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Cold Weather Survival |
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V. HYGIENE AND FIRST AID
3-33. General
In cold weather, the
care of the body requires special emphasis. If men are allowed to go without washing,
fail to eat properly, do not get sufficient liquids or salt, efficiency will suffer.
Lowered efficiency increases the possibility of casualties, either by cold injury
or enemy action. 3-34.
Dehydration
a. Definition and Principle. Dehydration means to lose
or be deprived of water or the elements of water. A growing plant loses (uses)
water in the growing process. If this water is not replaced by either natural
means (rain) or by watering, the plant will wither and eventually dry up. The
same principle applies to the human body which loses water and, an additional
element, salt. A certain amount of this loss is taking place constantly through
the normal body processes of elimination; through the normal daily intake of food
and liquids, these losses are replaced.
b. Dangers. When individuals
are engaged in any strenuous exercises or activities, an excessive amount of water
and salt is lost through perspiration. This excessive loss creates what is known
as “imbalance of liquids” in the body and it is then that the danger of dehydration
arises, unless this loss of liquids
and salt is replaced immediately and individuals
are allowed sufficient rest before continuing their activities.
c. Training
and Discipline. The danger of dehydration for troops operating under cold
weather conditions and over ice and deep snow is a problem that does exist and
cannot be overemphasized. It is equally important, however, to recognize that
the problem can be overcome and will present no great obstacle to well trained,
disciplined troops who have been thoroughly oriented in the causes, the symptoms,
and the effects of dehydration and who have been properly instructed in preventive
measures.
d. Differences. It is important, therefore, to be aware that
the danger of dehydration is as prevalent in cold regions as it is in hot, dry
areas. The difference is that in hot weather the individual is conscious of the
fact that the body is losing liquids and salt because he can see and feel the
perspiration with its saline taste and “feel” it running down the face, getting
in the eyes, and on the lips and tongue, and dripping from the body. In cold weather,
it is extremely difficult for an individual who is bundled up in many layers of
clothing to realize that this condition does exist. Under these conditions, perspiration
is rapidly absorbed by the heavy clothing or evaporated by the air and is rarely
visible on the skin.
e. Cause, Symptoms, Effects, Preventive Measures, and
Treatment.
(1) Dehydration results from failure to correct the body’s “imbalance
of liquids” through replacing liquid and salt which has been lost.
(2) 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. General nausea is felt and may be accompanied by spells of
faintness, extreme dizziness and vomiting. A feeling of general tiredness and
weakness sets in and muscle cramps may occur, especially in the legs. It becomes
difficult to keep the eyes in focus and fainting or “blacking out” may occur.
(3)
The effect of dehydration on the individual is to incapacitate him for a period
of from a few hours to several days. The effectiveness of the individual’s
unit
is likewise reduced by the loss of his contribution to the accomplishment of the
unit mission. Small patrols and detachments operating beyond range of immediate
help from the parent unit must be extra cautious to avoid dehydration since they
run the risk of a secondary but more dangerous effect of dehydration, that of
becoming cold weather casualties while incapacitated.
(4) Dehydration can be
prevented during cold weather operations by following the same general preventive
measures applicable to hot, dry areas. Salt and sufficient additional liquids
are consumed to offset excessive body losses of these elements. The amount will
vary according to the individual and the type of work he is doing, i.e., light,
heavy, very strenuous, etc. 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 how short the distance.
(5) In treating
a person who has become dehydrated, the individual should be kept warm but his
clothes loosened sufficiently to allow proper circulation;
liquids and salt
should be fed to him gradually and, most important of all, he must have plenty
of rest. When salt tablets are not available, common table salt may be used. Approximately
one-half of a level mess spoon of salt mixed in one gallon of water makes a palatable
solution. The individual should receive prompt attention of trained medical personnel. 3-35.
Personal Hygiene
Because of the extremes in temperatures and lack of
bathing and sanitary facilities, keeping the body clean in cold weather will not
be easy.
a. The entire body should be washed at least weekly. If bathing
facilities are not available, the entire body can be washed with the equivalent
of two canteen cups of water, using half for soap and washing, and half for rinsing.
