Medical Encounters During a Joint Canadian/U.S. Exercise in the High Arctic (Exercise Arctic Ram).

The Arctic Ram Exercise was conducted in February 2016, near Resolute Bay on Cornwallis Island in Nunavut, Canada, to demonstrate the ability of the Canadian Armed Forces (CAF) to rapidly deploy to the arctic as an immediate response team. This report describes medical problems experienced by the 187 CAF and 28 U.S. forces involved in the exercise. Sixty-six airborne soldiers performed tactical static line jumps and linked up with soldiers on the ground for the exercise. Medical events were recorded by medics on the drop zone and by medical personnel at the Unit Medical Station in Resolute Bay. Average temperature during the exercise was -21°C and wind chill was -44°C. Two U.S. soldiers were injured in association with the jump and an additional 62 patients presented at the clinic during the exercise for an overall medical event incidence of 30%. The incidence of frostbite was 17%. At the end of the exercise, a physician actively examined CAF soldiers in one unit (n = 126) and found that 21% had experienced frostbite. The incidence of frostbite was high in this exercise compared to past cold-weather military operations, likely related to the very low temperatures and wind chills.

The effect of ethnicity on the vascular responses to cold exposure of the extremities.

PURPOSE: Cold injuries are more prevalent in individuals of African descent (AFD). Therefore, we investigated the effect of extremity cooling on skin blood flow (SkBF) and temperature (T sk) between ethnic groups. METHODS: Thirty males [10 Caucasian (CAU), 10 Asian (ASN), 10 AFD] undertook three tests in 30 °C air whilst digit T sk and SkBF were measured: (i) vasomotor threshold (VT) test--arm immersed in 35 °C water progressively cooled to 10 °C and rewarmed to 35 °C to identify vasoconstriction and vasodilatation; (ii) cold-induced vasodilatation (CIVD) test--hand immersed in 8 °C water for 30 min followed by spontaneous warming; (iii) cold sensitivity (CS) test--foot immersed in 15 °C water for 2 min followed by spontaneous warming. Cold sensory thresholds of the forearm and finger were also assessed. RESULTS: In the VT test, vasoconstriction and vasodilatation occurred at a warmer finger T sk in AFD during cooling [21.2 (4.4) vs. 17.0 (3.1) °C, P = 0.034] and warming [22.0 (7.9) vs. 12.1 (4.1) °C, P = 0.002] compared with CAU. In the CIVD test, average SkBF during immersion was greater in CAU [42 (24) %] than ASN [25 (8) %, P = 0.036] and AFD [24 (13) %, P = 0.023]. Following immersion, SkBF was higher and rewarming faster in CAU [3.2 (0.4) °C min(-1)] compared with AFD [2.5 (0.7) °C min(-1), P = 0.037], but neither group differed from ASN [3.0 (0.6) °C min(-1)]. Responses to the CS test and cold sensory thresholds were similar between groups. CONCLUSION: AFD experienced a more intense protracted finger vasoconstriction than CAU during hand immersion, whilst ASN experienced an intermediate response. This greater sensitivity to cold may explain why AFD are more susceptible to cold injuries.

Update: Cold weather injuries, active and reserve components, U.S. Armed Forces, July 2007-June 2012.

From July 2011 through June 2012, the number of active and reserve component service members treated for cold injuries (n=499) was lower than the number in each of the four previous one year periods. Over the last five years, frostbite was the most common type of cold injury in all the Services except for the Marine Corps, in which hypothermia was slightly more frequent. Service members who were female, less than 20 years old, or of black, non-Hispanic race/ethnicity tended to have higher cold injury rates than their respective counterparts. Army personnel accounted for the majority of cold injuries. Service members who train in and deploy to areas with wet and freezing conditions - and their supervisors at all levels - should be able to recognize the signs of cold injury and should know and implement the standard countermeasures against the threat of cold injury.

Retrospective analysis of the ethnic origins of male British army soldiers with peripheral cold weather injury.

OBJECTIVES: To determine if African Americans, Pacific Islanders and Gurkhas have a different incidence and severity of peripheral cold injury when compared to Caucasians in the British Army. METHOD: The design was a retrospective analysis of those British male army personnel aged over 18 assessed at the Institute of Naval Medicine Cold Injury Clinic. The participants were 311 patients assessed on first attendance at the UK Institute of Naval Medicine. RESULTS: After excluding those classed as normal, African Americans had a relative incidence of 30.36 (95% CI 25.82 -35.70) when compared to Caucasians; Pacific Islanders a relative incidence of 2.58 (CI 1.24 - 5.38), again against Caucasians. Being of Gurkha ethnicity proved protective, with no abnormal cases found on assessment. The African Americans were more severely affected than Caucasians, with mean scores of 5.39 (SD 1.767) against 4.24 (SD 1.994) for Caucasians. The severity of Pacific Islanders were similar to Caucasians. The ages of African Americans, Pacific Islander and Caucasians had similar means of 26.05, 26.30 and 26.68 respectively, but with a broader age range for Caucasians; SDs 3.428, 2.958 and 7.735. CONCLUSION: Young male African Americans in the British Army are at 30 times greater chance of developing peripheral cold injury and are more severely affected than their Caucasian counterparts following similar climatic exposure, using similar clothing and equipment. Pacific Islanders are at a 2.6 times increased risk, while being a Gurkha is protective.

Military cold injury during the war in the Falkland Islands 1982: an evaluation of possible risk factors.

Throughout the history of war, there have been many instances when the cold has ravaged armies more effectively than their enemies. Delineated risk factors are restricted to negro origins, previous cold injury, moderate but not heavy smoking and the possession of blood group O. No attention has been directed to the possibility that abnormal blood constituents could feasibly predispose to the development of local cold injury. This study considers this possibility and investigates the potential contribution of certain components of the circulating blood which might do so. Three groups of soldiers from two of the battalions who served during the war in the Falklands Islands in 1982 were investigated. The risk factors which were sought included the presence or absence of asymptomatic cryoglobulinaemia, abnormal total protein, albumin, individual gamma globulin or complement C3 or C4 levels, plasma hyperviscosity or evidence of chronic alcoholism manifesting as high haemoglobin, PCV, RBC, MCV or gamma glutamyl transpeptidase (GGT). No cases of cryoglobulinaemia were isolated and there was no haematological evidence to suggest that any of those men who had developed cold injury, one year before this study was performed, had abnormal circulating proteins, plasma hyperviscosity or indicators of alcohol abuse. Individual blood groups were not incriminated as a predisposing factor although the small numbers of negroes in this series fared badly. Although this investigation has excluded a range of potential risk factors which could contribute to the development of cold injury, the problem persists. Two areas of further study are needed: the first involves research into the production of better protective clothing in the form of effective cold weather boots and gloves and the second requires the delineation of those dietary and ethnic factors which allow certain communities to adapt successfully to the cold. A review of the literature in this latter area is presented.

[Serious frostbite in a homeless psychiatric patient]. / Ernstige bevriezing bij een dakloze psychiatrische patiënt.

A 22-year-old homeless male psychiatric patient of Ghanaian origin was diagnosed with severe frostbite in both lower legs. The lesion consisted of haemorrhagic blistering with already visible demarcation. When sepsis developed both lower legs had to be amputated as a matter of urgency.