Immersion syndrome (immersion foot/trench foot). Immersion foot and trench
foot are injuries that result from fairly long exposure of the feet to wet conditions
at temperatures from approximately 50° to 32°F. Inactive feet in damp
or wet socks and boots, or tightly laced boots which impair circulation are even
more susceptible to injury. This injury can be very serious; it can lead to loss
of toes or parts of the feet. If exposure of the feet has been prolonged and severe,
the feet may swell so much that pressure closes the blood vessels and cuts off
circulation. Should an immersion injury occur, dry the feet thoroughly; and evacuate
the casualty to a medical treatment facility by the fastest means possible.
At first, the parts of the affected foot are cold and painless, the pulse is weak,
and numbness may be present. Second, the parts may feel hot, and burning and shooting
pains may begin. In later stages, the skin is pale with a bluish cast and the
pulse decreases. Other signs/symptoms that may follow are blistering, swelling,
redness, heat, hemorrhages (bleeding), and gangrene.
Treatment is required for all stages of immersion syndrome injury. Rewarm the
injured part gradually by exposing it to warm air. DO NOT massage it. DO NOT moisten
the skin and DO NOT apply heat or ice. Protect it from trauma and secondary infections.
Dry, loose clothing or several layers of warm coverings are preferable to extreme
heat. Under no circumstances should the injured part be exposed to an open fire.
Elevate the injured part to relieve the swelling. Evacuate the casualty to a medical
treatment facility as soon as possible. When the part is rewarmed, the casualty
often feels a burning sensation and pain. Symptoms may persist for days or weeks
even after rewarming.
Prevention. Immersion syndrome can be prevented
by good hygienic care of the feet and avoiding moist conditions for prolonged
periods. Changing socks at least daily (depending on environmental conditions)
is also a preventive measure. Wet socks can be air dried, then can be placed inside
the shirt to warm them prior to putting them on.
(3) Frostbite. Frostbite
is the injury of tissue caused from exposure to cold, usually below 32°F depending
on the wind-chill factor, duration of exposure, and adequacy of protection. Individuals
with a history of cold injury are likely to be more easily affected for an indefinite
period. The body parts most easily frostbitten are the cheeks, nose, ears, chin,
forehead, wrists, hands, and feet. Proper treatment and management depend upon
accurate diagnosis. Frostbite may involve only the skin (superficial), or it may
extend to a depth below the skin (deep). Deep 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.
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.
Progressive signs/symptoms (081-831-1009).
o Loss of sensation,
or numb feeling in any part of the body.
o Sudden blanching (whitening)
of the skin of the affected part, followed by a momentary “tingling” sensation.
Redness of skin in light-skinned soldiers; grayish coloring in dark-skinned
o Swelling or tender areas.
of previous sensation of pain in affected area.
o Pale, yellowish,
o Frozen tissue that feels solid (or wooden) to the
frostbite is a very serious injury and requires immediate first aid and subsequent
medical treatment to avoid or minimize loss of body parts.
o Face, ears, and nose. Cover the casualty‘s
affected area with his and/or your bare hands until sensation and color return.
Hands. Open the casualty’s field jacket and shirt. (In a chemical environment
never remove the clothing. ) Place the affected hands under the casualty’s armpits.
Close the field jacket and shirt to prevent additional exposure.
Remove the casualty’s boots and socks if he does not need to walk any further
to receive additional treatment. (Thawing the casualty’s feet and forcing him
to walk on them will cause additional pain/injury. ) Place the affected feet under
clothing and against the body of another soldier.
DO NOT attempt to thaw the casualty’s feet or other seriously
frozen areas if he will be required to walk or travel to receive further treatment.
The casualty should avoid walking, if possible, because there is less danger in
walking while the feet are frozen than after they have been thawed. Thawing in
the field increases the possibilities of infection, gangrene, or other injury.
may occur spontaneously during transportation to the medical facility; this cannot
be avoided since the body in general must be kept warm.
all of the above areas, ensure that the casualty is kept warm and that he is covered
(to avoid further injury). Seek medical treatment as soon as possible.
Reassure the casualty, protect the affected area from further injury by covering
it lightly with a blanket or any dry clothing, and seek shelter out of the wind.
Remove/minimize constricting clothing and increase insulation. Ensure that the
casualty exercises as much as possible, avoiding trauma to the injured part, and
is prepared for pain when thawing occurs. Protect the frostbitten part from additional
injury. DO NOT rub the injured part with snow or apply cold water soaks. DO NOT
warm the part by massage or exposure to open fire because the frozen part may
be burned due to the lack of feeling. DO NOT use ointments or other medications.
