To provide effective support during mountainous operations, certain medical aspects must be considered. Personnel may suffer injuries and illnesses that are not associated with other areas.
Since unit's aid stations cannot normally be reached by vehicle, due to rough terrain, it may be necessary to use litter bearers to move casualties to the rear where they can be evacuated by ground or air to clearing stations. Training must be accomplished with all litter bearers on evacuation techniques and first aid. The most important course of action is to provide injured soldiers with medical aid as soon as possible.
Cold-weather injuries can occur during any season of the year. Most of these accidents can be prevented by proper planning, to include: timely requisition and receipt of supplies and proper clothing; thorough training of personnel with respect to the hazards of cold weather; effective methods for the receipt, dissemination, and use of cold weather data; periodic inspections of clothing, personnel, and equipment; and personnel receiving a balance of water, rest, and nutrition. As a soldier, you must be prepared to survive, move, and fight in winter conditions.
• There are two types of cold-weather injuries: freezing and nonfreezing. The freezing type is known as frostbite. The nonfreezing type includes hypothermia, dehydration, trench foot, and immersion foot.
Significant injuries may occur when the temperature falls below 10 degrees C (50 degrees F). Cold injuries result from impaired circulation, and the action of ice formation and cold upon the tissues of the body.
• Many other factors, in various combinations, determine if cold injuries will occur. These factors include humidity, wind speed, exposure time, activity, type and condition of clothing, and numerous host factors such as: previous cold injuries; race; geographic origin; ambient temperatures; wind chill factor; type of mission; terrain; clothing; moisture; dehydration; age; fatigue; concomitant injury; discipline, training, and experience; nutrition; excess activity; and radical changes in the weather.
• As a leader, you should ensure that:
Soldiers' uniforms are kept as dry as possible and are protected from the elements.
Soldiers know proper use of clothing systems to avoid the effects of overheating and perspiration (layer dressing and ventilate).
The buddy system is used to observe for early signs of cold-weather injuries.
The rate of movement should be slow, deliberate, and careful. Soldiers should not move out at a force march pace and then be stationary after they have perspired heavily. They should not wear excessive cold-weather clothing while moving.
• The following medical procedures must be implemented when sickness and injuries occur:
Assess the situation (tactical and environmental). Approach the victim safely (avoid rock or snow slide). Perform emergency first aid.
Treat for shock (always assume that shock is present). Check for other injuries/cold injuries.
Develop a course of action (decide on a means of evacuation). Execute the plan and monitor the patient's condition.
• Body heat may be lost through five different mechanisms:
Radiation. The direct heat loss from the body to its surrounding atmosphere is called radiation heat loss.
Conduction. The direct transfer of heat from one object in contact with another (being rained on or sitting in snow) is called conduction. Convection. Convection is the loss of heat due to moving air or water in contact with the skin. The layer of warm air next to the skin must be controlled by clothing that ventilates, insulates, and protects. Evaporation. The evaporation of perspiration causes heat loss. Dressing in layers allows removal or adding of clothing as needed. Respiration. Respiration also cools the body. Placing a wool scarf or mask over the mouth and nose warms inhaled air and assists in keeping the body warm.
• Some of the most common cold-weather injuries are shock; dehydration; hypothermia; immersion or trenchfoot; blisters; frostbite; constipation; carbon monoxide poisoning; and snow blindness.
Shock. Shock is a symptom or the result of other injuries, and is the depressed state of vital organs due to the cardiovascular (heart) system not providing enough blood. Initial signs of shock include apprehension, shortness of breath, sweating, cold skin, rapid and faint pulse, and excessive thirst. Provide immediate and adequate first aid because even minor injuries can produce shock resulting in incoherence, slower heart beat, unconsciousness, and possibly death. When treating a patient you should make him as comfortable as possible and try to relieve the pain. If needed provide artificial respiration or cardiopulmonary resuscitation. Keep the patient warm but do not overheat him. If there are no abdominal injuries, and the patient is conscious, you may administer water. Obtain proper medical attention as soon as possible.
Dehydration. Dehydration is the loss of your body fluids. It precedes all cold-weather injuries and is a major symptom in acute mountain sickness. Cold weather requirements for water are no different than in the desert. You need about 6 liters of water each day to prevent dehydration when living and performing physical labor in a cold or mountainous environment. You should avoid drinking large quantities of coffee and tea since they cause excessive urination.