If circumstances prevent use of water, a rubdown with a dry cloth will help. Care
should be taken not to abrade the skin. The feet, crotch, and armpits should be
cleaned daily.
b. A temporary steam bath can be built in a large-size
tent. Stones are piled up to form a furnace. The furnace is either heated inside
the tent (ventilation flaps wide open) or in the open with the tent pitched over
the furnace after the stones are heated. Wood is used for fuel. Seats and water
buckets are taken into the tent after the stones are nearly red-hot and the fire
has died down, so that they do not get sooty. The pouring and washing water is
usually
heated outside the tent. The water is thrown on the hot stones in small
quantities. Thus it does not drop into the ashes and the temperature does not
rise too fast. A naked person spends from 15 minutes to 1 hour in this steam bath.
After thoroughly perspiring, the body is washed with tepid water.
c. Beards
should be shaved or clipped close. Hair should be combed daily and not allowed
to grow too long. A beard or long hair adds very little in insulation value and
soils clothing with the natural hair oils. In winter, a beard or a mustache is
a nuisance since it serves as a base for the buildup of ice from moisture in the
breath and will mask the presence of frostbite. All individuals should shave daily,
when possible. Because shaving with a blade and soap removes the protective face
oils, the individuals should shave, if possible several hours before exposing
his face to the elements. This action will reduce the danger of frostbite. Shaving
with an electric razor will not remove the protective oils. Under chemical or
biological warfare conditions a beardless face and daily shaving are especially
important, since an airtight seal of the protective mask is difficult to obtain
with even stubble on the face.
d. Socks should be changed and the feet
washed daily. If this is not possible, the boots and socks should be removed,
and the feet massaged and dried. By sprinkling the feet liberally with foot powder
and then rubbing the powder off, the feet can be efficiently dry-cleaned.
e.
Sleeping bags should be kept clean. Subject to operational requirements, the best
method is to wear the minimum clothing in the sleeping bag. Never wear damp socks
or underwear in the sleeping bag. Dry underwear and socks should be put on before
going to sleep and the other set hung up to dry. Perspiration will soil a sleeping
bag, and cause it to become damp, therefore, the bag should be aired as frequently
as possible. In the morning, the bag should be opened wide and air pumped in and
out to remove the moist air within the bag.
f. Teeth should be cleaned
daily. If a toothbrush is not available, a clean piece of gauze or other cloth
wrapped around the finger, or end of a twig chewed into a pulp may be used in
lieu of a toothbrush.
g. Underwear and shirts should be changed at least
twice weekly; however, if it is not possible to wash the clothing this often the
clothing should be crumpled, shaken out, and aired for about 2 hours. 3-36.
Cold Injury
a. Frostbite. Frostbite is the freezing of some part
of the body by exposure to temperatures below freezing. It is a constant hazard
in operations performed at freezing temperatures, especially when the wind is
strong. Usually there is an uncomfortable sensation of coldness followed by numbness.
There may be a tingling, stinging, or aching sensation, even a cramping pain.
The skin initially turns red. Later it becomes pale gray or waxy white. For all
practical purposes frostbite may be classified as superficial or deep. Treatment
and management are based solely upon this classification.
(1) It is easier
to prevent frostbite, or stop it in its very early stages, than to thaw and take
care of badly frozen flesh. Clothing and equipment must be fitted and worn so
as to avoid interference with circulation. To prevent severe frostbite-
(a)
Sufficient clothing must be worn for protection against cold and wind. The face
must be protected in high wind, and when exposed to aircraft prop blast.
(b)
Every effort must be made to keep clothing and body as dry as possible. This includes
avoidance of perspiring. For heavy work in the cold, remove outer layers as needed,
and replace as soon as work is stopped. Socks should be changed as needed whenever
the feet become moist, either from perspiration or other sources.
(c)
Any interference with the circulation of the blood reduces the amount of heat
delivered to the extremities. All clothing and equipment must be properly fitted
and worn to avoid interference with the circulation. Tight fitting socks, shoes
and hand wear are especially dangerous in very cold climates.
(d) Cold
metal should not be touched with the bare skin in extreme-low temperatures. To
do so could mean loss of skin.
(e) Adequate clothing and shelter must be provided
during periods of inactivity.
(f) The face, fingers, and toes should
be exercised from time to time to keep them warm and to detect, any numb or hard
areas. The ears should be massaged from time to time with the hands for the same
purpose.
(g) The buddy system should always be used. Men should pair
off and watch each other closely for signs of frostbite and for mutual aid if
frostbite occurs. Any small frozen spots should be thawed immediately, using bare
hands or other sources of body heat.
