Cold Weather Injuries Among the Active and Reserve Components of the U.S. Armed Forces, July 2018-June 2023.

Cold injuries are a predictable and preventable threat. Continuous surveillance is essential to prevent cold weather injuries and mitigate their adverse impacts on military operations. Military training and combat operations require continued emphasis on effective cold weather injury prevention strategies and adherence to relevant policies and procedures to protect service members against such injuries. For all active component service members (ACSM), the rate of cold weather injuries in 2022-2023 decreased by 15.2% compared to the preceding cold season. The decrease was most pronounced in the Marine Corps, with a 22.0% reduction in the incidence rate of cold injuries. This year's report includes cold injury rates for the Coast Guard. From July 2022 through June 2023, a total of 423 members of the active (n=376) and reserve (n=47) components of the U.S. Armed Forces had at least 1 cold weather injury. The crude overall incidence rate of cold injury among all ACSM during the 2022-2023 cold season was 28.5 per 100,000 person-years (p-yrs), 15.2% lower than the rate observed during the 2021-2022 cold season (33.6 per 100,000 p-yrs). The rates of cold injuries varied among the Armed Forces, with the highest rates per 100,000 p-yrs observed in the Army, at 50.9, followed by the Marine Corps, at 32.2, the Air Force, at 18.9, the Navy, at 8.1, and the Coast Guard, at 5.1. Consistent with previous cold seasons, frostbite (54.0%) remained the most common type of cold injury among ACSM during the 2022-2023 cold season, while the proportions of hypothermia and immersion injuries were 16.5% and 30.3%, respectively. Cold injury rates among ACSM during the 2018 to 2023 cold seasons were generally highest for males, non-Hispanic Blacks, those under 20 years of age, and enlisted members. The number of cold injuries identified in service members deployed outside the U.S during the 2022-2023 cold season (n=10) was comparable to the 2 preceding cold seasons (11 in 2020-2021 and 12 in 2021-2022), with frostbite accounting for half (n=5) of the 2022-2023 cases.

Can iloprost be used for treatment of cold weather injury at the point of wounding in a forward operating environment? A literature review.

INTRODUCTION: Cold Weather Injury (CWI) represents a spectrum of pathology, the two main divisions being Freezing Cold Injury (FCI) and Non-Freezing Cold Injury (NFCI). Both are disabling conditions associated with microvascular and nerve injury often treated hours after initial insult when presenting to a healthcarestablishment. Given that iloprost is used for the treatment of FCI, could it be used in a forward operating environment to mitigate treatment delay? Is there a role for its use in the forward treatment of NFCI? This review sought to evaluate the strength of evidence for the potential use of iloprost in a forward operating environment. METHODS: Literature searches were undertaken using the following question for both FCI and NFCI: in [patients with FCI/NFCI] does [the use of iloprost] compared to [standard care] reduce the incidence of [long-term complications]. Medline, CINAHL and EMBASE databases were searched using the above question and relevant alternative terminology. Abstracts were reviewed before full articles were requested. RESULTS: The FCI search yielded 17 articles that were found to refer to the use of iloprost and FCI. Of the 17, one referred to pre-hospital treatment of frostbite at K2 base camp; however, this was utilising tPA. No articles referred to pre-hospital use in either FCI or NFCI. DISCUSSION: Although evidence exists to support the use of iloprost in the treatment of FCI, its use to date has been in hospital. A common theme is delayed treatment due to the challenges of evacuating casualties from a remote location. There may be a role for iloprost in the treatment of FCI; however, further study is required to better understand the risk of its use.

A prospective study on local cold injuries in northern Sweden.

