AC64562

Commander’s Guide to Cold InjuryBased upon JSP 375 (Management of Health and Safety in Defence), Chapter 42, Cold Injury Prevention Ver 1.0

ContentsCommander’s Responsibilities 4Cold Injuries 6

Classification 6How does it happen? 7Risk Factors 7Wind Chill Chart 8Recognition and response 10Hypothermia 10Non-Freezing Cold Injury (NFCI) 11Freezing Cold Injury 12Commanders’ Cold Injury Risk Assessment Checklist 14

Commander’s Notes 16Contact Details 20

3

Commanders must understand

how serious cold injury can be:

death is a potential consequence.

Commanders should note that

it is entirely possible to be at

risk from both heat illness and

cold injury in the same theatre of

operations.

Risk ManagementCommanders have a duty to assess the risks of cold injury arising from military training or operations and to ensure these risks are minimised in accordance with policy (JSP375, Chap 42, Cold Injury Prevention). Failure to manage this risk may expose individuals to risk and affect the operational efficiency of the force.

Commanders should ensure that they are fully aware of the conditions to which their subordinates are exposed.

Commanders at all levels should ensure that a suitable and sufficient risk assessment is undertaken in accordance with JSP 375 prior to every activity carrying a risk of cold injury, whether involving a single individual or multiple personnel.

The full risk assessment must be recorded on MOD Form 5010 or a single Service equivalent as mandated by Policy.

Commanders must consider seeking medical input for all aspects of the risk assessment process.

Commanders must ensure they have enough information to undertake an appropriate risk assessment, which must include as a minimum:

• Work type, rate and duration of the activity

• Environmental conditions• Individual risk factors• Clothing, equipment and load

carriage for activity• Food and water intake/availability

Commander’s Responsibilities

Commanders must plan and put in place appropriate control measures to reduce the risk (which may include rescheduling or modifying the activity).Commanders must ensure that all personnel taking part are adequately briefed and prepared.

Commanders must understand any residual risk and decide whether the objectives of the activity justify the risk. This must be raised to the Chain of Command. If the residual risk cannot be justified or is unacceptably high the activity is not to proceed.

4

ReportingAll cases of cold injury must be reported by the Chain of Command.

Commanders are responsible for the supervision of all personnel and control measures during the duration of the activity.

Commanders must ensure that an activity is covered by an appropriate degree of first aid/medical cover.

Commanders should ensure that their medical staff are involved in medical planning at the earliest opportunity, and are empowered to raise concerns about cold injury at any stage before and during an activity.

Commanders must review their risk assessment throughout an activity as circumstances change.

TrainingCommanders must ensure all personnel are made aware of cold injury including methods of prevention, identification and first-aid management. This must be covered as part of single Service periodic mandatory training.

5

Commanders have a duty to ensure risk of cold exposure is as low as reasonably practicable (ALARP)

Cold InjuriesCold environments represent a

serious hazard to the unprepared.

Each year significant numbers

of Service personnel are medically

discharged as a result of cold injury.

Hypothermia can and does kill.

Military personnel are at

increased risk from cold-related

injuries due to the unavoidable

need to expose them to adverse

environmental conditions on

operations and exercises both in

the UK and abroad.

Classification.

Cold injuries occur as a result of the exposure of cold/wet and cold/dry conditions on the body and are classified as follows:

Hypothermia occurs due to low core body temperature. This may be mild, moderate or severe and can be due to:

• Immersion. Caused by severe cold stress; often rapid. e.g. a sailor washed overboard.

• Exhaustion. Caused by a combination of wind and wet conditions with moderately low temperature. e.g. usually found in mountaineers or hill walkers.

• Urban. Where the cold is relatively mild but prolonged.

6

e.g. most common in the elderly and malnourished.

Non-Freezing Cold Injury (NFCI) is the most common cold injury in land operations and exercise. It is a serious injury and is neither an illness nor a weakness. It can lead to serious disability for the sufferer and could lead to a medical discharge.

It can also affect the immediate operational effectiveness of your unit and yet it is entirely preventable. The main cause is allowing feet or hands to remain wet and cold for long periods.

NFCI causes numbness which does not go away; persistent numbness on rewarming following exposure to the cold is NOT normal and must be addressed. Other symptoms are pain and pins and needles.

Freezing Cold Injury (FCI) is a significant cause of disability. Parts of the body most prone to freezing are the extremities and exposed areas - face, fingers, toes, heels and soles of the feet.