(2) Some cases of frostbite may be superficial,
involving the skin. But if freezing extends to a depth below the skin it constitutes
a much more serious
situation, demanding radically different treatment to avoid
or minimize the loss of the part (fingers, toes, hands, feet). If a part of the
body becomes frostbitten it appears yellowish or whitish gray. Frequently there
is no pain, so keep watching one another’s face and hands for signs. The face,
hands, and feet are the parts most frequently frostbitten. The problem is to distinguish
between superficial and deep frostbite. This can usually be told with respect
to the face. The hands and feet are a different matter. A person may be able to
judge by remembering how long the part has been without sensation.
If the time
was very short the frostbite is probably superficial. Otherwise assume the injury
to be deep and therefore serious.
(3) For treatment of superficial frostbite
in the field—
(a) Cover the cheeks with warm hands until pain returns;
(b)
Place uncovered superficially frostbitten fingers under the opposing armpits,
next to the skin.
(c) Place bared, superficially frostbitten feet under
the clothing against the belly of a companion.
(d) Do not rewarm by
such measures as massage, exposure to open fires, cold water soaks, rubbing with
snow.
(e) Be prepared for pain when thawing occurs.
(4) In treatment
of deep frostbite (freezing injury) the following measures must be taken: If freezing
is believed to be deep, do not attempt to treat it in the field. Get to a hospital
or aid station by the fastest means possible. If transportation is available,
avoid walking. Protect the frozen part from additional injury but do not attempt
to thaw it out by rubbing, bending, massage. Do not rub with snow; do not place
in either cold or warm water; do not expose to hot air or open fires; do not use
ointments or poultices. Thawing in the field increases pain and invites infection,
greater damage, and gangrene. There is less danger of walking on feet while frozen
than after thawing. Thawing may occur spontaneously, however, during transportation
to a medical facility. This cannot readily be avoided since the body in general
must be kept warm.
b. Trenchfoot. Trenchfoot is the thermal injury sustained
as a result of exposure to cold, short of freezing, in a damp or wet environment.
Arbitrarily, it is said to occur in the temperature range between 32° F and
50° F. Partial causes include immobility of the limbs (legs and feet down
as in sitting or standing), insufficient clothing, and constriction of parts of
the body by boots, socks, and other garments. This type of cold injury is almost
identical with gradual frostbite, which might be expected, since the primary causes
are the same except for differences in the degree of cold. In the early stages
of trenchfoot, feet and toes are pale and feel cold, numb, and stiff. Walking
becomes difficult. If preventive action is not taken at this stage, the feet will
swell
and become painful. In extreme cases of trenchfoot the flesh dies and
amputation of the foot or of the leg may be necessary. Because the early stages
are not painful, individuals must be constantly alert to prevent the development
of trenchfoot. To prevent this condition—
(1) Feet should be kept dry by wearing
waterproof footgear and by keeping the floor of shelters dry.
(2) Socks and
boots should be cleaned and dried at every opportunity, preferably daily.
(3)
The feet should be dried as soon as possible after getting them wet. They may
be warmed with the hands. Foot powder should be applied and dry socks put on.
(4)
If it becomes necessary to wear wet boots and socks, the feet should be exercised
continually by wriggling the toes and bending the ankles. Tight boots should never
be worn.
(5) In treating trenchfoot, the feet should be handled very gently.
They should not be rubbed or massaged. If necessary, they may be cleansed carefully
with
plain white soap and water, dried, elevated, and allowed to remain exposed. While
it is desirable to warm the patient, the feet should always be kept at room temperature.
The casualty should be carried and not permitted to walk on damaged feet.
c.
Immersion Foot. Immersion foot is a form of injury which follows prolonged
immersion of the feet in water not sufficiently cold to cause freezing or frostbite.
It has been observed after exposure in subtropical waters also. Clinically and
pathologically, it is indistinguishable from trenchfoot which would be expected,
since its cause is essentially the same, lowering of the temperature of the part
of the body involved. It is usually associated with dependency
(legs and feet
down as in sitting or standing) and immobility of the lower extremities and with
constriction of the limbs by clothing and shoes. Other factors which play more
or less important roles are-body cooling, as the result of wind; total immersion;
and inadequate clothing (protection), sickness, and starvation. The incidence
and severity of immersion foot however, is more directly influenced by the other
factors listed. The treatment is the same as that given for trenchfoot.
d.