The study aimed to determine the prevalence and incidence proportion of local cold injuries in northern Sweden, and identify associated factors. It was based on prospective data from surveys in 2015 and 2021 sent to a population-based sample in northern Sweden. Multiple binary logistic regression was performed. The study included 5,017 subjects (response rate 44.4%). The prevalence of cold injuries in the hands was 11.4%, feet 12.6%, and face 19.9%, while the incidence proportion was 1.0%, 1.0%, and 0.9%, respectively. Male gender was associated with incident cold injuries in the hands (OR 1.69; 95% CI 1.31-1.28), feet (OR 1.34; 95% CI 1.04-1.73), and face (OR 1.53; 95% CI 1.15-2.03); mental stress with cold injuries in the hands (OR 1.55; 95% CI 1.16-2.05) and feet (OR 1.39; 95% CI 1.04-1.88); previous stroke with cold injuries in the hands (OR 2.64; 95% CI 1.09-6.40) and face (OR 3.09; 95% CI 1.26-7.56); and Raynaud's phenomenon with cold injuries in the hands (OR 2.48; 95% CI 1.80-3.41) and feet (OR 2.07; 95% CI 1.50-2.87). We conclude that male gender, mental stress, previous stroke, and Raynaud's phenomenon increased the probability of contracting local cold injuries.

Nonfreezing Cold Injury and Cold Intolerance in Paddlesport.

INTRODUCTION: Nonfreezing cold injury (NFCI) occurs when tissues are subjected to prolonged cooling that causes tissue damage, but not freezing. Long-term effects include cold intolerance, with allodynia, pain, or numbness of the affected limb. Those who participate in outdoor paddlesports are at particular risk. METHODS: This is an epidemiological study that aimed to determine the risk factors for paddlesport athletes developing NFCI and chronic cold intolerance in their hands. Secondary outcomes were to correlate cumulative cold exposure with the development of cold intolerance and to identify risk factors for developing NFCI or cold intolerance. Six hundred nine athletes responded to a survey distributed by their national governing body obtaining demographic and activity details, symptoms of NFCI, and a cold intolerance severity score (CISS). RESULTS: Twenty-three percent reported symptoms consistent with acute NFCI. The median CISS was 31 y (interquartile range 25-43), and 15% had a pathological CISS defined as >50. Females and individuals with Raynaud's phenomenon or migraines had a significantly higher CISS (P<0.05). Regression analysis found that females, smokers, and those with Raynaud's phenomenon or a previous nerve injury had a significantly higher risk of developing pathological cold intolerance (CISS >50). There was no correlation between cumulative cold exposure and CISS. CONCLUSIONS: A large proportion of paddlesport athletes undertaking activity in cold conditions have a pathological CISS or episodes consistent with NFCI. Cumulative cold exposure was not associated with a pathologically high CISS. The risk factors were female sex, smokers, and those suffering from either Raynaud's phenomenon or nerve injury.

Update: Cold Injuries, Active and Reserve Components, U.S. Armed Forces, July 2017­June 2022

From July 2021 through June 2022, a total of 482 members of the active (n=435) and reserve (n=47) components had at least 1 cold injury. The crude overall incidence rate of cold injury for all active component service members in 2021-2022 (33.1 per 100,000 person-years [p-yrs]) was slightly lower than the rate for the 2020-2021 cold season (35.5 per 100,000 p-yrs). In 2021-2022, frostbite was the most common type of cold injury among active component service members in all 4 services. Among active component members during the 2017-2022 cold seasons, overall rates of cold injuries were generally highest among male service members, non-Hispanic Black service members, the youngest (less than 20 years old), and those who were enlisted. The number of cold injuries associated with overseas deployments during the 2021-2022 cold season (n=13) was similar to the two previous cold seasons (10 in 2019-2020 and 11 in 2020-2021). Frostbite accounted for more than half (n=9) of the cold injuries identified in service members deployed outside of the U.S. during the 2021-2022 cold season.

Update: Cold weather injuries, active and reserve components, U.S. Armed Forces, July 2016-June 2021.

From July 2020 through June 2021, a total of 539 members of the active (n=469) and reserve (n=70) components had at least 1 medical encounter with a pri­mary diagnosis of cold injury. The crude overall incidence rate of cold injury for all active component service members in 2020­2021 (35.4 per 100,000 person-years [p-yrs]) was higher than the rate for the 2019­2020 cold season (27.5 per 100,000 p-yrs). In 2020­2021, frostbite was the most common type of cold injury among active component service members in all 4 services. Among active component members during the 2016­2021 cold seasons, overall rates of cold injuries were generally highest among male service members, non-Hispanic Black service members, the youngest (less than 20 years old), and those who were enlisted. The number of cold inju­ries associated with overseas deployments during the 2020­2021 cold season (n=10) was the lowest count during the 5-year surveillance period. Immersion foot accounted for half (n=5) of the cold weather injuries diagnosed and treated in service members deployed outside of the U.S. during the 2020­2021 cold season.

