. About 10 percent may experience symptoms of acute mountain sickness (AMS). Conduct training at a high altitude of about 2,500 meters gradually increasing it and ending at 5,000 meters; acclimatization beyond 5,000 meters will result in degradation of the body greater than the benefits gained. Employment of the local population may be advantageous because they have lived at higher elevations, and can be expected to out perform the most fit and acclimatized soldier.

2. Symptoms and Adjustments.

You are acclimatized to high altitudes when you are able to effectively perform physically and mentally. The acclimatization process begins immediately upon arrival at the higher elevation, and if the change is abrupt, it is expected that most of you will suffer the symptoms of acute mountain sickness.

These symptoms will disappear from four to seven days, but their disappearance does not indicate complete acclimatization. The process of adjustment continues for weeks or months. Complete acclimatization is achieved at about 5,000 meters.

• Immediately upon arrival at high elevations, only minimal physical work can be performed because of physiological changes. The ability to work decreases as you go higher, about a 10 percent reduction for every 1,000 meters gained above 10,000 meters.

• Unacclimatized soldiers will display some or all of the following behavioral effects:

Increased errors in performing simple mental arithmetic.

Decreased ability for sustained concentration.

Deterioration of memory.

Decreased vigilance.

Increased irritability in some individuals.

Impairment of night vision and some constriction in peripheral vision (up to 30 percent at 2,000 meters).

Loss of appetite.

Sleep disturbances.

Irregular breathing.

• Your judgement and self-evaluation are impaired the same as if you were intoxicated. Because of the high altitude adjustment, during the first few days your unit will experience difficulties maintaining a coordinated, operational unit. The terrain and weather will contribute to the problems of unacclimatized soldiers. If you cannot walk a straight line and you have a loss of balance, you should be evacuated to a lower altitude. To walk a straight line, place one foot in front of the other.

3. Personal Hygiene and Sanitation.

The principles of personal hygiene and sanitation that govern operations in low terrain also apply in the mountains.

Good health is primarily a personal responsibility, and inspections must be conducted frequently to ensure that personal habits of hygiene are not neglected. You must maintain standards as a deterrent to disease, and as a reinforcement to discipline and morale.

• Personal hygiene. During periods of cold weather, your personal hygiene is very important in the high mountains. Due to the cold weather and scarcity of water, you may neglect washing, which can result in skin infection and vermin infestation. You should check your skin and clean it as often as possible. To help reduce skin infections you should take snow baths in lieu of water baths.

During cold weather, snow may be used instead of toilet paper. You must avoid waterbase creams and lotions since their use will further dehydrate tissues and induce frostbite by freezing. If possible, use nonwater-base creams to shave in lieu of soap. It is essential that you use chapsticks on your lips, nose, and eyelids. Make sure you carry topical ointments for rashes. In order to prevent tooth decay and gum disease your teeth should be brushed daily. Change your underwear as often as possible, but do not substitute it for bathing. If possible, you should carry a complete change of clothing, and you should wash your uniform at least once a week, or if laundering is difficult, your uniform should be shaken and air dried. To protect yourself, clean and air your sleeping bag on a regular basis.

To protect your feet from cold injuries, you must follow the principles of foot hygiene. When climbing, your boots should be laced tightly to provide needed support. To avoid blisters on your feet, wear your socks with no wrinkles, wash your feet daily, and if possible, keep them dry and clean. If you cannot wash your feet on a regular basis, try to change your socks daily during halts and rest periods. Massage, dry, and sprinkle them with talc or anti-fungal powder, brushing off the excess powder to avoid clumping, which may cause blisters. You may use snow to clean your feet, but dry them quickly. When you change your socks, check your feet for wrinkles, cracks, blisters, and discolorations. Trim your nails (long nails wear out socks) but not too short because they will not provide proper support for the ends of your toes. Seek medical attention for any problems.

You should spray your feet two or three times a day with an aluminum chlorohydrate antiperspirant for a week and then once a day for the rest of the winter.