There are two types of FCI:

• Frost nip. Where people recover fully within 30 mins of re-warming of the injured part.

• Frost bite. Which goes deeper and causes longer lasting damage.

How does it happen?Control of human body temperature is dependent on the balance of heat production and the rate of heat loss.

The rate of heat loss through convection and conduction depends on the temperature difference between skin and the environment.

Air movement over the body known as ‘wind chill’ increases both types of heat loss.

Risk Factors.The key to the prevention of cold injuries is the commander’s awareness of the risk that their personnel are being exposed to.

• Individual factors. Personnel are at greater risk of cold injury if they are:

• Of an African-Caribbean ethnicity

• Unwell or unfit

• Inactive or static

• Dehydrated - cold weather increases respiratory and urine fluid loss

• Poorly fed - i.e. in a negative energy balance e.g. resting adult male energy requirements increase from 2500 kcl (at room temp) to 5000 kcal at -20ºC

• Have a past history of cold-related problems

• Current smoker

• Environmental conditions. Particular care is needed during outdoor training when the still air temperature (SAT) is less than 5ºC. Great care required below -5ºC.

7HEAT STORAGE = HEAT GAINED - HEAT LOST

• Wind chill index.

Equivalent chill temperature (ºC)

SAT (ºC) 4 -1 -7 -12 -18 -23 -29 -34 -40 -46

Measured wind speed (mph)

0 4 -1 -7 -12 -18 -23 -29 -34 -40 -46

5 2 -4 -12 -15 -21 -26 -32 -37 -43 -48

10 -1 -9 -15 -23 -29 -37 -34 -51 -57 -62

15 -4 -12 -21 -29 -34 -43 -51 -57 -65 -73

20 -7 -15 -23 -32 -37 -46 -54 -62 -71 -79

25 -9 -18 -26 -34 -43 -51 -59 -68 -76 -84

30 -12 -18 -29 -34 -46 -54 -62 -71 -79 -87

35 -12 -21 -29 -37 -46 -54 -62 -73 -82 -90

40 -12

Danger

cold injury

-21

- risk

-29

of

-37 -48 -57 -65 -73 -82 -90

Increasing danger;

flesh may freeze

within one minute.

Greater danger; flesh may

freeze within 30 seconds

Skin temperature can be affected by even moderate wind speeds and the index shown helps calculate the equivalent still air temperature in terms of its effect on the rate of cooling:

• Work intensity. Inactivity in open areas exposed to the wind may make an individual vulnerable. Additionally, the sweating

8

Wind Chill Chart

produced after periods of exertion and the diversion of blood to the muscles and skin, away from the

body core, may lead to excessive cooling thus predisposing further to cold related problems.

• Clothing and equipment. Inappropriate clothing and equipment (or lack of training in their correct use) will increase the risk of cold related injuries. Suitable clothing advice can be found in JSP 768.

• Prevention of immersion hypothermia depends on wearing adequate waterproof clothing which stops the entry of water.

• Prevention of exhaustion hypothermia requires the correct use of clothing and equipment.

• Headwear. Specialist headwear must be worn when SAT is below -10ºC. Helmets and berets offer no protection against frostbite and do not significantly reduce heat loss from the head.

• Layered Clothing. The layering principle should be adopted in cold conditions. Layers of clothing should be removed immediately prior to, and during, physical exercise in order to allow adequate ventilation, limit sweating and the danger of wet clothing.

• Footwear.

• Boots should not be laced tightly in cold conditions.

• Socks should be changed when wet.

• Dirty old or compressed socks don’t work well.

• Feet should be inspected regularly.

• Hand protection. Hand protection should be available when SAT falls below +5ºC, and mandatory below -5ºC. Spare gloves should be carried as wet hand wear may result in injury.

• Sleeping systems. Sleeping bags (suitably rated for the temperature range to be encountered) must be kept dry and insulated matting used as a protection from the cold.

Particular responsibilities for Commanders are:

• Conduct a risk assessment and continually review this

• Ensure all personnel are adequately briefed and prepared

• Ensure adequate shelter

• Ensure adequate food and water intake, warm where possible

• Ensure standing orders and instructions regarding training restrictions are well understood by all

• Ensure the activity has an appropriate level of medical cover, and that a clear and efficient means of evacuation is agreed in the event of an emergency

• Consider retiming, amending

9

or cancelling if conditions warrant it

Hypothermia.