Perfil de los recién nacidos de riesgo relacionados con la termorregulación en una Unidad de Cuidados Intensivos Neonatales / Perfil de recém-nascidos de risco relacionado à termorregulação em Unidade de Terapia Intensiva Neonatal / Profile of risky newborns related to thermoregulation in a Neonatal Intensive Care Unit

OBJETIVO: Analizar el patrón de temperatura de recién nacidos de bajo peso al nacer ingresados en una Unidad de Cuidados Intensivos Neonatales. METODOLOGÍA: Este es un estudio transversal y cuantitativo realizado en una Unidad de Cuidados Intensivos Neonatales en un hospital de maternidad en el noreste de Brasil. La muestra consistió en 45 niños de bajo peso al nacer, muy bajo peso al nacer o extremadamente bajo peso al nacer ingresados ​​en la unidad. RESULTADOS: Al ingreso se obtuvo una temperatura axilar promedio de 34.98ºC con una desviación estándar de 1.12. La tasa de hipotermia al ingreso fue considerablemente severa, por lo que en la primera hora, con seis horas y con 12 horas de hospitalización, el porcentaje de recién nacidos hipotérmicos (<36.5ºC) fue respectivamente: 93.33%, 73.33 % y 57.78%. CONCLUSIÓN: Hubo fallas en los procesos cuando se trata de termorregulación, dado que casi toda la muestra llega con potencial estrés por frío

OBJETIVO: Analisar o padrão de temperatura dos recém-nascidos de baixo peso internados em uma Unidade de Terapia Intensiva Neonatal. METODOLOGIA: Trata-se de um estudo transversal e quantitativo realizado numa Unidade de Terapia Intensiva Neonatal de uma maternidade no Nordeste do Brasil. A amostra foi constituída de 45 recém-nascidos de baixo peso, muito baixo peso ou extremo baixo peso admitidos na unidade. RESULTADOS: Na admissão obteve-se uma média de temperatura axilar de 34,98ºC com desvio padrão de 1,12. A taxa de hipotermia na admissão foi consideravelmente grave, de forma que na primeira hora, com seis horas e com 12 horas de internação a porcentagem de recém-nascidos hipotérmicos (<36,5ºC) foi respectivamente: 93,33%, 73,33% e 57,78%. CONCLUSÃO: Verificou-se falhas nos processos quando se trata de termorregulação, haja vista que quase a totalidade da amostra chega com potencial estresse ao frio

OBJECTIVE: To analyze the temperature pattern of low birth weight newborns admitted to a Neonatal Intensive Care Unit METHODOLOGY: This is a cross-sectional and quantitative study conducted in a Neonatal Intensive Care Unit of a maternity hospital in Northeastern Brazil. The sample consisted of 45 low birth weight, very low birth weight or extremely low birth weight newborns admitted to the unit. RESULTS: At admission, we obtained an axillary temperature average of 34.98ºC with a standard deviation of 1.12. The hypothermia rate at the time of admission was considerably severe, so that in the first hour, with 06 hours and with 12 hours of hospitalization, the percentages of hypothermic newborns (<36.5ºC) were respectively: 93.33%, 73.33 % and 57.78%. CONCLUSION: We found flaws in the processes when it comes to thermoregulation, given that almost the entire sample arrives with potential cold stress

Update: Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces, July 2015-June 2020.

From July 2019 through June 2020, a total of 415 members of the active (n=363) and reserve (n=52) components had at least 1 medical encounter with a primary diagnosis of cold injury. The crude overall incidence rate of cold injury for all active component service members in 2019-2020 (27.4 per 100,000 person-years [p-yrs]) was lower than the rate for the 2018-2019 cold season (35.1 per 100,000 p-yrs) and was the lowest rate during the 5-year surveillance period. In 2019-2020, frostbite was the most common type of cold injury among active component service members in all 4 services. Among active component members during the 2015-2020 cold seasons, overall rates of cold injuries were generally highest among males, non-Hispanic black service members, the youngest (less than 20 years old), and those who were enlisted. The number of cold injuries associated with overseas deployments during the 2019-2020 cold season (n=10) was the lowest count during the 5-year surveillance period. Frostbite accounted for three-fifths (n=6; 60.0%) of the cold weather injuries diagnosed and treated in service members deployed outside of the U.S during the 2019-2020 cold season.