The contributing factors for dehydration are:
The thirst mechanism does not function properly in cold weather. Water is often inconvenient to obtain and purify.
There is a lack of moisture in the air in cold climates and at high altitudes. Cold causes frequent urination.
The signs of dehydration include darkening urine, decreased amounts of urine being produced, dry mouth, tiredness, mental sluggishness, lack of appetite, headache, fainting, rapid heart- beat, dizziness, higher temperature, upset stomach, unconscious- ness and diarrhea. The symptoms of dehydration are similar to those of hypothermia. To distinguish between them, open the victim's clothes and feel the stomach wall. If the stomach is cold, the victim is probably hypothermic; if it is warm, he is probably dehydrated.
To treat dehydration, you must consume 4 to 10 liters of fluids each day, and avoid caffeine and alcohol. Seek shelter from wind and cold. Do not eat snow; eating snow uses body heat. Fluid replacement, rest, and prompt medical attention are critical to your recovery.
Hypothermia. Hypothermia is a general cooling of your body. It may be caused by exposure or by sudden immersion of the body, such as falling into a lake or being sprayed with fuel or other liquid. Hypothermia is classified as mild (core temperature be- low 95 degrees F or 32 degrees C) or severe (core temperature be- low 90 degrees F or 32 degrees C). An individual is considered to be "clinically hypothermic" when the core temperature is less than or equal to 95 degrees F.
• The contributing factors for hypothermia are:
Decreased physical activity. Accidental immersion in water.
Change in weather. High winds.
The main sign of hypothermia is when the body core (rectal) temperature falls to about 96 degrees F. Other symptoms are: shivering, which begins after a drop in body temperature of 1 to 2 degrees, making it hard for an individual to take care of himself; body temperature drop from 95 degrees F to 90 degrees F, which can cause sluggish thinking in general; body temperature drop from 90 degrees to 85 degrees F, which causes total incoherence; and body temperature drop from 85 degrees F and below, which causes a comatose state, and related signs.
To guard against hypothermia, you should pair up with a buddy to observe each other for signs, consume adequate amounts of liquids daily, rest, and eat properly. You may avoid hypothermia by dressing in layers to permit easy additions or deletions; to prevent overheating, becoming too cold, getting wet or windblown.
Treatment of hypothermia depends upon whether the case is mild or severe.
Mild cases: If there are signs of hypothermia in a buddy, prevent additional heat loss by getting the victim into a shelter, and replace wet clothing with dry, insulated clothing or a sleeping bag. You should rewarm the body evenly and without delay. Rehydrate the victim with warm liquids, sweets, and food, however, you must never force 1liquids on an unconscious or semiconscious person because you might choke him. Keep the victim conscious until his vital signs are normal, and seek medical assistance.
Severe cases: If the victim is unconscious or appears dead without any obvious injury, prevent further heat loss. It is extremely dangerous to attempt to rewarm a victim in the field, and rapid rewarming of an unconscious victim may create problems and should1d not be attempted. It is best to stabilize the victim's temperature; to attempt to avoid further heat loss; to handle the victim gently; to provide artificial respiration if breathing stops; to be aware that severe complications may arise as the body temperature rises, which may result in cardiac arrest even though the victim seems to be doing well; and evacuate the victim immediately to the nearest medical treatment facility.
Immersion or Trench foot. This is damage to the circulatory and nervous systems of the feet, which occurs from prolonged exposure to cold and wet at above freezing temperatures. This can happen wearing boots or not. You may not feel uncomfortable until the injury has already begun.
• Contributing factors for immersion or trench foot are:
• Stepping into water over the boot tops.
• Not changing socks often.
• Improper hygiene.
• Prolonged exposure (three to five days).
The main signs of immersion or trench foot include the sensation of tingling, numbness, and then pain. As symptoms progress and damage appears, the skin becomes red and then bluish or black. Swelling may occur.
To treat immersion or trench foot, you should keep your feet dry and clean. You should change socks often, dry the inside of boots, and use foot powder. You must move your feet gently and you must not moisten or massage the skin. You must elevate and expose your feet to room temperature. You must stay off your feet and seek medical attention. When a severe case does not allow the feet to dry, you must be evacuated as a litter casualty. Drying the feet for 24 hours usually heals mild cases. Moderate cases usually heal within three to five days. To prevent it, take good care of your feet.