Hypothermia occurs when the core body temperature drops below 35ºC, a fall below 32ºC is a life threatening emergency. (Normal core body temperature is 37ºC). It is a high risk in cold and wet conditions.

• Initial signs:

• Feeling very cold

• Stiffness, tiredness

• Violent shivering

• Increased heart rate

• Irrational behaviour

• Later signs: (core temp

Non-Freezing Cold Injury (NFCI).

If an individual has numbness, pain and or pins and needles in hands or feet, ensure they report it at the earliest opportunity. NFCI can occur in temperatures that are not particularly cold if there are other risk factors such as: damp / wet conditions or immobility are present.

Immediate actions.

If individuals get hands or feet wet. Make sure they:

• Dry them as soon as they can

• Change into any dry socks and / or gloves

• Use foot powder

• Wriggle their toes and fingers to keep them warm

If they have to stand still for long periods:

• Order 10 mins of step ups or marching on the spot to keep the circulation going

If exercise is not possible (with help if required):

• Remove wet boots and socks and / or gloves

• Gently re-warm their feet/hands

• Try to get their feet into a dry sleeping bag - they should then massage them gently

• Change into dry kit as soon as possible

• Check for symptoms in others

For FCI and NFCI: DO NOT use any artificial heat, hot water or stoves. This will make the injury worse.

Commanders should conduct foot inspections at regular intervals during exercises.

11

Freezing cold injury (FCI).

• Early signs (frost nip):

• The affected part feels cold and is painful to touch

• A tingling sensation followed by numbness

• No feeling when the affected part is moved

• Skin looks mottled – white and pink

• Later signs (frost bite):

• No feeling in the affected part

• Skin white and waxy-looking

• A clear line between white and pink skin

• After re-warming, skin may appear bruised and blistered

Immediate actions.

• Get into shelter

• Remain sheltered until evacuation can be arranged

• Protect the affected part

• Do NOT re-warm if there is any danger of re-freezing

• Do NOT apply direct heat (heater). or rub the frozen part in an attempt to thaw

• Do NOT allow the casualty to smoke or take alcohol

• Do NOT use skin ointments e.g. Deep Heat

• Do NOT allow the casualty to use the limb when re-warmed

•

Once frostbite is suspected /evident, you must treat the casualty as a case for evacuation. If the casualty is going to be re-exposed to the cold, you must not re-warm until they are in the hands of medically trained personnel.

12

13

Com

man

der

s’ C

old

Inju

ry R

isk

Ass

essm

ent

Che

cklis

tK

ey R

efer

ence

– (J

SP

375

, C

hap

42

v1.0

.

14

Hav

e C

omm

and

er’s

and

Ind

ivid

ual g

uid

es

bee

n is

sued

?

Yes

No

Se

rR

isk

Fa

cto

rQ

ue

stio

nR

esu

lts

Re

ma

rks

1A

ctiv

ityIs

she

lter

ava

ilab

le f

or

stat

ic p

erio

ds?

Yes

No

No

Hav

e p

revi

ous

Co

ld I

njur

ies

bee

n d

ecla

red

to,

and

inve

stig

ated

by,

med

ical

sta

ff?

Yes

Ris

k o

f C

I is

incr

ease

d w

hen

stat

ic,

par

ticu

larl

y if

this

fo

llow

s a

per

iod

of

ard

uous

acti

vity

. Im

mer

sion

/ w

et c

loth

ing

grea

tly

incr

ease

s ris

k of

CI.

Can

long

sta

tic

per

iod

s b

e av

oid

ed?

Yes

No

No

Hav

e un

fit/i

ll p

eop

le b

een

excl

uded

fro

m

the

acti

vity

?

Yes

Can

imm

ersi

on

be

avo

ided

?Ye

s

No

No

Lack

of:

sle

ep;

foo

d;

fluid

s; p

oo

r fit

ness

;

and

illn

ess

all p

red

isp

ose

to

CI.

Tho

se w

ith

pre

vio

us C

I ar

e at

gre

ater

ris

k.H

ave

per

sonn

el b

een

pro

vid

ed w

ith fo

od

and

wat

er p

rior

to u

nder

taki

ng t

he a

ctiv

ity?

Yes

Are

the

re p

lans

to

allo

w c

hang

ing

into

dry

clot

hes

afte

r im

mer

sion

?

Yes

No

10

Pre

dis

po

sing

Fac

tors

Can

the

act

ivit

y b

e p

ost

po

ned

unt

il

per

sonn

el h

ave

rest

ed?