DO NOT manipulate the part in any way to increase circulation. DO NOT allow the
casualty to use alcohol or
tobacco because this reduces the body’s resistance
to cold. Remember, when freezing extends to a depth below the skin, it involves
a much more serious injury. Extra care is required to reduce or avoid the chances
of losing all or part of the toes or feet. This also applies to the fingers and
Prevention. Prevention of frostbite or any cold injury
depends on adequate nutrition, hot meals and warm fluids. Other cold injury preventive
factors are proper clothing and maintenance of general body temperature. Fatigue,
dehydration, tobacco, and alcoholic beverages should be avoided.
clothing must be worn for protection against cold and wind. Layers of clothing
that can be removed and replaced as needed are the most effective. Every effort
must be made to keep clothing and body as dry as possible. This includes avoiding
any excessive perspiration by removing and replacing layers of clothing. Socks
should be changed whenever the feet become moist or wet. Clothing and equipment
should be properly fitted to avoid any interference with blood circulation. Improper
blood circulation reduces the amount of heat that reaches the extremities. Tight
fitting socks, shoes, and hand wear are especially hazardous in very cold climates.
The face needs extra protection against high winds, and the ears need massaging
from time to time to maintain circulation. Hands may be used to massage and warm
the face. By using the buddy system, individuals can watch each other’s face for
signs of frostbite to detect it early and keep tissue damage to a minimum. A mask
or headgear tunneled in front of the face guards against direct wind injury. Fingers
and toes should be exercised to keep them warm and to detect any numbness. Wearing
windproof leather gloves or mittens and avoiding kerosene, gasoline, or alcohol
on the skin are also preventive measures. Cold metal should not be touched with
bare skin; doing so could result in severe skin damage.
o Adequate clothing
and shelter are also necessary during periods of inactivity.
(4) Snow blindness.
Snow blindness is the effect that glare from an ice field or snowfield has on
the eyes. It is more likely to occur in hazy, cloudy weather than when the sun
is shining. Glare from the sun will cause an individual to instinctively protect
his eyes. However, in cloudy weather, he may be overconfident and expose his eyes
longer than when the threat is more obvious. He may also neglect precautions such
as the use of protective eyewear. Waiting until discomfort (pain) is felt before
using protective eyewear is dangerous because a deep burn of the eyes may already
Signs/Symptoms. Symptoms of snow blindness are
a sensation of grit in the eyes with pain in and over the eyes, made worse by
eyeball movement. Other signs/symptoms are watering, redness, headache, and increased
pain on exposure to light. The same condition that causes snow blindness can cause
snowburn of skin, lips, and eyelids. If a snowburn is neglected, the result is
the same as a sunburn.
Treatment. First aid measures consist
of blindfolding or covering the eyes with a dark cloth which stops painful eye
movement. Complete rest is desirable. If further exposure to light is not preventable,
the eyes should be protected with dark bandages or the darkest glasses available.
Once unprotected exposure to sunlight stops, the condition usually heals in a
few days without permanent damage. The casualty should be evacuated to the nearest
Prevention. Putting on protective eye wear
is essential not only to prevent injury, but to prevent further injury
if any has occurred. When protective eye wear is not available, an emergency pair
can be made from a piece of wood or cardboard cut and shaped to the width of the
face. Cut slits for the eyes and attach strings to hold the improvised glasses
in place. Slits are made at the point of vision to allow just enough space to
see and reduce the risk of injury. Blackening the eyelids and face around the
eyes absorbs some of the harmful rays.
(5) Dehydration. Dehydration
occurs when the body loses too much fluid, salt, and minerals. A certain amount
of body fluid is lost through normal body processes. A normal daily intake of
food and liquids replaces these losses. When individuals are engaged in any strenuous
exercises or activities, an excessive amount of fluid and salt is lost through
sweat. This excessive loss creates an imbalance of fluids, and dehydration occurs
when fluid and salt are not replaced. It is very important to know that it can
be prevented if troops are instructed in its causes, symptoms, and preventive
measures. The danger of dehydration is as prevalent in cold regions as it is in
hot regions. In hot weather the individual is aware of his body losing
fluids and salt. He can see, taste, and feel the sweat as it runs down his face,
gets into his eyes, and on his lips and tongue, and drips from his body. In cold
weather, however, it is extremely difficult to realize that this condition
exists. The danger of dehydration in cold weather operations is a serious problem.
In cold climates, sweat evaporates so rapidly or is absorbed so thoroughly by
layers of heavy clothing that it is rarely visible on the skin. Dehydration also
occurs during cold weather operations because drinking is inconvenient. Dehydration
will weaken or incapacitate a casualty for a few hours, or sometimes, several
days. Because rest is an important part of the recovery process, casualties must
take care that limited movement during their recuperative period does not enhance
the risk of becoming a cold weather casualty.
The symptoms of cold weather dehydration are similar to those encountered in heat
exhaustion. The mouth, tongue, and throat become parched and dry, and swallowing
becomes difficult. The casualty may have nausea with or without vomiting along
with extreme dizziness and fainting. The casualty may also feel generally tired
and weak and may experience muscle cramps (especially in the legs). Focusing eyes
may also become difficult.
Treatment. The casualty should be
kept warm and his clothes should be loosened to allow proper circulation. Shelter
from wind and cold will aid in this treatment. Fluid replacement, rest, and prompt
medical treatment are critical. Medical personnel will determine the need for
Prevention. These general preventive measures
apply for both hot and cold weather. Sufficient additional liquids should be consumed
to offset excessive body losses of these elements. The amount should vary according
to the individual and the type of work he is doing (light, heavy, or very strenuous).