This process controls about 70 percent of the sweating in the feet. If fissures or cracks occur in the feet, then discontinue spraying until they are healed or spray less often to control the sweating.

During periods of extreme cold weather, you may become constipated. Adequate water intake plus a low protein, high roughage diet can be helpful in preventing constipation.

• Sanitation. If you have to dig latrines, make sure they are located downwind from your positions and are buried or covered immediately after use. When using a "cathole" latrine, make sure it is located away from water sources. Since waste freezes, it can be covered with snow and ice or pushed down a crevasse. In rocky areas you may cover waste with stones.

4. Water Supply.

You should never assume that mountain water is safe for consumption. You must drink water only from approved sources. In order for you to operate efficiently, fluids lost through respiration, perspiration, and urination must be replaced.

• In mountain operations, hyperventilation and the cool, dry atmosphere bring about a three-to-four-fold increase in water loss by evaporation through the lungs. You must make an effort to drink liquids even when you do not feel thirsty. You should drink one quart of water, or the equivalent, every four hours. If your unit is conducting rigorous physical activities, you should drink more water.

• You should drink at least four quarts of water each day. A loss of two quarts of body fluid (2.5 percent of body weight) decreases physical efficiency by 25 percent. A loss of 12 quarts (15 percent of body weight) is usually fatal. In your meals you should replace the salt lost by sweating to avoid deficiency and cramping. Salt tablets are not necessary and may contribute to dehydration. Your military rations (three meals a day) provide sufficient sodium replacement.

• Drink small amounts of water often, a large volume may slow you down. If you are hot, and the water is cold, severe cramping may result. Keep pure water in reserve for first aid use. You must place emphasis on the three rules of water discipline.

Drink only treated water.

Conserve water for drinking. Potable water in the mountains may be in short supply.

Do not contaminate or pollute water sources.

• Other sources of water are snow, mountain streams, springs, rain, and lakes. You must make sure the water has been purified, no matter how clear it appears. After the water has been purified, you may add fruits, juices, and powdered beverages to supplement and encourage water intake. If the water supply is insufficient, reduce your physical activities. Any temporary deficiency must be replaced to maintain maximum performance.

• All water that is to be consumed must be potable. Make sure that you drink water only from approved sources or purify it to avoid contamination and disease. Do not drink nonpotable water. Water that is unfit to drink, but is not dangerous, may be used for bathing. You must avoid wasting water. To stay cool and maintain a functioning body it is best to drink water as often as possible.

• Since water is scarce above the timberline, watering parties should be established. Snow and ice may be available for melting after sundown. You may dig a shallow reservoir to collect water in areas where it trickles off rocks. Purify water by using iodine or calcium hypochlorite tablets, or by boiling for 10 minutes (longer at higher elevations). Filtering will remove sediment. Protect the water from freezing by storing it next to you or by placing it in a sleeping bag.

5. Nutrition.

Success in mountain operations depends on proper nutrition. Higher altitudes affect eating habits, therefore, you should take precautions. If possible, you should eat at least one hot meal each day, which may require heating of individual rations.

• The following elements are characteristics of nutritional acclimatization in mountain operations:

Weight loss during the first two to three days at high elevation.

A loss of appetite with symptoms of mountain sickness.

Loss of weight usually stops with acclimatization.

At progressively higher elevations (greater than 4,300 meters), the tolerance of fatty foods rapidly decreases. A high carbohydrate diet may lessen the symptoms of acute mountain sickness and is digested better than fat at high altitudes.

• Malnutrition may result from the lack of eating properly due to increased fatigue, and the unpleasant taste of cold rations. To increase morale and a sense of well-being, you should ensure that fuel tablets and squad stoves as well as flammable material are available and used for heating foods. Since you will experience loss of weight due to dehydration, metabolic changes, and loss of appetite, it is necessary that you increase consumption of carbohydrates, energy, and liquids by drinking carbohydrate-containing beverages, such as fruit juices and cocoa.

