Update: Cold weather injuries, active and reserve components, U.S. Armed Forces, July 2010-June 2015.

From July 2014 through June 2015, the number of active and reserve component service members treated for cold injuries (n=603) was much lower than the 719 cases diagnosed during the previous, unusually cold winter of 2013- 2014. Army personnel accounted for the majority (51%) of cold injuries. Frostbite was the most common type of cold injury in each of the services except the Marine Corps for which immersion foot was unusually common. Consistent with trends from previous cold seasons, service members who were female, younger than 20 years old, or of black, non-Hispanic race/ethnicity tended to have higher cold injury rates than their respective counterparts. Numbers of cases in the combat zone have decreased in the past 3 years, most likely the result of declining numbers of personnel exposed and the changing nature of operations. It is important that awareness, policies, and procedures continue to be emphasized to reduce the toll of cold injuries among U.S. service members.

Update: cold weather injuries, active and reserve components, U.S. Armed Forces, July 2009-June 2014.

From July 2013 through June 2014, the number of active and reserve component service members treated for cold injuries (n=719) was the highest of the past five cold seasons (2009-2014). The rate of cold injury among active component personnel was also the highest of the 5-year period. Army personnel accounted for the majority (62%) of cold injuries. Frostbite was the most common type of cold injury in each of the services. Consistent with trends from previous cold seasons, service members who were female, younger than 20 years old, or of black, non-Hispanic race/ethnicity tended to have higher cold injury rates than their respective counterparts. Numbers of cases in the combat zone have decreased in the past 2 years, presumably as a result of declining numbers of personnel exposed and the changing nature of operations. The increase in numbers and the geographic distribution of cold injuries in the previous cold season are compatible with the unusual pattern of cold weather that marked Winter 2013-2014.

The epidemiology of cold injury in Antarctica.

METHOD: A retrospective study was performed of 10 yr of medical records to determine the type, severity, etiological factors and treatment of cold injury experienced by members of the British Antarctic Survey between 1986-95. RESULTS: There were 61 new consultations for cold injury. These comprised 2.5% of all new consultations with an incidence of 65.6 per 1000 per year. Cold injuries seen were frostbite (95%), hypothermia (3%) and trench foot (2%). Superficial frostbite was the most common injury (74% of cases) with the face the most frequently affected area (47% of injuries). No cases of frostbite severe enough to cause permanent tissue loss were seen. The prevalence of cold injury increased with falling temperature to a maximum between -25 and -35 degrees C, despite these temperatures occurring infrequently. The relationship with windchill is not as clear cut with frequency of injury tending to follow the frequency of windchill values except at higher windchill values. Neither temperature nor windchill were found to significantly influence the severity of frostbite. Prior cold injury was shown to be significantly (chi2 p < 0.001) associated with further cold injury. Most injuries (78%) occurred during recreation; skiing and snowmobile driving were often implicated. CONCLUSIONS: Cold injury is uncommon in Antarctica. Despite this, it warrants a continued high profile as under most circumstances it may be regarded as an entirely preventable occurrence.

Warm water immersion foot: still a threat to the soldier.

We report a significant incidence of warm water immersion foot (WWIF) in a light infantry battalion during a field exercise. Four hundred soldiers belonging to this battalion were surveyed to determine the prevalence of the WWIF syndrome. One hundred forty-nine soldiers surveyed developed the WWIF syndrome. The affected soldiers had a wide range of disability, ranging from mild discomfort to the inability to ambulate. All soldiers had full recovery within 2 weeks of the injuries. Although the syndrome is self-limited, the loss of these soldiers from combat critically impaired the battalion in its mission. We present this report as a reminder that effective preventive measures should be taken prior to field exercises and deployments.

Cold weather injuries during peacetime military training.

Demographic data on 220 cold weather injuries seen over a 52-month period at the 67th Evacuation Hospital in Wuerzburg, Germany, was reviewed. Data were collected at the time of presentation and all diagnoses were made by a general/vascular surgeon. Statistics on age, gender, race, rank, unit, prior injury, use of tobacco products, classes on prevention, and activity at the time of injury were reviewed. Previously identified risk factors were confirmed except for tobacco use. There appeared to be no risk associated with gender or rank. Most injuries were sustained by soldiers performing low-risk activities for which no clear predisposing event could be ascribed. Prevention and early detection appear critical since injuries were not necessarily associated with specific actions or events.

Immersion foot. A problem of the homeless in the 1990s.

The syndrome of immersion foot is being seen with increasing frequency among the homeless population. It represents the effects of injury by water absorption in the stratum corneum of the skin of the feet. The taxonomy of this disorder is confusing and the many colorful pseudonyms should probably be dropped in favor of a simple classification based on the temperature of the water and the duration of exposure. When uncomplicated by infection or ischemic injury, immersion foot will quickly resolve with conservative measures only. More complicated cases may require antibiotics and surgical treatment. This syndrome may be exacerbated by disturbances of cognition, peripheral neuropathy, peripheral vascular disease, or the use of tobacco or vasoconstrictor drugs such as cocaine. A major contributing factor seems to be lack of shelter in the homeless population. Attention to foot care problems among the homeless and education concerning preventive measures are incumbent on physicians who care for the indigent.