Rest is equally important as a preventive measure. Each individual must realize
that any work that must be done while bundled in several layers of clothing is
extremely exhausting. This is especially true of any movement by foot, regardless
of the distance.
(6) Hypothermia (general cooling). In intense cold
a soldier may become both mentally and physically numb, thus neglecting essential
tasks or requiring more time and effort to achieve them. Under some conditions
(particularly cold water immersion), even a soldier in excellent physical condition
may die in a matter of minutes. The destructive influence of cold on the body
is called hypothermia. This means bodies lose heat faster than they can
produce it. Frostbite may occur without hypothermia when extremities do not receive
sufficient heat from central body stores. The reason for this is inadequate circulation
and/or inadequate insulation. Nonetheless, hypothermia and frostbite may occur
at the same time with exposure to below-freezing temperatures. An example of this
is an avalanche accident. Hypothermia may occur from exposure to temperatures
above freezing, especially from
immersion in cold water, wet-cold conditions,
or from the effect of wind. Physical exhaustion and insufficient food intake may
also increase the risk of hypothermia. Excessive use of alcohol leading to unconsciousness
in a cold environment can also result in hypothermia. General cooling of the entire
body to a temperature below 95°F is caused by continued exposure to low or
rapidly dropping temperatures, cold moisture, snow, or ice. Fatigue, poor physical
condition, dehydration, faulty blood circulation, alcohol or other drug intoxication,
trauma, and immersion can cause hypothermia. Remember, cold affects the body systems
slowly and almost without notice. Soldiers exposed to low temperatures for extended
periods may suffer ill effects even if they are well protected by clothing.
Signs/Symptoms. As the body cools, there are several stages of progressive
discomfort and impairment. A sign/symptom that is noticed immediately is shivering.
Shivering is an attempt by the body to generate heat. The pulse is faint or very
difficult to detect. People with temperatures around 90°F may be drowsy and
mentally slow. Their ability to move may be hampered, stiff, and uncoordinated,
but they may be able to function minimally. Their speech
may be slurred. As
the body temperature drops further, shock becomes evident as the person’s eyes
assume a glassy state, breathing becomes slow and shallow, and the pulse becomes
weaker or absent. The person becomes very stiff and uncoordinated. Unconsciousness
may follow quickly. As the body temperature drops even lower, the extremities
freeze, and a deep (or core) body temperature (below 85°F) increases the risk
of irregular heart action. This irregular heart action or heart standstill can
result in sudden death.
Treatment. Except in cases of the most
severe hypothermia (marked by coma or unconsciousness, a weak pulse, and a body
temperature of approximately 90°F or below), the treatment for hypothermia
is directed towards rewarming the body evenly and without delay. Provide
heat by using a hot water bottle, electric blanket, campfire, or another soldier’s
body heat. Always call or send for help as soon as possible and protect the casualty
immediately with dry clothing or a sleeping bag. Then, move him to a warm place.
Evaluate other injuries and treat them. Treatment can be given while the casualty
is waiting evacuation or while he is en route. In the case of an accidental breakthrough
into ice water, or other hypothermic accident, strip the
casualty of wet clothing
immediately and bundle him into a sleeping bag. Mouth-to-mouth resuscitation should
be started at once if the casualty’s breathing has stopped or is irregular or
shallow. Warm liquids may be given gradually but must not be forced on an unconscious
or semiconscious person because he may choke. The casualty should be transported
on a litter because the exertion of walking may aggravate circulation problems.
A physician should immediately treat any hypothermia casualty. Hypothermia
is life-threatening until normal body temperature has been restored. The treatment
of a casualty with severe hypothermia is based upon the following principles:
stabilize the temperature, attempt to avoid further heat loss, handle the casualty
and evacuate as soon as possible to the nearest medical treatment facility!
Rewarming a severely hypothermic casualty is extremely dangerous in the field
due to the great possibility of such complications as rewarming shock and disturbances
in the rhythm of the heartbeat.
Hypothermia is a MEDICAL EMERGENCY! Prompt medical treatment
is necessary. Casualties with hypothermic complications should be transported
to a medical treatment facility immediately.
casualty is unable to generate his own body heat. Therefore, merely placing him
in a blanket or sleeping bag is not sufficient.
Prevention. Prevention of hypothermia consists of all actions that will avoid
rapid and uncontrollable loss of body heat. Individuals should be properly equipped
and properly dressed (as appropriate for conditions and exposure). Proper diet,
sufficient rest, and general principles apply. Ice thickness must be tested before
river or lake crossings. Anyone departing a fixed base by aircraft, ground vehicle,
or foot must carry sufficient protective clothing and food reserves to survive
during unexpected weather changes or other unforeseen emergencies. Traveling alone
is never safe. Expected itinerary and arrival time should be left with responsible
parties before any departure in severe weather. Anyone living in cold regions
should learn how to build
expedient shelters from available materials including
e. Table. See Table 5-2 for further information.