• There are three major components required to maintain a well-functioning body: proteins, fats and oils, and carbohydrates. They provide energy, amino acids, vitamins, fiber, and minerals. To maintain a healthy body, all three components must be provided in the correct proportions.

Proteins consist of a large number of amino acid units that are linked together to form the protein. The amino acids are absorbed through the intestine into the blood. They make or replace body proteins, muscle, and body tissue. Some of the usable animal proteins include eggs, milk, cheese, poultry, fish, and meats; other foods such as cereals, vegetables, and legumes also provide amino acid, but are not as balanced in essential amino compositions. As a daily protein requirement, the minimum is 8 ounces (227 grams) for a 154-pound (70-kg) man. Protein requires water for digestion and may facilitate dehydration.

Fats and oils are the most concentrated form of food energy. Main sources of fats and oils are meat, nuts, butter, eggs, milk, and cheese. Fats require more water and oxygen, and are harder to digest at higher altitudes.

Carbohydrates are an important source of calories, and can be found in the most important energy-producing cycles in the body's cells. If the intake exceeds energy needs, moderate amounts are stored in the muscles and liver; larger amounts are converted into fat and stored. The most useful sources of carbohydrates are foods such as unrefined grains, vegetables, and fruits.

There are two groups of vitamins. They are distinguished by their ability to dissolve in either fat or water. Fat-soluble vitamins include A, D, E, and K; water-soluble vitamins are B, and C, which are found in cereals, vegetables, fruits, and meats. It is necessary that you maintain a proper and well-balanced diet which provides all of the required vitamins, including fat- and water-soluble vitamins. If a deployment is to exceed 10 days, you should consider taking vitamin supplements to prevent the occurrence of an improper and unbalanced diet.

Mineral elements can be divided into two groups: those needed in the diet in amounts of 100 milligrams or more a day such as calcium, phosphorous, and magnesium; and trace elements needed in amounts of only a few milligrams a day such as iodine, iron, and zinc. Required minerals are contained in a balanced diet of meats, vegetables, and fruits.

• A balanced diet containing adequate amounts of vitamins and minerals ensures an efficient metabolism, and will promote the high level of energy needed to conduct daily activities in mountainous operations.

Depending on you, the efficiency of your body to work above the basal metabolism may vary from 20 to 40 percent. Over 50 percent of caloric intake is released as heat and is not available when you work; about 4,500 calories are expended for strenuous work and 3,500 calories for garrison activity. Perspiration causes excessive bodily heat loss. Your metabolism may not provide enough heat during inactive periods in cold weather, initiating the "internal thermostat" and causing the muscles to shiver. This releases heat and requires burn up of energy; up to 220 calories per hour is estimated for a 100-pound man.

During ascent to high altitudes, your body experiences physiological acclimatization, and your circulatory system labors to provide the needed oxygen to the body. While acclimatizing at higher elevations, you should eat light meals that are high in carbohydrates. Large meals require the digestive system to work harder, and may be accompanied by indigestion, shortness of breath, cramps, and illness. Carbohydrates, beginning in the morning and continuing through mid-afternoon, are important in maintaining energy levels. If possible, you should eat moderately, and rest before strenuous physical activity.

You should carry extra, lightweight food that can be eaten hot or cold in case resupply operations fail. Meals Ready to Eat (MREs) meet this criteria and provide all of the basic food groups.

As a leader, you may want to supplement MREs with breakfast bars, juices, fruits, and candies, cereal bars, and chocolate. Also, to replace water and salt you may use bouillon cubes which warm up cold bodies and stimulate appetites. You may consider hot beverages of soup, juices, powdered milk, and cider. Because coffee, tea, and hot chocolate are diuretics, do not rely on them for hydration and rehydration of the body.

