Deep freezing injuriesSymptoms• Hard, waxlike appearance of the skin• The skin is NOT MOVABLE in relation to deeper tissue and bone• The appearance of oedema with miscoloured fl uid• Frozen skin, dermis and possibly also frozen muscle and bone tissue

First Aid• Do NOT thaw the injury on the spot ( Injury is thawed in hospital )• Shelter patient - blankets and clothing• Give warm non-alcoholic beverage• Avoid further deterioration• Evacuate to hospital

Preventive measures to avoid hypothermia, non-freezing injuries and freezing injuries

Strict control and disipline• Food – a MINIMUM of one warm meal a day, preferably two ( every 6th hour )• Water – minimum 2,5 litres a day. Warm drinks when possible• Sleep – minimum 4 hours a day• Physical activity – adjust clothing according to activity and conditions• Avoid tight clothing and ventilate suffi ciently• Carry out inspection of feet minimum once daily and when conditions call for it. Must be carried out by superiors• Wash/rub feet, control condition and use dry socks when possible• Ongoing buddy control. Keep an eye on one another• Avoid shaving when temperatures are extremely low. If needed, shave the day before• Areas with previous freezing injury must be properly protected.• Keep dry and warm clothing for head and hands available!• Avoid the use of soap in the face.

• Ensure that you are well prepared for: - Prevention, signs and symtom - First Aid and treatment

REPORT IMMEDIATELY UPON SUSPICION OF FREEZING INJURIES.BE ACTIVE AND AWARE!

SNOW-BLINDNESS AND CARBONMONOXIDE POISONING

Snow-blindnessDefi nitionSnow-blindness occurs as a result of the eyes being aff ected by excessive amounts of ultravioletradiation from the sun.

SymptomsThe symptoms appear 6-12 hours after a person has been exposed to the strong sunlight, often in the evening or during the night. • Agonizing pain in the eyes• Tears• May be mistaken for sand or particles in the eye• The discomfort increases when exposed to light• Redness in the eyes• Musclespasms around the eyes

First Aid• The damage is superfi cial and heals relatively fast. The pain is short-lasting. Improvement can be expected within 24-48 hours of treatment.• The patient must rest in a dark place with eyes covered.• Medical personnel will often use eye drops with anaesthetics before evaluating the eyes. Anaesthetics will help relax the muscles around the eyes.• Kloramfenicol (antibiotics) is recommended during the fi rst 24 hrs of treatment. The medication is available both as ointment and eye drops.

Prevention• Use of sunglasses, also in cloudy weather.

Carbonmonoxide (CO) poisoning Defi nitionCO is formed as a result of incomplete combustion of fuel in cooking stoves.

Symptoms• Headache, dizziness, nausea, vomiting, distortion of sight and rapid pulse, shortness of breath.• Reduced consciousness, possibly towards coma, cramps and circulatory collaps.• When the pink colour under nails/mucous membranes becomes increasingly stronger, the condition is dramatic.

The eff ect of CO-poisoning occurs even before symptoms are visible. The symptoms are few and hardto detect.

Prevention• Ventilation during use of cooking stove• Use a lid on the pot to reduce cooking time

First Aid• Bring the patient into fresh air• ABCDE• Avoid re-exposure to source because of long half-time! • Consult medical personnel.

The purpose of this folder is to provide a checklist for symptoms and First Aid withthe regard to Cold Weather Injuries. The folder is meant to contribute to awarenessregarding the prevention of Cold Weather Injuries.

Proper ventilation prevents CO-poisoning. Be especially aware when melting snow on a cooking stove.

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HYPOTHERMIA, FREEZING INJURIES AND NON-FREEZING INJURIES

Temperature related injuries are categorized as HYPOTHERMIA, NON-FREEZING INJURIESFREEZING INJURIES and HEAT INJURIES. Heat injuries are not dealt with in this folder.

HYPOTHERMIADefinitionA general cooling of the body to core temperatures below 35° C (~rectal measure)Mild 35 – 33 ° CModerate 33 – 30 ° CDeep < 30 ° C

CausesExposure to cold, humid weather and/or poor clothing. Exposure to cold water.