Yes

2D

urat

ion

of

acti

vity

Can

res

t p

erio

ds

be

inco

rpor

ated

(in

shel

ter)?

Yes

No

No

Co

rrec

t cl

oth

ing

and

eq

uip

men

t

will

red

uce

CI

risk

.

Do

all

tro

op

s ha

ve s

par

e d

ry c

loth

es?

Yes

No

Exh

aust

ion

incr

ease

s C

I ris

k.

3E

nvir

onm

enta

l

cond

itio

ns

Has

acc

urat

e w

eath

er f

ore

cast

bee

n

ob

tain

ed?

Yes

No

No

Alc

oho

l inc

reas

es s

usce

pti

bili

ty t

o C

I.

9D

ress

& E

qui

pm

ent

Is c

orr

ect

clo

thin

g/s

leep

ing

sys

tem

issu

ed?

Yes

Ene

rgy

req

uire

men

ts in

crea

se in

co

ld

cond

itio

ns.

8 A

lco

hol

Has

alc

oho

l bee

n av

oid

ed f

or

48 h

our

s

pri

or

to a

ctiv

ity?

Yes

No

Ris

k o

f C

I in

crea

ses

whe

n S

AT is

bel

ow

min

us 5

ºC.

Win

dy

/ w

et c

ond

itio

ns g

reat

ly

incr

ease

ris

k.H

as w

ind

chi

ll fa

cto

r be

en ta

ken

into

acco

unt?

Yes

No

Deh

ydra

tio

n ca

n o

ccur

rap

idly

in c

old

cond

itio

ns.

7F

oo

d in

take

Hav

e in

crea

sed

cal

ori

fic n

eed

s b

een

cons

ider

ed?

Yes

No

No

Can

tra

inin

g b

e ca

rrie

d o

ut in

war

mer

/

mo

re s

helt

ered

co

ndit

ions

?

Yes

No

6W

ater

Int

ake

Is t

here

ad

equa

te s

afe

wat

er a

vaila

ble

thro

ugho

ut t

he in

tend

ed a

ctiv

ity?

Yes

4S

uper

visi

on

Are

DS

and

tra

inin

g st

aff a

deq

uate

ly t

rain

ed

and

com

pet

ent?

Yes

No

Trai

ners

and

DS

pro

vid

e a

vita

l mea

ns o

f

pre

vent

ing

CI

/ ea

rly

det

ecti

on

of

CI.

Is t

he m

edic

al s

upp

ort

pla

n ad

equa

te?

Yes

No

5P

rep

arat

ion

/

Ed

ucat

ion

Hav

e al

l tro

op

s re

ceiv

ed a

pre

sent

atio

n o

n

CI

or

wat

ched

the

tra

inin

g v

ideo

?

Yes

No

Kno

wle

dg

e o

f ri

sk f

acto

rs,

sig

ns a

nd

sym

pto

ms

sho

uld

ena

ble

avo

idan

ce o

f C

I

and

aid

ear

ly id

enti

ficat

ion.

Se

rR

isk

Fa

cto

rQ

ue

stio

nR

esu

lts

Re

ma

rks

1A

ctiv

ityIs

she

lter

ava

ilab

le f

or

stat

ic p

erio

ds?

Yes

Kno

wle

dg

e o

f ri

sk f

acto

rs,

sig

ns a

nd

sym

pto

ms

sho

uld

ena

ble

avo

idan

ce o

f C

I

and

aid

ear

ly id

enti

ficat

ion.

No

5P

rep

arat

ion

/

Ed

ucat

ion

Hav

e al

l tro

op

s re

ceiv

ed a

pre

sent

atio

n o

n

CI

or

wat

ched

the

tra

inin

g v

ideo

?

Yes

No

Trai

ners

and

DS

pro

vid

e a

vita

l mea

ns o

f

pre

vent

ing

CI

/ ea

rly

det

ecti

on

of

CI.

Is t

he m

edic

al s

upp

ort

pla

n ad

equa

te?

Yes

No

4S

uper

visi

on

Are

DS

and

tra

inin

g st

aff a

deq

uate

ly t

rain

ed

and

com

pet

ent?

Yes

No

Can

tra

inin

g b

e ca

rrie

d o

ut in

war

mer

/

mo

re s

helt

ered

co

ndit

ions

?