Blisters. Before its formation or once a blister has formed, cover it with a dressing large enough to fit over the blister, and then tape it. You must not drain a blister unless it is red or pus is detected; if this occurs, drain the blister using a clean sterile needle, and gently press out the fluid from the side leaving the skin intact. Make a doughnut of moleskin to go around the blister and apply to the skin. Toe blisters may be wrapped entirely with adhesive tape over the moleskin.
Frostbite. Frostbite is the freezing or crystalization of living tissues. The extremities of the body are the first to be affected; exposure time can be minutes or instantaneous. Damp hands and feet may freeze quickly since moisture conducts heat away from the body and destroys the insulating value of clothing. Heat loss is compounded with intense cold and inactivity. Your clothing and equipment are one of the most important factors in preventing frostbite. Frostbite is one of the major nonfatal cold-weather injuries encountered in military operations.
There are two categories of frostbite: superficial (mild) and deep (severe). Superficial frostbite involves only the skin. The layer immediately below usually appears white to grayish. The surface feels hard, while the underlying tissue is soft. Deep frostbite extends beyond the first layer of skin and may include the bone. Discoloration continues from gray to black. The texture becomes hard as the tissue freezes deeper. This case requires immediate evacuation to a medical facility.
The contributing factors for frostbite are:
• Below-freezing temperatures or wind chill.
• Skin contact with supercooled metals or liquids.
• Use of caffeine, tobacco, or alcohol.
The signs or symptoms of frostbite vary and may include a cold feeling, pain, burning, numbness, and in the final stages a false sense of warmth. There will be a redness of skin, turning pale; the color may be bluish, and then may appear frosty or waxy white; the skin may feel hard, may not be movable over the joints and bony prominences, or may be frozen. Deep frostbite is difficult to identify, and often requires three to seven days after rewarming for medical personnel to diagnose. Blisters, swelling, and pain may occur after thawing.
The "buddy system" is one of the primary preventers of frostbite. As buddies, you must watch each other for signs and provide mutual aid if frostbite occurs. You must ensure that prompt first aid care is applied in order to prevent further damage. Early signs may be treated by immediately rewarming the body with skin-to-skin contact or by sheltering the body part under the clothing next to the body. If tissues are allowed to freeze, you should not attempt to thaw any parts of the body. Thawing of a frostbitten victim is a hospital procedure. You must evacuate the victim before the part thaws, protect the frozen parts from further injury, and seek medical treatment as soon as possible. If frozen extremities are involved, evacuate as a litter casualty.
If frostbite is not recognized before it thaws, you should not let the area refreeze since this causes more damage and may require amputation. The parts of your body most often affected by frostbite are the hands, fingers, toes, feet, ears, chin, and nose. If evacuation as a litter case is not possible, and you must walk to seek additional treatment, you should not attempt to thaw your feet-it is better to walk on frozen feet than to have them thaw and refreeze.
You must always keep the person warm and covered using bandages to separate toes and fingers. If reheating is inevitable, you should not overheat the affected body parts near flame. Make sure the warming temperature is not greater than the normal body temperature. You should not rub the injured parts because the tissues may break internally causing more damage. Blisters should be covered with a sterile dressing. When MEDEVAC is not possible, you may have to self-evacuate. You can walk many miles on frozen feet, but thawed feet are impossible to walk on.
Constipation. Constipation is the infrequent or difficult passage of stools.
Contributing factors for constipation are:
• Improper nutrition.
• Not defecating when needed.
The main signs of constipation include headaches, cramping, painful bowel movement, and loss of appetite.
To treat constipation, you must consume adequate amounts and varieties of food. You should drink from 4 to 6 liters of liquid each day, and if possible, seek medical attention.
Carbon monoxide poisoning. This is the replacement of oxygen in the blood with carbon monoxide.
A contributing factor is the inhalation of fumes from burning fuel without proper ventilation such as fires, stoves, heaters, and running engines.
The main signs are headaches, fatigue, excessive yawning, nausea, dizziness, drowsiness, confusion, and unconsciousness. In some cases death may occur. The one visible sign is bright red lips, mouth, and inside of the eyelids.
To treat carbon monoxide poisoning, if possible, remove the victim from the contaminated area and administer CPR. Oxygen may be used, if available. You must evacuate the victim to a medical facility because severe complications may develop even in casualties who appear to have recovered.
