Cold Weather and Mountain Medical Considerations

Cold Weather Injuries : 

Cold Weather Injuries

Cold Weather InjuriesTerminal Learning Objective: 

Cold Weather Injuries Terminal Learning Objective Action: Manage cold weather injuries Condition: Given the ECWCS, other issued cold weather clothing items, and issued cold weather sleep system with insulating pad, access to a warming shelter, under field conditions where temperatures range from 40º F to – 60º F Standard: Soldier identified all of the signs and symptoms of each type of cold weather injury. selected and applied the recommended treatment for the specified cold weather injury. did not sustain a cold weather injury during the conduct of the course

Cold Weather Injuries: 

Cold Weather Injuries Total - 3446 Soldiers (approximately 1 BCT)

Cold Stress: 

Cold Stress Environmental Risk Factors: Temperature, wind, rain/snow, immersion, altitude Mission Risk Factors: Work intensity, duration of cold exposure and availability of adequate shelter, clothing and food Individual Risk Factors: Physical fitness, body composition, fatigue, race, gender, health

How does the body lose heat?: 

How does the body lose heat? Radiation - 60% Convection - variable Conduction - variable Respiration - 6% - 10% Evaporation - 12% - 15%

How does the Body Respond to the Heat Loss?: 

How does the Body Respond to the Heat Loss? Shell/Core Effect – body pulls blood from extremities in an effort to keep the core warm. Cold Diuresis – result of the shell/core effect; body rids itself of fluid (increased urination), because the kidneys sense an increase of volume in the core; thirst mechanism is also disrupted Shivering – involuntary reaction of skeletal muscles which produces heat

Slide7: 

Wind Chill Chart WCT (°F) = 35.74 + 0.6215T ‑ 35.75(V0.16) + 0.4275T(V0.16) Where T is temperature (°F) and V is wind speed (mph)

Slide8: 

Risk Of Frostbite

Slide9: 

Windchill Category These guidelines are generalized for worldwide use. Commanders of units with extensive extreme cold-weather training and specialized equipment may opt to use less conservative guidelines.

Individual Factors: 

Individual Factors Fatigue Gender and Race Nutrition Prior cold weather injuries Water intake Diseases or injuries Individual differences Drugs/Tobacco/Alcohol Fitness Psycho-Social Factor Age Discipline, Training, Experience

Food and Water Requirements: 

Food and Water Requirements Calories – 4500-6,000 calories per day 3.5-5 quarts of water per day

Personal Hygiene: 

Personal Hygiene Washing/Shaving Oral Hygiene Water Sources Food Sources Nicotine and Alcohol Latrines Clothing Sleeping Bags

Dehydration: 

Dehydration

Hypothermia: 

Hypothermia

Chilblain: 

Chilblain

Frostbite: 

Frostbite

Immersion Foot: 

Immersion Foot

Cold Weather InjuriesSummary: 

Cold Weather Injuries Summary Action: Manage cold weather injuries Condition: Given the ECWCS, other issued cold weather clothing items, and issued cold weather sleep system with insulating pad, access to a warming shelter, under field conditions where temperatures range from 40º F to – 60º F Standard: Soldier identified all of the signs and symptoms of each type of cold weather injury. selected and applied the recommended treatment for the specified cold weather injury. did not sustain a cold weather injury during the conduct of the course

Altitude IllnessTerminal Learning Objective: 

Altitude Illness Terminal Learning Objective Action: Manage altitude illness Condition: Under any field condition Standard: Soldier identified all of the signs and symptoms of altitude sickness selected and applied the recommended treatment for the specified altitude sickness

Altitude Classifications : 

Altitude Classifications Altitude: 8,000-12,000 High altitude: 12,000-18,000 Extreme altitude: 18,000-29,000 Reference: Medicine for Mountaineering, 5th edition by James A. Wilkerson, M.D. Low: Sea Level to 5,000 feet Moderate: 5,000-8,000 feet High: 8,000-14,000 feet Very High: 14,000-18,000 Extreme: 18,000 and higher Reference: FM 3-97.6 Mountain Operations

