THE NUMBER ONE PRIORITY IN ALL EMERGENCES DURING THE EVENT IS GETTING APPROPRIATE MEDICAL CARE TO THE INJURED PARTY AS PROMPTLY AS POSSIBLE

If an injury does occur, the first priority is to get help to the injured party. For this to effectively occur several things must occur:

In the field, call for a CORPSMAN NOT A MEDIC · The command tent must be contacted and advised of the emergency

All fighting in the area of the injured party must immediately come to a halt.

If one of the re-enactor real-world medical personnel is in the area, they should respond to the location and begin first responder care until relieved by Post Medical Personnel.

Prevention and Treatment of Cold Injuries

For “real-world” medical folks

Introduction

Cold injuries have had profound effects on military operations throughout history.  Most cold injuries are preventable and require unit commanders to work with medical personnel  to develop an effective prevention strategy.

Types of Cold Injuries

Hypothermia
Frostnip
Frostbite

Risk Factors for Cold Injury

Age  The very young and elderly are more susceptible
Lower Rank Lower enlisted rank associated with higher risk due to greater degree of exposure
Previous Cold Injury Increases risk of cold injury.
Fatigue Increases risk due to carelessness and neglect of survival-related activities
Discipline, Training, and Experience Poorly motivated individuals tend to be less active and pay less attention to personal hygiene needs increasing their risk of injury
Race and Area of Origin Dark skinned individuals and those from warmer climate tend to increase risk
Activity Lack of physical activity increases risk.  Exertion increases sweating, heat loss, and increases caloric requirements
Nutrition and Hydration Increased exercise due to heavy clothing and snow can increase caloric requirements to 7000 calories per day.
Drugs and Other Medications
Clothing Inadequate, tight fitting or wet clothing all increase the likelihood of cold injury.  Wear a hat, scarf, and mittens rather than gloves
Alcohol gives a false feeling of warmth but actually dilates blood vessels resulting in greater heat loss.
Tobacco has very powerful effects on the blood vessels that result in decreased blood flow.

Prevention of Cold Injuries

SPECIFIC TYPES OF COLD INJURIES

Frostnip 
 Frostnip is the formation of ice crystals in the subcutaneous tissue.  Usually encountered in conditions of high humidity, high wind, and and temperatures above freezing where the subject is exposed to chronic and intermittent cold exposure.  Affected tissue is painful and pallid due to vasoconstriction.  Symptoms resolve spontaneously.

Frostbite
 Freezing injury that results from exposure to temperature below freezing.  Factors that affect severity include temperature, wind speed, and duration of exposure.  Tissue injury results from formation of ice crystals in the tissue.  There are four “degrees” of frostbite

1.  First Degree Frostbite is marked by redness, itching, and swelling of the affected body part.  There is no blistering or peeling of the skin.
2.  Second Degree Frostbite is characterized by blister formation and peeling of the skin.
3. Third Degree Frostbite is associated with necrosis of the skin and subcutaneous tissue with ulceration.
4. Fourth Degree Frostbite involves destruction of connective tissues and bone with gangrene formation.  Secondary infections are common particularly in the case of freeze-thaw-refreeze injury.

TREATMENT OF FROSTBITE

Field  treatment of frostbite is based on the prevention of further injury to the affected body part.  The individual should be kept warm.  The medic should remove constricting clothing and apply a protective dressing.  Give the casualty something warm to drink and eat.  For lower extremity injury, the individual must be transported by litter.

THINGS TO AVOID IN THE FIELD TREATMENT OF FROSTBITE

1. Allow no alcohol consumption
2. No tobacco products
3. Do not rub the injured extremity
4. Do not expose the injured extremity  to campfires or car heaters