Mild hypothermia 35 – 33 ° CSymptoms• Decrease in consciousness – lethargy, confusion, apathy• Cold hands and feet• Shivering (a natural reaction)• Normal to rapid puls and respiration rate

First Aid by mild hypothermiaThe person is able to activate him/herself if necessary with assistance by:• Seeking shelter, put on warm clothes, wrap up• Warm non-alcoholic beverages• Physical activity• Speed march, activate large muscle groups to produce body heat

Moderate hypothermia 33 – 30 ° CSymptoms• Further decrease in consciousness increased lethargy, confusion and apathy• Stiffness of the muscles• Slow pulse and respiration rate• Irrational behavior – paradoxical undressing

First Aid by moderate hypothermiaThe patient is incapable of regaining body heat on his/her own and has become dependant on care:• Seek shelter, put on warm clothes, wrap up• Share body heat, lie undressed next to patient• Provide warm non-alcoholic beverages• Wrap the patient in blankets/survival sheets/sleeping bag• Monitor the patient• Further treatment in hospital

Deep hypothermia < 30 ° CSymptoms• Unconsciousness or coma• White, cold skin• Expanded and rigid eye pupils• Slow pulse rate – hard to detect • Slow respiration rate – hard to detect• Vital signs may seem absent, but the patient must not be declared dead

First Aid by deep hypothermiaImplement ABCDE-principles• Careful treatment• CPR preparednessAvoid further loss of body temperature• Avoid further exposure to cold and shelter the patient• Remove wet clothing, dress the patient in dry clothes. If no dry clothes are available, – wrap the patient in plastic

Unconscious patients to be put in recovery position.Gentle, but rapid, evacuation to hospital.

HUMIDITY AND WIND INCREASE LOSS OF BODY TEMPERATURE!

The extremities of the body are susceptible to heat loss in coldconditions

NON-FREEZING INJURIESDefinitionA local injury occurring in temperatures ranging from 0 to +10 degrees Celsius. The injury occurs with a persistent skin temperature of +8 degrees Celsius or lower.Non-freezing injuries are a result of prolonged exposure to low temperatures, in combination with humidity. By prolonged period one refers to 10 hours or more. Non-freezing injuries may, however, occur after shorter periods of time. The blood vessels will constrict as a result of a lowering of the core temperature, blood circulation is impaired and as a result oxygen and energy are prevented from reaching the cells.

Symptoms• Numbness and prickling sensation in the skin• Reddish skin – developing into white/bluegray skin• Oedema – blisters• Bleeding

First Aid• Dry, rub and warm the injured area• Avoid straining of the injured area • Transport the patient on a stretcher

Prevention• Dry boots and socks. Change socks frequently• Ensure dry feet during rest / sleep • If core temperature is low, the feet get cold

FREEZING INJURIESDefinitionA local freezing injury is tissue damaged by ice crystals forming in the cells and puncturing or bursting cell membranes. This, in turn, often leads to the retention of fluid after thawing of the dam-aged area. For a freezing injury to occur, hence, temperatures need to sink below 0 degrees Celsius.

We distinguish between superficial and deep freezing injuries.

Superficial freezing injuriesSymptoms• Superficial freezing injuries are revealed by white/grey spots as the skin gets a waxlike appearance but is still movable in relation to deeper tissue and bone.• There are two stages of development: - White skin that, when warmed up, turns normal after 15 minutes. The skin is red, not white, after treatment. - A superficial freezing injury reaching deeper into the skin will typically result in oedema and blisters with translucent fluid after thawing of the injured area.

First Aid• Skin against skin – palm against ear, nose, cheek or place injured area in armpit• Cover the area• General rewarming• DO NOT rub or massage

If no improvement after 15 minutes, bring the patient to a warmer place, as for example a tent, a vehicle or a house. Seek professional medical treatment.

When thawing injury be aware of the risk of burns. Thaw injured area at normal room or bodytemperature.

Temperaturecalm air

Gentle breeze5 m/sek

- 60o

- 50o

- 40o

- 30o

- 20o

- 10o

-0o

Fresh breeze10 m/sek

Near Gale15 m/sek

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