Keep equipment and ammunition away from cooking areas and remember at higher elevations cooking time may be doubled. You may conserve fuel, stoves, fires, and extra fuel tablets by shielding them from the wind while cooking. Store extra fuel in tightly sealed, marked, metal containers. To purify water and warm food, you should use stoves and heat tabs. You should clean all utensils and canteen cups after use, and your unit must carry all food items and garbage. If possible, garbage should be burned or deep-buried to prevent animals from foraging. As all missions are tactical, no trace of a unit should be detected.

When operating in extremely cold conditions or at high altitudes, you should avoid certain drugs and medications, alcohol, and smoking. These substances will affect your circulation, perspiration, hydration, and judgement.

6. Physical and Psychological Conditioning.

To ensure the success of mountain operations, as a leader, you must implement and prioritize a conditioning/training program in your unit.

• U.S. forces do not routinely train in mountainous terrain. To achieve individual and unit effectiveness, the unit must be physically and psychologically conditioned, and adjusted before undertaking rigorous mountain operations, as well as trained as a team to cope with the terrain, environment, and enemy situation.

• The following factors must be considered:

What are the climatic and terrain conditions of the area of operations?

How much time is available for conditioning and training?

Will the unit conduct operations with other U.S. or Allied Forces? Are there language barriers? What assistance will be required? Will training and conditioning be required for attached personnel?

What additional personnel will accompany the unit? Will they be available for training and conditioning?

What is the current level of physical fitness of the unit?

What is the current level of individual expertise in mountaineering?

What type of operations can be expected?

What is the composition of the advance party? Will they be available to assist in training and acclimatization?

What areas in the U.S. most closely resemble the area of operations?

Are predeployment areas and ranges available?

Does the unit have qualified instructors in mountain warfare?

What type equipment will be required (to fit the season, mission, terrain)?

Does the unit have enough of the required equipment? Do personnel know how to use the equipment? Will the equipment go with the advance party, with the unit, or follow after the unit's arrival?

Are any modifications to equipment required?

Are there any special maintenance requirements for weapons and equipment?

• Upon arrival at the area of operations, all personnel will require a period of conditioning and acclimatization; the time schedule should allow for larger and more frequent periods of rest initially. Water, food, and rest must be considered as priorities, ensuring enough amounts, while individual metabolisms and bodies become accustomed to functioning at higher elevations.

• Since the acclimatization process cannot be shortened, and the absence of acclimatization hampers the successful execution of operations, deployment to higher elevations must consider the following:

Move upward by stages, spending two or three days at each stage. The first stage begins at the 2,500-meter level, and subsequent daily stages are at each succeeding 300-meter increment until the destination is reached. By this time, some acclimatization will have occurred, mountain sickness reduced, and the operational potential increased.

A unit should rest after each 1,000 meters of elevation gain to recuperate and acclimatize from the lower elevations. Units can leapfrog, taking an extended rest period every third night.

When available from the medical support channels, pretreat with carbonic anhydrase inhibitors (such as acetazolamide). This reduces the incidence and severity of acute mountain sickness from 40 percent to 60 percent, depending upon the height of deployment.

Initially, acclimatize at a high altitude in the continental U.S., or other safe area; then deploy to the operational site by rapid transport. Do not go down to lower altitudes (24- to 48-hour periods) before deployment since reentry to altitude can cause problems in acclimatization.

Move troops directly to high altitudes if allowances can be made for inactivity for the first three to five days before mission commitment. Moving troops directly to high altitude can increase the probability of altitude sickness. Even if there is inactivity following deployment the incidence of altitude sickness is more likely than with a gradual ascent.

• Personnel involved in mountaineering may have preconceived beliefs about the harmful effects of high altitude. Psychological adjustment is an important factor in the success of the operation. Ill effects of high altitude can be prevented through implementation of educational programs, gradually introducing personnel to the new terrain and encouraging confidence when negotiating steep slopes of cliffs. Personnel will overcome the fear of heights by becoming familiar with the problem, and learning the many climbing techniques and principles of mountain movement.