Total immersion. Immersion in near freezing water for but a few minutes, or
exposure to severe dry cold while inadequately dressed will cause total body cooling,
including a marked drop in the inner body (core) temperatures. For description
and therapy see appendix F.
e. Miscellaneous. The length of time that
a casualty may be exposed to the weather without danger of cold injury varies
directly with the temperature and wind velocity. The lower the temperature and
the stronger the wind, the sooner injury will occur. There is a great variation
in individual reactions to cold. To give competent care to the injured in extreme
cold, the medical personnel must have heated shelter in which to operate. Battle
wounds in the cold are no different from those sustained in more temperate climates,
and should be treated in the same manner. Morale is helped by the assurance that
the sick and wounded can be rapidly evacuated from the battlefield to hospitals,
and that for the nontransportable cases requiring prompt lifesaving surgery, hospitals
with highly skilled surgical personnel are available adjacent to division clearing
station level. 3-37.
Shock
Shock is brought about by a reduction of the circulating blood volume
within the body. This can be caused by severe injuries, loss of blood, pain, emotional
disturbances, or any of many factors. The normal reaction of the body to severe
cold, reduction of the volume of blood circulating to extremities, is very similar
to the reaction of the circulatory system to the condition of shock. Shock will
usually develop more rapidly and progress more deeply in extreme cold than in
normal temperature.
a. Signs of Shock. The signs of shock are apprehension;
sweating; pallor; rapid, faint pulse; cold clammy skin; and thirst. If the patient
is not given good first aid treatment immediately the condition of shock may progress
until the patient passes into unconsciousness and further into death.
b.
First Aid for Shock.
(1) The injured person should be made as comfortable
as possible.
(2) Pain may be relieved by proper positioning, good bandaging
and splinting. Aspirin will also help, if it is available and if there is no known
or suspected abdominal injury.
(3) The litter should be positioned so that
the patient is comfortable and not apt to inhale vomitus.
(4) The patient should
be kept warm with blankets and sleeping bags.
(5) When the patient is conscious
he should be given warm soup, chocolate, coffee, or tea if there is no known or
suspected abdominal injury.
(6) The patient should receive medical attention
as soon as possible. 3-38.
Sunburn
An individual may get sunburned when the temperature of the air
is below freezing. On snow, ice, and water, the sun’s rays reflect from all angles;
in a valley the rays come from every direction. Sunlight reflected upward from
the bright surfaces attacks man where the skin is very sensitive-around the lips,
nostrils, and eyelids. The exposure time which will result in a burn is reduced
in the clear air of high altitudes. Sunburn cream and a chapstick
should be
carried in the pocket, and applied to those parts of the face that are exposed
to direct or reflected light. In mild weather protection of the neck and ears
can be improvised by draping a handkerchief over the back of the head which is
held in place by the cap in the manner of a desert neckcloth.
Soap or shaving
lotions with a high alcoholic content should not be used because they remove natural
oils that protect the skin from the sun. If blistered, report to an aid station
as soon as possible, as the blistered area, especially lips, may become badly
infected. 3-39.
Snow Blindness
Snow blindness occurs when the sun is shining brightly
on an expanse of snow, and is due to the reflection of ultraviolet rays. It is
particularly likely to occur after a fall of new snow, even when the rays of the
sun are partially obscured by alight mist or fog. The risk is also increased at
high altitudes. In most cases, snow blindness is due to negligence or failure
on the part of the soldier to use his sunglasses. Waiting for discomfort to develop
before putting on glasses is folly. A deep burn of the eyes may already have
occurred by the time any pain is felt. Putting on the glasses then is essential
to prevent further injury but the damage has already been done. Symptoms of snow
blindness area sensation of grit in the eyes with pain in and over the eyes made
worse by eyeball movement, watering, redness, headache, and increased pain on
exposure to light. First aid measures consist of blindfolding, which stops the
painful eye movement, or covering the eyes with a damp cloth, which accomplishes
the same thing. Rest is desirable. If further exposure to light is unavoidable
the eyes should be protected with dark bandages or the darkest available glasses.
The condition heals in a few days without permanent damage once unprotected exposure
to sunlight is stopped. 3-40.
Constipation
a. When operating under cold weather conditions there
is a general tendency for individuals to allow themselves to become constipated.