Snow blindness. Snow blindness is a sunburn of the cornea of the eye due to exposure to ultraviolet radiation. You may prevent it by using quality sunglasses. In an emergency, you may make a substitute from materials such as cardboard or birchbark.
The contributing factors for snow blindness are:
• Reflection of sunlight from all directions off the snow, ice, and water.
• Ultraviolet rays can cause vision problems even on cloudy days. They are less filtered at higher altitudes than at low altitudes.
The main signs of snow blindness are painful, red, watery eyes; sensation of grit in your eyes; blurred vision; a pink cast to the vision; and a headache.
To treat snow blindness, you may patch both eyes with cold compresses for 24 hours and take two aspirins every six hours. If possible, seek shelter in a dark place. You must not rub your eyes. Keep your eyes patched until evacuation as a litter patient is possible.
Although associated with hot weather, these injuries can occur in cold-weather environments. Most of these accidents can be prevented by proper planning, periodic inspection of personnel clothing and equipment, a balance of water and food intake, and proper rest.
• Some of the most common heat injuries are sunburn, heat cramps, heat exhaustion, and heat stroke.
Sunburn. This is the burning of exposed skin surfaces by ultraviolet radiation. The contributing factors for sunburn are: • Fair skin.
• Not accustomed to direct sunlight.
• Exposure to intense ultraviolet rays for extended periods.
The main signs of sunburn are painful, burning red or blistered skin with a slight swelling, the skin may be warm to the touch. In severe cases chills, fever, and headaches may occur.
To treat sunburn, you should keep the skin covered with clothing or sunburn cream even on cloudy days. Take two aspirins every two to six hours to stop the burning sensation. You may apply cool saline dressings to alleviate pain and swelling. You should not pop any blisters; if they break, wash and use bandages, and seek medical attention.
Heat cramps. They are caused by an accumulation of lactic acid in the muscles and a loss of salt through perspiration.
The main contributing factor is that the strenuous exertion causes the body to heat up and to produce heavy perspiration.
The main signs include pain and cramping in the arms, legs, back, and stomach. The victim sweats profusely and cannot quench his thirst.
To treat heat cramps, you must rest in a cool shady area, breathe deeply and stretch the cramped muscle as soon as possible to obtain relief. Loosen your clothes and drink cool water. If pain and cramps continue, seek medical attention.
Heat exhaustion. Strenuous activities in any environment may overheat the body. The blood vessels in the skin become so dilated that the blood flow to the brain and other organs is reduced.
The contributing factors for heat exhaustion are:
• Strenuous activity in hot areas.
• Unacclimatized troops.
• Inadequate diet.
The main signs of heat exhaustion are similar to fainting but may also include weakness, dizziness, confusion, headache, cold clammy skin, nausea, and a rapid but weak pulse.
To treat heat exhaustion, you must rest in a cool shady area, loosen your clothes and boots, and drink water. You should elevate your legs to help restore proper circulation. If the symptoms persist, seek medical attention.
Heat Stroke. This is a life-threatening situation caused by overexposure to the sun. The body is so depleted of liquids that its internal cooling mechanisms fail to function.
The contributing factors for heat stroke are prolonged exposure to direct sunlight and overexertion.
The main signs of heat stroke include hot and dry skin, dizziness, confusion and incoherency, headache, nausea, seizures, breathing difficulty, a slow pulse, and loss of consciousness.
To treat heat stroke, you should cool the victim at once, and restore breathing and circulation. If the victim is conscious, administer water. If possible, submerge the victim in water to reduce his temperature, treat for shock, and prepare for immediate evacuation.
Acute mountain sickness (AMS) is a temporary illness that affects both the beginner and experienced climber. You may experience this sickness in altitudes as low as 2,400 meters. About 50 to 80 percent of the troops suffer disability and ineffectiveness when they are rapidly brought to altitudes above 4,000 meters. At lower altitudes, or where ascent to altitudes is gradual, most personnel can complete assignments with moderate effectiveness and little discomfort.
• Severe symptoms may begin 4 to 12 hours after your arrival at higher altitudes of 3,000 to 4,000 meters. These symptoms are:
Rapid and labored breathing.
• A headache is the most noticeable symptom and may be severe. Even without the headache, you may lose your appetite, and experience nausea, leading to less food intake. Vomiting may occur and contribute to dehydration. Despite extreme fatigue, you will be unable to sleep. The symptoms usually develop and increase for a period of five to seven days. The headache may persist until you are returned to a lower elevation. AMS is nonfatal.