• Regardless of previous flat cross-country Army training, personnel will find mountain movement hard and tiring. During the operation, new techniques of rhythmic movement must be learned, and different groups of muscles will be used, developed, and hardened. The back and legs will be conditioned by frequently marching, carrying Table of Organization and Equipment (TOE) and special equipment loads. Proper physical conditioning results in decreased exhaustion.

• To increase endurance and physical conditioning, a physical training program should include: long-distance running for aerobic conditioning; calisthenics and weight training to strengthen the heart, lungs, abdomen, legs, back, arms, and hands; a swimming program to increase lung efficiency; and road marches over mountainous terrain with all combat equipment. Once deployed to high elevations, the heart rate, metabolism, and lungs must become accustomed to the elevation and thinner air. Therefore, set up a conditioning program on site and integrate in gradual stages where acclimatization, conditioning, and mountaineering skills are realized.

• The conditioning program should begin with basic climbing procedures. The key to learning and maintaining climbing proficiency and technical skills is repetitive and reinforcement practice until an instinctive reaction is acquired.

7. Mountain Living.

For the operation to be successful, training should be conducted as realistically as possible. The units involved must receive advanced training to survive in the harsh mountain environment. Training should include activities that require specialized techniques such as navigation, communications, and movement, and should be conducted under severe conditions so the individual soldier gains confidence.

• During the development of training, the following factors should be considered:

Temperature extremes.

Hygiene and sanitation.

Limited living space (difficulty of bivouac).

Air (dehydration and breathing).

Clothing requirements.

8. Mountain Navigation.

Navigation in the mountains is more difficult than on flat terrain because of inaccurate mapping, magnetic attraction affecting compass accuracy, and irregular pace. Soldiers must be trained to use a variety of equipment and techniques as aids to navigation: compasses, altimeter, pace, rope lengths, map, celestial navigation, terrain association, dead reckoning, resection, and artillery marking.

• Skill in navigation develops through experience. To ensure that directions and routes are correctly determined, the individual soldier must display an effective use of lensatic, liquid-filled, prismatic, and other compasses. Also, grid-magnetic (GM) angles must be considered when determining azimuths for direction, intersection, and resection. Do not rely on a compass alone for determining a location because hidden magnetic anomalies may deflect the earth's magnetic field. Pace counts should be used in conjunction with a map and altimeter through terrain association, and determined before movement.

• Altimeters are useful in determining altitude and verifying location, but they are only as accurate as the skill and experience of the individual soldier. Altimeters are usually accurate to within 10 meters of their indicated altitude.

• Maps provide a primary source of information concerning the area of operations, 1:25,000 maps depict much more detail than 1:50,000 maps, and should be used when choosing routes.

All available information about the friendly and enemy situations must be reviewed before selecting a route. Aerial photographs provide details normally not shown on maps. Do not rely on sketch maps' accuracy, but they may be used as a supplement to other sources of information, and if available, you may use forest service and hunters' maps. Standard, military topographic maps are available and are usually accurate graphic descriptions of the area of operations.

9. Survival.

Survival training should include psychological preparation, locating water, shelter considerations, fire building, health hazards, and techniques for obtaining food. An individual soldier well trained and prepared to fight and survive in a mountain environment will have increased confidence in himself.

10. Communications. During mountainous operations, all means of communication should be considered: FM, AM, multichannel, wire, satellite, visual, and messenger. They require precise planning and extensive coordination among all operational elements. All personnel should receive communications training.

To maintain communications, special antennas and retransmission procedures may have to be used. Weather may cause problems with communications equipment and maintenance.

11. Medical Considerations.

After acclimatization, personnel injuries such as sprains, strains, fractures, frostbite, hypothermia, and trench foot pose many problems for medical personnel because facilities and supplies may be inadequate to treat all patients. Evacuation of the sick and wounded is compounded by the terrain and weather.

Continue reading here: Part D Illness And Injury

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