This condition is brought about by the desire to avoid the inconvenience and discomfort
of relieving themselves under adverse conditions. This condition is also caused
by changes in eating habits and failure to drink a sufficient amount of liquids.
b.
Constipation can usually be prevented by adjusting the normal eating and drinking
habits to fit the activities in which engaged, and by not “putting off” the normal,
natural, processes of relieving the body of waste matter. Medical personnel should
be consulted if constipation persists. Each individual must be educated concerning
the consequences of neglecting personal hygiene habits. 3-41.
Carbon Monoxide Poisoning
a. Whenever a stove, fire, gasoline heater,
or internal combustion engine is used indoors there is danger of carbon monoxide
poisoning. A steady supply of fresh air in living and working quarters is vital.
Carbon monoxide is a deadly gas, even in low concentration, and is particularly
dangerous because it is odorless.
b. Units should appoint a qualified
carbon monoxide safety officer. AR 386-55 and TB Med 269 should be used
as references by these safety officers.
c. Generally there are no symptoms.
With mild poisoning, however, these signs may be present-headache, dizziness,
yawning, weariness, nausea, and ringing in the ears. Later on, the heart begins
to flutter or throb. But the gas may hit without any warning whatsoever. A soldier
may not know anything is wrong until his knees buckle. When this happens, he may
not be able to walk or crawl. Unconsciousness follows; then death. Men may be
fatally poisoned
as they sleep.
d. In a case of carbon monoxide poisoning,
the victim must be moved into the fresh air at once, but must be kept warm. In
the winter, fresh air means merely circulating air that is free from gases. Exposure
to outdoor cold might cause collapse. If the only fresh air is outdoors, the patient
should be put into a sleeping bag for warmth. A carbon monoxide victim should
never be exercised, because this will further increase his requirements for oxygen.
If
a gassed person stops breathing or breathes only in gasps, mouth-to-mouth resuscitation
should be started immediately. In the latter case, the operator’s movements must
be carefully synchronized with the victim’s gasps. Breathing pure oxygen removes
carbon monoxide from the blood faster than does breathing air and greatly hastens
recovery. Carbon monoxide is serious and a victim who survives it must be kept
absolutely quiet and warm for at least a day. Hot water bottles and hot pads are
helpful in maintaining body temperatures. 3-42.
Care of Casualties
If any member of a group is injured, the most important
course of action is to get him to competent medical aid as soon as possible. The
casualty should be given first aid treatment, protected from the cold and shock
effects, and evacuated to an aid station with a minimum of delay. He should be
placed in a
casualty bag, sleeping bag, or the best available substitute. He
should have warm drinking water or other hot drinks, except in the case of
abdominal injury.
Warning: Once a tourniquet has been
applied, the wounded man should be examined by a medical officer as soon as possible.
If possible, the tourniquet should not be loosened by anyone except a medical
officer who is prepared to stop the hemorrhage or bleeding by other means and
to administer other treatment as necessary. Repeated loosening of the tourniquet
by inexperienced personnel is extremely dangerous, can result in considerable
loss of blood, and endanger the life of the patient. Halting of circulation to
the extremities is an invitation to frostbite. If morphine is to be administered,
caution must be exercised to avoid overdosage. 3-43.
Emergency Evacuation
Personnel who have been wounded should be evacuated
to the nearest medical facility by the fastest means of transport available. Sleds
can be used if oversnow vehicles or air evacuation facilities cannot be obtained.
It may be necessary to use man-hauled sleds to move the wounded a safe distance
behind the frontlines before they can be transferred to faster means of transport
(fig. 3-19). Speed in evacuation is essential because of the combined effects
of severe cold and shock on the wounded.
 3-44.
Body Parasites
a. General. Body parasites are very common in the
more populated cold regions because of the crowded living conditions and shortage
of bathing and cleaning facilities. When in the midst of a native population,
or when occupying shelters which have been used before, individuals must inspect
clothing and body each night for parasites.
b. Means of Control. If
clothing has become infested with lice, the following methods of removing them
are recommended:
(1) While extreme cold does not kill lice, it paralyzes them.
The garments should be hung in the cold; then beaten and brushed. This will help
rid the garments of lice, but not of louse eggs.
(2) An appropriate insecticide
powder can be used to free the body and clothing of body parasites.
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