• Treatment for AMS includes:
Take aspirin or an equivalent. Wear sunglasses since bright sunlight aggravates a headache.
Consume liquids and light foods in small amounts often.
Move to lower altitudes (600 to 900 meters) to alleviate symptoms, which provides for a more gradual acclimatization.
Realize physical limitations and progress slowly.
Practice deep-breathing exercises.
5. High-Altitude Pulmonary Edema (HAPE).
This is a swelling and filling of the lungs with fluids, caused by rapid ascent to altitude. It occurs at high altitudes and limits the oxygen supply to the body.
• HAPE occurs under conditions of low oxygen pressure encountered at high elevations of 3,000 meters, and may occur in healthy soldiers. HAPE may be considered a form of or manifestation of AMS since it occurs during the period of susceptibility to this disorder.
• HAPE can cause death. Except for acclimatization to altitude, there are no known factors to indicate resistance or immunity. Few cases have been reported after 10 days at high altitudes. When remaining at the same altitude, the incidence of HAPE is less frequent than that of AMS. There is no common indicator that dictates how you will react from one exposure to another.
• The contributing factors for HAPE are:
A history of high-altitude pulmonary edema. A rapid or abrupt transition to high altitudes. Strenuous physical exertion. Exposure to cold. Anxiety.
Progressive dry coughing with frothy white or pink spectum (this is usually a later sign) and then coughing up blood.
Cyanosis; a blue color to the face, hands, and feet.
Symptoms of AMS can mask early pulmonary difficulties.
An increased ill feeling, labored breathing, dizziness, fainting, repeated clearing of the throat, and development of a cough.
Respiratory difficulty may be sudden, accompanied by choking and rapid deterioration.
Progressive shortness of breath, rapid heart beat (pulse 120 to 160), and coughing (in contrast to others who arrived at the same time to that altitude).
Crackling, cellophane-like noises (rales) in the lungs (a stethoscope is usually needed to hear them) caused by fluid buildup. If untreated, the victim becomes unconscious. Bubbles form in the nose and mouth, and death results.
• HAPE is prevented by good nutrition, hydration, and gradual ascent to altitude or climbing no more than 300 meters each night for sleeping. A rest day, with no gain in altitude or heavy physical exertion is planned for every 1,000 meters of altitude gained. After all precautions have been taken, and a soldier still develops symptoms, immediate descent is mandatory where he receives prompt treatment, rest, warmth, and oxygen. Evacuation to a lower altitude as a litter patient is required. A descent of 300 meters may help. Manual descent must not be delayed to await air evacuation. If untreated, HAPE may become irreversible and cause death. Cases that are recognized early and treated promptly may recover with no after effects. Soldiers who have had previous attacks of HAPE are prone to second attacks.
6. High-Altitude Cerebral Edema (HACE).
This is the accumulation of fluid in the brain, which results in swelling and a depression of brain function that may result in death. It is caused by a rapid ascent to higher altitudes without progressive acclimatization. HAPE and HACE may occur in experienced well-acclimatized mountaineers without warning or obvious predisposing conditions. They can be fatal; when the first symptoms occur, immediate descent is mandatory.
• The contributing factors for HACE are rapid ascent to heights over 2,400 meters and aggravation by overexertion.
• The main signs of HACE include mild personality changes, paralysis, stupor, convulsions, coma, inability to concentrate, headaches, vomiting, decrease in urination, and lack of coordination. The main symptom is a severe headache. When this headache is associated with any other disturbances, it should be assumed to be manifestations of HACE. The headache may be accompanied by a loss of coordination, confusion, hallucinations, and unconsciousness, combined with symptoms of HAPE. If these symptoms occur, do not leave the person alone even though you may think he is irritable or temperamental. The symptoms may rapidly progress to death. Prompt descent to a lower altitude is vital. Seek medical attention as soon as possible.
• To prevent HACE, you must maintain good eating habits, hydration, and use gradual ascent to higher altitudes. Rest, warmth, and oxygen at lower elevations enhance recovery. REMEMBER! Due to the severity of high-altitude sickness, the best treatment is immediate descent.
Conclusion. You have now completed the instructional material for Lesson 1. Before you complete the practice exercise for this lesson, you should review the material presented in this lesson. Answers and feedback for the questions in the practice exercise are provided to show you where further study is required.
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