20 Armoured Infantry Brigade downgrade study: epidemiology of principal conditions and plugging leaks in the rehabilitation pipeline.

INTRODUCTION: In April 2017, 22% of Army Full-time Trade Trained Strength was downgraded, reducing fully deployable strength to 60 546, against a target of 82 000. In June 2017, Commander 20 Armoured Infantry Brigade (20 AI Bde) initiated a study to look at the principal conditions causing medical downgrading, as a stepping stone to finding ways of reducing injury, enhancing rehabilitation and improving deployability. METHOD: The Defence Medical Information Capability Programme medical records for every downgraded soldier in 20 AI Bde and supporting units were scrutinised to identify their Medical Deployment Standard and the primary condition causing downgrading. RESULTS: A total of 842 downgraded soldiers were identified from a held strength of 3827 personnel. Sixty-five per cent of these downgrades were due to musculoskeletal injury (MSKI). Of this 65%, the majority were due to knee (31%), spine (28%) and foot/ankle (23%). Of the remaining 35%, the majority were due to noise-induced hearing loss (NIHL) (22%), adjustment disorders (19%) and non-freezing cold injury (NFCI) (13%).Several factors that slowed an individual's recovery pathway were identified. They mainly relate to soldiers being lost to follow-up through lack of active case management. CONCLUSIONS: MSKI is responsible for most downgraded personnel at Brigade level. The distribution of principal conditions is similar to previous studies looking at recruits and individual units.The creation of a rehabilitation troop, delivering active case management, can reduce the number of soldiers leaking out of the rehabilitation pipeline.

Update: Cold weather injuries, active and reserve components, U.S. Armed Forces, July 2014-June 2019.

From July 2018 through June 2019, a total of 513 members of the active (n=446) and reserve (n=67) components had at least 1 medical encounter with a primary diagnosis of cold injury. The crude overall incidence rate of cold injury for all active component service members in 2018-2019 (36.5 per 100,000 person-years [p-yrs]) was slightly higher than the rate for the 2017-2018 cold season (35.8 per 100,000 p-yrs) and was the highest rate during the 5-year surveillance period. In 2018-2019, frostbite was the most common type of cold injury among active component service members in all 4 services. Among active component members during the 2014-2019 cold seasons, overall rates of cold injuries were generally highest among males, non-Hispanic black service members, the youngest (less than 20 years old), and those who were enlisted. As noted in prior MSMR updates, the rate of all cold injuries among active component Army members was higher in women than in men because of a much higher rate of frostbite among female soldiers. The number of cold injuries associated with overseas deployments during the 2018-2019 cold season (n=24) was the highest count during the 5-year surveillance period.

Case series of non-freezing cold injury: epidemiology and risk factors.

BACKGROUND: Non-freezing cold injury (NFCI) occurs when the peripheral tissue is cooled sufficiently that damage occurs, but not to the point of tissue freezing. Historically, the phenotype of the injuries studied was often severe, and it is unclear whether knowledge gained from these cases is entirely relevant to the frequently subtle injuries seen today. METHODS: We therefore sought to characterise a recent case series of 100 patients referred with suspected NFCI to a military UK NFCI clinic. Their demographics, medical history and situational risk factors leading to their injuries were analysed, and comparison was made between those subsequently diagnosed with NFCI (n=76) and those receiving alternate diagnoses (n=24). RESULTS: Statistically significant predisposing factors for NFCI in the UK service personnel (SP) were being of African-Caribbean ethnicity and having a short duration of service in the Armed Forces. Past or current smoking was not identified as a risk factor. Injuries were almost always suffered on training exercises (most commonly in the UK); being generally cold and being on static duties were statistically significant situational risk factors. Non-significant trends of risk were also found for having wet clothing, wet boots and immersion. Self-reported dehydration was not found to be a risk factor for NFCI. CONCLUSIONS: Our demographic findings are in general agreement with those of previous studies. Our situational risk factor findings, however, highlight a pattern of NFCI risk factors to the modern UK SP: winter training exercises, when troops are generally cold and extremities often wet, with static duties frequently implicated in the disease mechanism.

