Abstract

Peripheral cold injuries have disabled entire armies in the past and, as recently as the Falklands conflict of 1982, jeopardised the success of an entire military operation. They can be divided into those that involve freezing of the peripheral tissue and those that do not, termed Freezing Cold Injury (FCI) and Non-Freezing Cold Injury (NFCI) respectively.

This article focuses on the recognition and management of cold injuries in the field. It draws from the current literature, briefly outlining the pathophysiological basis of the two injuries, then focuses on the challenges of field recognition of cold injuries, especially NFCI, which is characterised by a lack of overt physical signs. A framework for field management of these injuries is then outlined, with an emphasis on the contrasting re-warming strategies for FCI and NFCI, and the pharmacological therapies used in each condition.

The article is pertinent to those who may train or deploy to an area with temperatures lower than 20° Celsius, the generally accepted temperature below which peripheral cold injuries may occur. It is hoped that improved awareness of the risks coupled with better field recognition and management may reduce the incidence of cold injury, especially in light of recent observations that re-exposure to cold in those with NFCI can cause more significant morbidity, highlighting the importance of getting the diagnosis and management right in the field.