Posted on Apr 16, 2021
Have you been exposed to trauma in near or freezing conditions? Are there institutional courses or classes available that discuss this topic?
4K
22
19
6
6
0
Fire and Ice: The Winter War of Finland and Russia
2005 Documentary
25th ID in Alaska and Ft. Drum regularly send people through the Cold Weather Leader Course, and Mountaineering courses that aid those units in learning about TTPs and lessons learned from cold weather conflicts in the past and how to negotiate the terrain more effectively, reduce risk, and much more. Many of the references and lessons were taken from the Russo and Finnish war, several references to the documentary Fire and Ice https://www.youtube.com/watch?v=QBtSP_X7fog&list=PL0tVClD-FkQon3lAVx94LwBcPJW07uW1Q&index=2.
A large problem that remains with little focus is how to respond to trauma in cold weather. We talk about cold weather injuries all the time but there is very little in the way of courses or classes dedicated to treatment of trauma within near or freezing conditions. History, if unchanged, would show that if you experience severe trauma in these arctic conditions, you are guaranteed death. Is there any more information offered on the SOF side to address this issue? I have not come across any in either conventional or SOF in the communities I worked with.
A large problem that remains with little focus is how to respond to trauma in cold weather. We talk about cold weather injuries all the time but there is very little in the way of courses or classes dedicated to treatment of trauma within near or freezing conditions. History, if unchanged, would show that if you experience severe trauma in these arctic conditions, you are guaranteed death. Is there any more information offered on the SOF side to address this issue? I have not come across any in either conventional or SOF in the communities I worked with.
Combat Medic
68W: Healthcare Specialist (Combat Medic)
Medic
Cold Weather Leaders Course CWLC (NWTC)
Posted >1 y ago
Responses: 6
5
5
0
I would suggest you look at mountaineering medicine and wilderness medicine sources for answers. My take is that the ability to maintain body temperature is the biggest concern, so if you have a wound that has profound blood loss, you are trying to deal with shock and maintain a non hypothermic body temperature, which would be difficult if rapid evacuation is unavailable. I taught Swiftwater Rescue for about a decade and have had to deal with hypothermia alone on rivers on a number of occasions where there were not any additional conditions involved. If the condition gets beyond the "umbles" stage, evacuation is required to a definitive care facility. Google "Medicine for Mountaineering" as a good place to start. Here are a number of Wilderness Medical Schools in the nation, from NOLS to WMI. They can be a good source too.
(5)
(0)
4
4
0
I spent 4+ years at Fort Drum. I would definitely classify those winters as traumatic.
(4)
(0)
3
3
0
Avoiding hypothermia and the ability to evac are the 2 issues. We know how to treat our wounded, but cold weather is just a plain old--KILLER. So make sure you know how to get the individual warm. and keep them warm-FAST. (And yes, this is where you may have to do the two in one bag thing) So, your basic jobs are to perform first aide and to keep them warm till they are evacuated.
Now keeping your soldiers in good physical shape is biggest thing you can do to help them survive being wounded in extreme cold. There is a host of PREVENTATIVE things that go along with this and everyone of them is absolutely important, and if not strictly enforced, will hugely retard a individual's ability to resist trauma in cold weather operations. Oh, I usually count frost-bite as stupidity and NCO negligence; unless you accidently fell into water.
Here are a few of them, and trust me, they are just little common sense things and orders of discipline. Clean and dry clothes, enough hot food to eat as you need additional calories to survive in cold weather, buddy system, hygiene, enough decent sleep, the discipline to follow winter SOPs, and good moral. I will only give you one example and you will see how something small becomes something big; frozen clothes don't keep you warm and have you ever tried to get them off?? Nuff said.
I used to be in the 205th Artic Light and I'm coined. The book Frozen Hell by William R. Trotter is excellent. An Oldie but Goodie that I have is the US Army's Pamphlet No. 20-271 by Earl Ziemke, on German Northern Operations from WWII; printed June 1959. While at a higher level, it covers a lot of issues of large scale northern operations and you can see how it filters down to the individual unit. This is really a old but excellent read. Oh, and it's actually a hard cover book and not a paper pamphlet.
Now keeping your soldiers in good physical shape is biggest thing you can do to help them survive being wounded in extreme cold. There is a host of PREVENTATIVE things that go along with this and everyone of them is absolutely important, and if not strictly enforced, will hugely retard a individual's ability to resist trauma in cold weather operations. Oh, I usually count frost-bite as stupidity and NCO negligence; unless you accidently fell into water.
