British Military freezing cold injuries: a 13-year review.

INTRODUCTION: Cold injuries have been a recurrent feature of warfare for millennia and continue to present during British Military operations today. Those affecting the peripheries are divided into freezing cold injury (FCI) and non-FCI. FCI occurs when tissue fluids freeze at around -0.5°C and is commonly referred to as frostnip or frostbite. METHOD: All FMED7 notes held at the Institute of Naval Medicine's Cold Weather Injury Clinic (CIC) from 2002 to 2014 were searched for the terms 'frostbite' and 'frostnip' and then analysed to identify common themes. RESULTS: In total 245 results were found and from these, 149 patients with a positive FCI diagnosis were identified and formed the cohort of this study. Royal Marines (RM) represented over 50% of patients and Arctic training in Norway accounted for over two thirds of the total cases. The extremities were almost always those areas which were affected by FCI. Further analysis of the RM cases showed the majority of those injured were of the most junior rank (Marine/Private or Lance Corporal). CONCLUSIONS: A lack of supporting climatic and activity data meant that it was difficult to draw additional conclusions from the data collected. In future, a greater emphasis should be placed on collection of climatic and additional data when FCIs are diagnosed. These data should be collated at the end of each deployment and published as was regularly done historically. It is hoped that these data could then be used as the starting point for an annual climatic study day, where issues related to FCIs could be discussed in a Tri-Service environment and lessons learned disseminated around all British Forces personnel.

Repeatability of a cold stress test to assess cold sensitization.

BACKGROUND: Non-freezing cold injury (NFCI) is a syndrome in which damage to peripheral tissues occurs without the tissues freezing following exposure to low ambient temperatures. AIMS: To assess the test-retest reliability of a cold stress test (CST) used to assess cold sensitization. METHODS: Volunteers with no self-reported history of NFCI undertook the CST on three occasions. Thermal images were taken of the foot and hand before, immediately after and 5min after immersion of the limb in cold water for 2min. Cold sensitization was graded by the two clinicians and the lead author. Spot temperatures from the toe and finger pads were recorded. RESULTS: There were 30 white and 19 black male participants. The ratings indicated substantial agreement [a Cohen's kappa (κ) value of 0.61-0.8] to within ± one grading category for the hands and feet of the white volunteers and the hands of the black volunteers. Limits of agreement (LoA) analysis for toe and finger pad temperatures indicated high agreement (absolute 95% LoA < 5.5°C). Test-retest reliability for the feet of the black volunteers was not supported by the gradings (κ = 0.38) and toe pad temperatures (absolute 95% LoA = 9.5°C and coefficient of variation = 11%). CONCLUSIONS: The test-retest reliability of the CST is considered adequate for the assessment of the cold sensitization of the hands and feet of white and the hands of black healthy non-patients. The study should be repeated with patients who have suffered a NFCI.

The recognition and management of body temperature disturbances in Royal Navy personnel.

This article discusses hypothermia and hyperthermia, described together as thermal illness. These conditions are seen within the United Kingdom (UK) Armed Forces population at home and abroad and may endanger life, with significant implications for both the individual and the chain of command. Recognition and management from initial presentation to return to duty is discussed and guidance given on occupational considerations.

Findings from a simulated disabled submarine survival trial.

Eleven volunteer submariners were exposed to simulated disabled submarine conditions for a maximum of 7 days to determine if the limited clothing and rations provided in escape compartments would compromise survival prospects. Daily rations were 0.568 liters of water (none on Day 1) and 100 g of barley sugar. The subjects wore working rig and the liner from the Mark 10 submarine escape and immersion equipment throughout, and slept in the outer dry suit. Air temperature fell from 22 degrees to 4.4 degrees C over 2 days and then remained at 4.4 degrees C. Although the subjects felt cold they were able to maintain their deep body temperature. The greatest threat to survival in this situation would be dehydration, one subject was withdrawn on Day 4 as his urine production over the previous 24 h was 130 ml and if not withdrawn and rehydrated this may have led to renal failure. Other medical problems suffered by the subjects during the 7 days included diarrhea, vomiting, hypoglycemia, headaches, and back pains, and, following the trial, non-freezing cold injuries to their feet. It is concluded that the rations are not adequate and could compromise the submariners ability to survive for 7 days in these conditions and during a subsequent escape procedure.

Environmental hazards and health.

Significant health hazards to the traveller arise from altitude, heat, cold and water. Altitude-induced illness encompasses the benign but common syndrome of acute mountain sickness and also life-threatening pulmonary and cerebral oedema; inadequate acclimatization and rapid ascent are important precipitating factors in each case. Prophylaxis and up to date choices of treatment are discussed in the context of underlying physiological changes. Heat illnesses include exhaustion and heat stroke; they result from increased core temperature and/or physiological responses including peripheral vasodilation and sweating. Preventive measures include acclimatization, ample water without added salt, and matching dress and exercise to the environment. Cold environments pose risk of hypothermia and local cold injury which include frostbite and non-freezing cold injury; as frostnip is only diagnosed after treatment, it is a category of limited usefulness. Prevention of each disorder requires correct clothing and equipment and good training. Other hazards include immersion, and flying too soon after diving.

A large outbreak of streptococcal pyoderma in a military training establishment.

An outbreak of streptococcal pyoderma in a military institution into which fresh susceptible recruits were regularly introduced involved more than 1300 persons over an eighteen-month period. Two M types were responsible for the great majority of the cases and an attack by one conferred immunity to that strain but not to the other. Lesions varied from trivial to disabling. Epidemiological studies indicated that contact -- direct or indirect -- through such things as gymnasium equipment and room dust was the means of transmission. The outbreak was eventually controlled by vigorous case finding, thorough treatment of cases and the strict application of hygienic principles to prevent spread. There were no late complications and throat streptococci were not involved. It is possible to control such an outbreak without isolation or the making of any significant concessions in the training programme even when large numbers of persons are living and working at close quarters.

Methods for the calculation of weight loss by water evaporation from small biopsy specimens.

The rate of loss of weight by water evaporation was obtained for biopsies taken from lamprey muscle, and this was related to the original weight of each sample. Hence, two alternative methods are proposed for the correction of small biopsy weights to allow for this evaporation in air. It is suggested that these methods may permit good approximations for corrections in similar conditions to those used, and that the methods for evaluating empirical coefficients may be applied elsewhere to allow for other situations.