Yes

No

Ris

k o

f C

I in

crea

ses

whe

n S

AT is

bel

ow

min

us 5

ºC.

Win

dy

/ w

et c

ond

itio

ns g

reat

ly

incr

ease

ris

k.H

as w

ind

chi

ll fa

cto

r be

enta

ken

into

acco

unt?

Yes

No

Exh

aust

ion

incr

ease

s C

I ris

k.

3E

nvir

onm

enta

l

cond

itio

ns

Has

acc

urat

e w

eath

er f

ore

cast

bee

n

ob

tain

ed?

Yes

No

Ris

k o

f C

I is

incr

ease

d w

hen

stat

ic,

par

ticu

larl

y if

this

fo

llow

s a

per

iod

of

ard

uous

acti

vity

.Im

mer

sion

/ w

et c

loth

ing

grea

tly

incr

ease

s ris

k of

CI.

Can

long

sta

tic

per

iod

s b

e av

oid

ed?

Yes

No

Can

imm

ersi

on

be

avo

ided

?Ye

s

No

Are

the

re p

lans

to

allo

w c

hang

ing

into

dry

clot

hes

afte

r im

mer

sion

?

Yes

No

2D

urat

ion

of

acti

vity

Can

res

t p

erio

ds

be

inco

rpor

ated

(in

shel

ter)?

Yes

No

Hav

e C

omm

and

er’s

and

Ind

ivid

ual g

uid

es

bee

n is

sued

?

Yes

No

6W

ater

Int

ake

Is t

here

ad

equa

te s

afe

wat

er a

vaila

ble

thro

ugho

ut t

he in

tend

ed a

ctiv

ity?

Yes

No

Deh

ydra

tio

n ca

n o

ccur

rap

idly

in c

old

cond

itio

ns.

7F

oo

d in

take

Hav

e in

crea

sed

cal

ori

fic n

eed

s b

een

cons

ider

ed?

Yes

No

Ene

rgy

req

uire

men

ts in

crea

se in

co

ld

cond

itio

ns.

8A

lco

hol

Has

alc

oho

l bee

n av

oid

ed f

or

48 h

our

s

pri

or

to a

ctiv

ity?

Yes

No

Alc

oho

l inc

reas

es s

usce

pti

bili

ty t

o C

I.

9D

ress

& E

qui

pm

ent

Is c

orr

ect

clo

thin

g/s

leep

ing

sys

tem

issu

ed?

Yes

No

Co

rrec

t cl

oth

ing

and

eq

uip

men

t

will

red

uce

CI

risk

.

Do

all

tro

op

s ha

ve s

par

e d

ry c

loth

es?

Yes

No

10P

red

isp

osi

ng

Fac

tors

Can

the

act

ivit

y b

e p

ost

po

ned

unt

il

per

sonn

el h

ave

rest

ed?

Yes

No

Lack

of:

sle

ep;

foo

d;

fluid

s; p

oo

r fit

ness

;

and

illn

ess

all p

red

isp

ose

to

CI.

Tho

se w

ith

pre

vio

us C

I ar

e at

gre

ater

ris

k.H

ave

per

sonn

el b

een

pro

vid

ed w

ith fo

od

and

wat

er p

rior

to u

nder

taki

ng t

he a

ctiv

ity?

Yes

No

Hav

e un

fit/i

ll p

eop

le b

een

excl

uded

fro

m

the

acti

vity

?

Yes

No

Hav

e p

revi

ous

Co

ld I

njur

ies

bee

n d

ecla

red

to,

and

inve

stig

ated

by,

med

ical

sta

ff?

Yes

No

Reporting Cold Injury

Commander’s ResponsibilitiesAll cases of cold injury must be reported by the Chain of Command.

See JSP375, Chap 42, Cold Injury Prevention. for details of how to report cold injury for each service.

Where there are multiple casualties or any fatalities an appropriate investigation must be undertaken.

A rapid local alert mechanism must be in place to make other local units conducting similar activities aware of cold injury incidents as they occur.

Reporting thresholdAll cases must be reported. This includes all cases where individuals are unable to continue with their duties/training for any amount of time because of cold injury, whether there was medical involvement or not.

Medical Recording The medical chain must also record cases of cold injury but this does not replace commanders duty to report all cases that meet the reporting threshold. Unit medical centres are to be notified by the CofC of all reported cases.

16

17

18Notes

19Notes

Points of Contact:

HSEP-GroupMailbox@mod.gov.uk

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