Here are a few of them, and trust me, they are just little common sense things and orders of discipline. Clean and dry clothes, enough hot food to eat as you need additional calories to survive in cold weather, buddy system, hygiene, enough decent sleep, the discipline to follow winter SOPs, and good moral. I will only give you one example and you will see how something small becomes something big; frozen clothes don't keep you warm and have you ever tried to get them off?? Nuff said.
I used to be in the 205th Artic Light and I'm coined. The book Frozen Hell by William R. Trotter is excellent. An Oldie but Goodie that I have is the US Army's Pamphlet No. 20-271 by Earl Ziemke, on German Northern Operations from WWII; printed June 1959. While at a higher level, it covers a lot of issues of large scale northern operations and you can see how it filters down to the individual unit. This is really a old but excellent read. Oh, and it's actually a hard cover book and not a paper pamphlet.
(3)
(0)
3
3
0
Great question and I hope someone knowledgeable chimes in so I can learn more. All I can offer is that I routinely carried a "space blanket" (commercial name) in my ruck sack. Its just a sheet of mylar the size of a poncho liner. This was in case anyone took a dunk in freezing weather. Never needed it but I thought it couldn't hurt.
(3)
(0)
1
1
0
I appreciate the added response of mountain medicine and like courses but in my experience they still mostly just cover cold weather injuries (including hypothermia) and response to them but still treat them as separate issues from the trauma sustained.
What I haven't seen yet is any official guidance that teaches medical providers when it's time to deviate from the book answer (TC3 guidelines specifically) and understand that exposing the patient will kill them. Giving them cold fluids that have been in your bag will kill them, applying moist dressings will increase risk of hypothermia, etc.
I have not witnessed any official guidance that tells the first responder at what temperature to stop administering fluid, exposing patients, changing the items we apply directly to the skin, etc..
It's a common problem that I have run into when it is 40 degrees outside or even snow on the ground and these first responders are still cutting or ripping clothing off and seeing the TC3 guideline indications for fluid administration and pulling out a bag that has been in their dismounted pack for the movement that took 30+ minutes and not even thinking twice before giving it to a hypovolemic patient. They are hot from the movement and don't even comprehend that it is near or freezing outside where they are providing tactical medicine.
What I haven't seen yet is any official guidance that teaches medical providers when it's time to deviate from the book answer (TC3 guidelines specifically) and understand that exposing the patient will kill them. Giving them cold fluids that have been in your bag will kill them, applying moist dressings will increase risk of hypothermia, etc.
I have not witnessed any official guidance that tells the first responder at what temperature to stop administering fluid, exposing patients, changing the items we apply directly to the skin, etc..
It's a common problem that I have run into when it is 40 degrees outside or even snow on the ground and these first responders are still cutting or ripping clothing off and seeing the TC3 guideline indications for fluid administration and pulling out a bag that has been in their dismounted pack for the movement that took 30+ minutes and not even thinking twice before giving it to a hypovolemic patient. They are hot from the movement and don't even comprehend that it is near or freezing outside where they are providing tactical medicine.
(1)
(0)
SFC Casey O'Mally
SFC (Join to see) - We had this happen when I was at Drum. 12 mile ruck march in 25 degrees with snow gusting around us. One of our lovely brilliant troops knew that it was cold outside, so disobeyed orders and wore his poly-pro. He went down with hyperthermia around mile 8. PLT medic stuck him, and he recovered just fine.
He DID go into shock. But Medic said it was a VERY simple choice between sending his patient into shock - which is VERY RARELY deadly if treated and monitored - or letting him burn up.
I understand that isn't the answer you are looking for, probably. But sometimes our only choice is the least bad option.
He DID go into shock. But Medic said it was a VERY simple choice between sending his patient into shock - which is VERY RARELY deadly if treated and monitored - or letting him burn up.
I understand that isn't the answer you are looking for, probably. But sometimes our only choice is the least bad option.
(0)
(0)
SFC Randy Hellenbrand
SFC (Join to see) - I said you have to know to get them warm. We had ALL of our stuff on a ahkio; that we pulled. Or didn't you guys stay out overnight??
(0)
(0)
SFC (Join to see)
SFC Randy Hellenbrand - SFC Casey O'Mally We did use ahkios and set up camps overnight. What I believe is being overlooked in my original questions and the intent behind my responses, is trauma in cold weather, not cold weather injuries. The most common cause of death on the battlefield is extremity hemorrhage. Knowing this, the TC3 guidelines state that fluid resuscitation is a critical part of achieving homeostasis.