Update: Cold weather injuries, active and reserve components, U.S. Armed Forces, July 2013-June 2018.

From July 2017 through June 2018, a total of 478 members of the active (n=402) and reserve (n=76) components had at least one medical encounter with a primary diagnosis of cold injury. The crude overall incidence rate of cold injury for all active component service members in 2017-2018 was 19.6% higher than the rate for the 2016-2017 cold season and was the highest rate since the 2013-2014 season. Frostbite was the most common type of cold injury among active component service members in 2017-2018. Among active component members during the 2013-2018 cold seasons, overall rates of cold injuries were generally highest among males, non-Hispanic black service members, the youngest (less than 20 years old), and those who were enlisted. As noted in prior MSMR updates, the rate of all cold injuries among active component Army members was considerably higher in females than in males due to a much higher rate of frostbite among female soldiers. The numbers of cold injuries associated with overseas deployments have fallen precipitously in the past three cold seasons and included 17 cases in the most recent year.

Cold sensitivity and associated factors: a nested case-control study performed in Northern Sweden.

PURPOSE: To identify factors associated with the reporting of cold sensitivity, by comparing cases to controls with regard to anthropometry, previous illnesses and injuries, as well as external exposures such as hand-arm vibration (HAV) and ambient cold. METHODS: Through a questionnaire responded to by the general population, ages 18-70, living in Northern Sweden (N = 12,627), cold sensitivity cases (N = 502) and matched controls (N = 1004) were identified, and asked to respond to a second questionnaire focusing on different aspects of cold sensitivity as well as individual and external exposure factors suggested to be related to the condition. Conditional logistic regression analyses were performed to determine statistical significance. RESULTS: In total, 997 out of 1506 study subjects answered the second questionnaire, yielding a response rate of 81.7%. In the multiple conditional logistic regression model, identified associated factors among cold sensitive cases were: frostbite affecting the hands (OR 10.3, 95% CI 5.5-19.3); rheumatic disease (OR 3.1, 95% CI 1.7-5.7); upper extremity nerve injury (OR 2.0, 95% CI 1.3-3.0); migraines (OR 2.4, 95% CI 1.3-4.3); and vascular disease (OR 1.9, 95% CI 1.2-2.9). A body mass index ≥ 25 was inversely related to reporting of cold sensitivity (0.4, 95% CI 0.3-0.6). CONCLUSIONS: Cold sensitivity was associated with both individual and external exposure factors. Being overweight was associated with a lower occurrence of cold sensitivity; and among the acquired conditions, both cold injuries, rheumatic diseases, nerve injuries, migraines and vascular diseases were associated with the reporting of cold sensitivity.

Update: Cold weather injuries, active and reserve components, U.S. Armed Forces, July 2012-June 2017.

From July 2016 through June 2017, a total of 387 members of the active (n=328) and reserve (n=59) components had at least one medical encounter with a primary diagnosis of cold injury. Among active component service members, the total number of cold injuries in the 2016-2017 cold season was the lowest since 1999 and the overall incidence rate was lower than in any of the previous four cold seasons. Frostbite was the most common type of cold injury. During the five cold seasons in the surveillance period (2012-2017), rates tended to be higher among service members who were in the youngest age groups, female, non-Hispanic black, or in the Army. The numbers of cold injuries associated with overseas deployments have fallen precipitously in the past three cold seasons and included just 10 cases in the most recent year.

Neurovascular hand symptoms in relation to cold exposure in northern Sweden: a population-based study.