Altitude Overview : 

Altitude Overview At all altitudes the air is made up of 21% oxygen As you gain altitude the air pressure drops Less oxygen is available to the body because of this reduced pressure Less oxygen available means you suffer the effects of altitude BarP: barometric pressure PIO2: pressure of inhaled oxygen PaO2: arterial oxygen pressure PaCO2: arterial carbon dioxide pressure SaO2: percent of arterial oxygen saturation

Initial Physiological Response to Altitude: 

Initial Physiological Response to Altitude Increased rate and depth of breathing Decreased oxygen saturation Changes in pH Pulse Rate and Cardiac Output Blood Volume Sleep Hypoxia

Acclimatization: 

Acclimatization Increased Respiratory Volume Increased Pulmonary Artery Pressure Increased Cardiac Output Increased Number of Red Blood Cells Changes in Oxygen-Carrying Capacity Changes in Body Tissues

Acute Mountain Sickness: 

Acute Mountain Sickness

High Altitude Pulmonary Edema (HAPE): 

High Altitude Pulmonary Edema (HAPE)

High Altitude Cerebral Edema (HACE): 

High Altitude Cerebral Edema (HACE)

Gamow Bag: 

Gamow Bag

Tips for Operations at Altitude: 

Tips for Operations at Altitude Driving or flying to altitudes above 10,000 feet is not recommended; it will take 24-72 hours to adjust if you do fly to altitudes above 10,000 feet Stay properly hydrated…you can lose up to 4 liters per day just breathing…think about water sources, and the resources required to make the water drinkable (filters, stoves, iodine etc.) High carbohydrate diets are recommended If an individual shows symptoms of altitude illness, you cannot take that person to a higher altitude until the symptoms have subsided; if the symptoms worsen, it is time to evacuate that individual to a lower altitude. Even a wait of a few hours can mean the difference between life and death.

Tips for Operations at Altitude: 

Tips for Operations at Altitude 24-72 hours after arrival at altitude, begin a PT program that will mimic the operations you will be conducting; if possible train at higher altitudes and sleep at lower altitudes Diamox can help but may not be appropriate for all individuals Tobacco, alcohol, dehydration, depressant drugs and over-exertion will inhibit acclimatization Remember that you and your soldiers will never be able to perform to sea level capacity; everything will take longer to accomplish

Altitude IllnessSummary: 

Altitude Illness Summary Action: Manage altitude illness Condition: Under any field condition Standard: Soldier identified all of the signs and symptoms of altitude sickness selected and applied the recommended treatment for the specified altitude sickness

Cold Weather and Mountain Environmental InjuriesTerminal Learning Objective: 

Cold Weather and Mountain Environmental Injuries Terminal Learning Objective Action: Manage common cold weather and mountain environmental injuries Condition: Given the ECWCS, other issued cold weather clothing items, and issued cold weather sleep system with insulating pad, access to a warming shelter, under field conditions where temperatures range from 40º F to – 60º F Standard: Soldier identified all of the signs and symptoms of common cold weather and mountain environmental injuries. selected and applied the recommended treatment for common cold weather and mountain environmental injuries

Snow Blindness: 

Snow Blindness

Improvised Slit Glasses: 

Improvised Slit Glasses

Carbon Monoxide Poisoning: 

Carbon Monoxide Poisoning

Giardia: 

Giardia

Constipation: 

Constipation

Heat Exhaustion : 

Heat Exhaustion

Heat Stroke: 

Heat Stroke

Hyponatremia: 

Hyponatremia

Cold Weather and Mountain Environmental InjuriesSummary: 

Cold Weather and Mountain Environmental Injuries Summary Action: Manage common cold weather and mountain environmental injuries Condition: Given the ECWCS, other issued cold weather clothing items, and issued cold weather sleep system with insulating pad, access to a warming shelter, under field conditions where temperatures range from 40º F to – 60º F Standard: Soldier identified all of the signs and symptoms of common cold weather and mountain environmental injuries. selected and applied the recommended treatment for common cold weather and mountain environmental injuries