In the case of the guy with hyperthermia, you are still dealing with a closed system that is easier to return to homeostasis than an open container system that is missing a large amount of substance required to sustain the system and adding another lethal factor on top of the existing issue.
In this most common situation that leads to death on the battlefield, the patient has most commonly lost large amounts of blood reducing the ability for them to regulate temperature, clot, perfuse, etc.. This is the problem. How do we effectively provide fluids ((1) Cold stored low titer O whole blood, (2) Pre-screened low titer O fresh whole blood, (3) Plasma, red blood cells (RBCs) and platelets in a 1:1:1 ratio, (4) Plasma and RBCs in a 1:1 ratio, (5) Plasma or RBCs alone) without lowering body temperature disrupting homeostasis, clotting cascade, perfusion, etc. that would kill the patient.
A larger problem set that this whole conversation falls into is why is there such a great difference in the percentage of preventable death on the battlefield from SOF (0-3%) and conventional forces (24%). How do we bridge that gap and get more people back home? Education and working through systemic problems like my original question is just one way.
The thing that we have failed to educate and include in training or things like the TC3 Guidelines is the fact that even the preferred choices listed above have different affects on the system when infused. For example. Blood products will lower the temperature of a patient less than the crystalloid solutions we are currently fielding our first responders which makes them a more ideal choice in most circumstances.
How accessible are these blood products to our conventional forces first responders (self aid, buddy aid, and line medics)? In this freezing or arctic environment, you may have a few units of cold stored blood available to you. The problem here is how do we get more when we run out whether that be from massive trauma or multiple patients? The current guidelines of using a walking blood bank in these temperatures and conditions could be significantly affected by these conditions and may, in certain circumstances, make this option unavailable.
https://learning-media.allogy.com/api/v1/pdf/9e7beef5-e713-472f-9eb3-1f7f0fdf33a3/contents
In the case of the guy with hyperthermia, you are still dealing with a closed system that is easier to return to homeostasis than an open container system that is missing a large amount of substance required to sustain the system and adding another lethal factor on top of the existing issue.
In this most common situation that leads to death on the battlefield, the patient has most commonly lost large amounts of blood reducing the ability for them to regulate temperature, clot, perfuse, etc.. This is the problem. How do we effectively provide fluids ((1) Cold stored low titer O whole blood, (2) Pre-screened low titer O fresh whole blood, (3) Plasma, red blood cells (RBCs) and platelets in a 1:1:1 ratio, (4) Plasma and RBCs in a 1:1 ratio, (5) Plasma or RBCs alone) without lowering body temperature disrupting homeostasis, clotting cascade, perfusion, etc. that would kill the patient.
A larger problem set that this whole conversation falls into is why is there such a great difference in the percentage of preventable death on the battlefield from SOF (0-3%) and conventional forces (24%). How do we bridge that gap and get more people back home? Education and working through systemic problems like my original question is just one way.
The thing that we have failed to educate and include in training or things like the TC3 Guidelines is the fact that even the preferred choices listed above have different affects on the system when infused. For example. Blood products will lower the temperature of a patient less than the crystalloid solutions we are currently fielding our first responders which makes them a more ideal choice in most circumstances.
How accessible are these blood products to our conventional forces first responders (self aid, buddy aid, and line medics)? In this freezing or arctic environment, you may have a few units of cold stored blood available to you. The problem here is how do we get more when we run out whether that be from massive trauma or multiple patients? The current guidelines of using a walking blood bank in these temperatures and conditions could be significantly affected by these conditions and may, in certain circumstances, make this option unavailable.
https://learning-media.allogy.com/api/v1/pdf/9e7beef5-e713-472f-9eb3-1f7f0fdf33a3/contents
µ¡äú·DÁv'ËËq[ßôZÛ}HñÛëÎÞôÌ_wFI·ÃÝ*{ÝÚ^ïQ4a`êh``¶èè Ñ@(J .ÏØ``àC\À4RhLTJjTfz8Ì3T)àhÒ :l@Ù"H X$ÈÁÔÉÅøIñ?Ã/Æ7'ß2q1ú\þÝÿ5ßl+7ò*00{8YÞþÑow@Ü%`2æf`.'9¿AD Û endstream endobj 1192 0 obj
(0)
(0)
SFC (Join to see)
CPT Lawrence Cable - There is the common phrase of "pain is the patients problem" which is completely applicable when it is in the best interest to save the patient and resources to address pain management are limited, unavailable, or would have a severe affect on their system.