PURPOSE: To describe the self-reported ambient cold exposure in northern Sweden and to relate the level of cumulative cold exposure to the occurrence of sensory and vascular hand symptoms. We hypothesize that cold exposure is positively related to reporting such symptoms. METHODS: A questionnaire about cold exposure and related symptoms was sent out to 35,144 subjects aged 18-70 years and living in northern Sweden. RESULTS: A total of 12,627 out of 35,144 subjects returned the questionnaire (response rate 35.9%). Subjects living in the rural alpine areas reported more extensive cold exposure both during work and leisure time compared to the urbanized coastal regions. Frostbite in the hands was present in 11.4% of men and 7.1% of women, cold sensitivity was present in 9.7 and 14.4%, and Raynaud's phenomenon was present in 11.0% of men and 14.0% of women. There was a positive association between cumulative cold exposure and neurovascular hand symptoms. CONCLUSION: The present study demonstrates that the cold environment in northern Sweden might be an underestimated health risk. Our hypothesis that cold exposure is positively related to reporting of neurovascular hand symptoms was supported by our findings. In addition, such symptoms were common not only in conjunction with an overt cold injury. Our results warrant further study on pathophysiological mechanisms and suggest the need for confirmatory prevalence studies to support national public health planning.

Update: Cold weather injuries, active and reserve components, U.S. Armed Forces, July 2011-June 2016.

From July 2015 through June 2016, a total of 447 members of the active (n=383) and reserve (n=64) components had at least one medical encounter with a primary diagnosis of cold injury. The numbers of affected individuals in both components were the lowest since the 2011-2012 cold season, when the total was 394. In the active component, the service-specific incidence rates for each of the four services were lower than the respective rates for the previous (2014-2015) cold season. Frostbite was the most common type of cold injury. During the five cold seasons in the surveillance period (2011-2016), rates tended to be higher among service members who were in the youngest age groups; female; black, non-Hispanic; or in the Army. The numbers of cold injuries associated with service in Iraq and Afghanistan have fallen precipitously in the past four cold seasons and included just 11 cases in the most recent year.

Freezing and non-freezing cold weather injuries: a systematic review.

INTRODUCTION: The debilitating impact of cold weather on the human body is one of the world's oldest recorded injuries. The severe and life-changing damage which can be caused is now more commonly seen recreationally in extreme outdoor sports rather than in occupational settings such as the military. The diagnosis and treatment of these injuries need to be completed carefully but quickly to reduce the risk of loss of limb and possibly life. Therefore, we have conducted a systematic review of the literature surrounding cold weather injuries (CWIs) to ascertain the epidemiology and current management strategies. SOURCES OF DATA: Medline (PubMED), EMBASE, CINHAL, Cochrane Collaboration Database, Web of Science, Scopus and Google Scholar. AREAS OF AGREEMENT IMMEDIATE FIELD TREATMENT: The risk of freeze thaw freeze injuries. Delayed surgical intervention when possible. Different epidemiology of freezing and non-freezing injuries. AREAS OF CONTROVERSY: Prophylatic use of antibiotics; the use of vasodilators surgical and medical. GROWING POINTS: The use of ilioprost and PFG2a for the treatment of deep frostbite. AREAS TIMELY FOR DEVELOPING RESEARCH: The treatment of non-freezing CWIs with their long-term follow-up.

Winter Deployment 14 and 15: an audit of injury and illness rates in an Arctic environment.

INTRODUCTION: Arduous military training in a cold weather environment is likely to lead to a variety of injuries to the population at risk (PAR). This paper examines injury rates and medical presentations over the two years of Winter Deployments in 2014 and 2015 (WD14 and WD15) and proposes recommendations for future WDs. METHODS: Data on injury rates, number of aeromedical evacuations, and number of days of restricted duties allocated were collected prospectively for all patients presenting to Asegarden Medical Centre, Norway, during WD14 and WD15. The data were calculated as a percentage of the total PAR on each deployment to allow meaningful comparison. RESULTS: During WD14, 22.8% of the PAR presented to the Medical Centre compared to 26.9% during WD15. WD15 saw a reduction in the presentation of musculoskeletal (MSK) injuries, cold weather (CW) injuries and burns. Skin problems and diarrhoea and vomiting (D&V) remained similar in both years. An increase in dental and other presentations was seen in WD15. A reduction in the overall aeromedical evacuations and number of patients requiring a light duties (LD) chit was seen during WD15. CONCLUSION: WD15 has seen a decrease in injury rates, the number of aeromedical evacuations and LD chits issued. It is difficult to know whether these changes are a result of improved medical support, training or equipment. The liaison between the command, medical and training elements has led to improvements and should now concentrate on ways to further reduce injury rates whilst maximising arduous training benefits in an Arctic environment.

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.