Heat packs can help with warming fluids but the problem lies in that I haven't seen any official guidance that tells us at what temperature to stop administering fluids. We also don't have an effective way of checking the temperature of the fluids with MTOE provided equipment for the first responders.
We had set up a local SOP that determined in an artic condition, treat them as a CBRN casualty in that you will not take off any clothing but rather apply what you can over the clothing or use holes or tears in the clothing to access and address the injury.
Heat packs can help with warming fluids but the problem lies in that I haven't seen any official guidance that tells us at what temperature to stop administering fluids. We also don't have an effective way of checking the temperature of the fluids with MTOE provided equipment for the first responders.
We had set up a local SOP that determined in an artic condition, treat them as a CBRN casualty in that you will not take off any clothing but rather apply what you can over the clothing or use holes or tears in the clothing to access and address the injury.
(0)
(0)
0
0
0
So this is only talking about training scenarios? This is not something that would even be considered practical anymore because of the massive cost that would be associated with it and the fact that such expeditions would not be happening anymore because it is way safer and more cost effective to simply avoid those areas entirely when making troop movements. I have to confess I don't know much about the training aspect of it because most of my time was spent in combat zones but I do know about the budgeting aspect and trying to secure the necessary funds for training that would ultimately be deemed unnecessary would be almost impossible. I remember when I was teaching combat life saver classes to my unit that me and the other two guys teaching the class actually even had to secure our own supplies for teaching the class and even setup our own lesson plan and everything and that was training that the unit actually wanted to happen.
(0)
(0)
SFC (Join to see)
SPC Joshua Dawson My question covers broad spectrum including any type of real world casualty response, no matter how it was sustained. We have more people die every year from Disease Non Battle Incidents (DNBI) than combat. As for the cost, I'm confident you are completely right in that the cost is significantly higher however, we are already operating in these environments every day. The average temperature at Fort Wainwright in the winter is -20. The lowest temperatures for most stateside installations gets below freezing. South Korea gets well below the freezing point. Most importantly it gets below freezing in the mountains of Afghanistan.
We simply choose to ignore the fact that we are already routinely operating and fighting whether training or combat in near or freezing conditions. This is the problem. When someone is conducting operations at 40 degrees and they are sweating and tired after conducting a long movement, bounding, or battle drills, all they process at that time of high stress is gross sensory items and their own temperature and fatigue levels. Generally only the well trained have learned to pause, reduce their heart rate, and open their aperture to see everything that is happening around them. Those people are not the average.
For those average personnel, they don't realize that they may be exposing their patient to hypothermia, giving their patient freezing fluids, etc.. That is where my question comes in. What training is there to educate our first responders about this issue? Are there any institutional classes our courses that really get into this topic? My experience says no. I want to know what others have found or done to address this problem. Thanks for the response.
We simply choose to ignore the fact that we are already routinely operating and fighting whether training or combat in near or freezing conditions. This is the problem. When someone is conducting operations at 40 degrees and they are sweating and tired after conducting a long movement, bounding, or battle drills, all they process at that time of high stress is gross sensory items and their own temperature and fatigue levels. Generally only the well trained have learned to pause, reduce their heart rate, and open their aperture to see everything that is happening around them. Those people are not the average.
For those average personnel, they don't realize that they may be exposing their patient to hypothermia, giving their patient freezing fluids, etc.. That is where my question comes in. What training is there to educate our first responders about this issue? Are there any institutional classes our courses that really get into this topic? My experience says no. I want to know what others have found or done to address this problem. Thanks for the response.
(0)
(0)
SPC Joshua Dawson
SFC (Join to see) - Yes your unit may be operating in that environment but the entire Army is not and to my knowledge there has never been any sort of training exercise that was not setup in accordance with the entirety of the Army and not specific based on a unit by unit case. If that was the case then no training exercises would ever get approved.
(0)
(0)
SFC (Join to see)
SPC Joshua Dawson - It looks like you missed the part in my previous reply that states just a few of the places people are stationed and exposed to the mentioned environment everyday so, yes, the entire Army save a few posts operate in cold weather environments during the appropriate season during the year.
(0)
(0)
Read This Next
Continue with Facebook 
Continue with Google