Non-Freezing Cold Injury Signs and Symptoms in the Armed Forces

Non-freezing cold injury (NFCI) presents a significant challenge within the armed forces, affecting many individuals exposed to cold conditions without proper protection. NFCIs are distinct from other cold-related injuries such as trench foot or local cold injury, and can heavily impact the health and operational effectiveness of military personnel. NFCI is not always immediately recognised, making awareness and early detection vital for those at risk.

Here, JMW provides an overview of NFCI, highlighting the signs, symptoms and implications for those serving in the military. Understanding these factors is essential for prevention, effective treatment, and ensuring the wellbeing of our armed forces.

What are Non-Freezing Cold Injuries?

Non-freezing cold injuries affect military personnel exposed to cold and wet conditions for extended periods. This type of injury is different from freezing injuries like frostbite that occur when skin and tissues freeze. NFCIs instead result from prolonged cold exposure that does not lead to freezing, but can significantly harm blood vessels, nerves and muscles.

The risk of NFCIs in military settings is heightened due to the nature of outdoor operations, which often involve prolonged exposure to damp and cold environments. Conditions impede normal blood flow and, without timely intervention, can lead to lasting damage.

Understanding the difference between non-freezing and freezing cold injuries is key for proper treatment. While freezing injuries demand immediate medical response to prevent tissue death, NFCIs require a different approach focused on restoring normal blood flow and preventing long-term issues like chronic pain or peripheral vascular disease.

Prolonged exposure to cold affects the body in several ways beyond the immediate discomfort. It can lead to decreased core body temperature and altered blood flow, challenging the body's normal functions. 

Signs and Symptoms of Non-Freezing Cold Injury

Recognising the signs and symptoms of non-freezing cold injury is essential for military personnel, enabling timely intervention and treatment. Awareness can significantly reduce the risk of long-term complications associated with NFCI.

Initial Sensations and Changes in Skin Appearance

• Numbness and tingling: initially, individuals may experience a loss of sensation or a tingling feeling in the affected areas, typically the feet or hands.
• Skin discolouration: the skin may start red then change to pale, and eventually appear blue or mottled. This indicates a disturbance in blood flow and is a clear sign of cold exposure.
• Swelling sensation: there might be a feeling of swelling without actual visible enlargement, often accompanied by a sense of tightness in the skin.

Sensitivity to Temperature Changes

• Cold sensitivity: affected areas become abnormally sensitive to cold, feeling excessively cold even in mild conditions. This sensitivity can disrupt daily activities and operational duties.
• Pain responses: there can be varying degrees of pain, from mild to severe, which may not always align with the visible signs of injury.

Chronic Symptoms and Complications

• Persistent coldness and pain: over time, individuals may experience ongoing coldness and pain in the limbs, which can indicate long-term damage.
• Recurrent symptoms: episodes of numbness, tingling and pain can reoccur, particularly in cold weather.
• Peripheral vascular disease: prolonged NFCI can lead to this condition, characterised by reduced blood flow to the extremities, exacerbating symptoms.

Psychological Impact

• Mental wellbeing: living with chronic pain and discomfort from NFCI can affect psychological health, impacting morale and mental resilience.
• Operational effectiveness: the psychological strain, coupled with physical symptoms, can hinder a military personnel's ability to perform their duties effectively.

Risk Factors and Prevention of Non-Freezing Cold Injury

Understanding the risk factors associated with non-freezing cold injury is vital for military personnel and their commanders. Awareness and preventive measures can significantly mitigate the risks associated with cold environments.

Identifying Risk Factors

• Prolonged cold exposure: extended periods spent in cold, wet conditions increase the likelihood of NFCI.
• Inadequate clothing and equipment: proper gear is essential for protecting against cold conditions; lack of appropriate clothing and footwear can elevate the risk.
• Personal health and circulation issues: individuals with pre-existing health conditions affecting circulation, such as Raynaud’s phenomenon, are at higher risk.
• Previous cold injury: a history of cold injury can predispose individuals to further incidents.

Preventive Measures

• Appropriate gear: ensuring that all personnel are equipped with suitable, well-insulated and waterproof clothing and footwear is fundamental. Layering allows for adjustments based on activity level and conditions.
• Education and training: regular training sessions on recognising the early signs of NFCI and the importance of self-care and buddy care in cold environments are important.
• Regular breaks and dry clothing: encouraging regular breaks to warm up and ensuring that individuals change into dry clothing when wet can prevent the onset of NFCI.
• Nutrition and hydration: maintaining good nutrition and hydration supports body heat production and overall health, reducing vulnerability to cold injuries.

Avoiding Risk in Operational Settings

• Environmental awareness: commanders should be mindful of the environmental conditions and plan operations to minimise exposure to cold and wet conditions.
• Risk assessment: continuous assessment of the risk of NFCI among personnel, with particular attention to those previously affected or with known risk factors.
• Emergency plans: establishing clear procedures for the treatment and evacuation of personnel displaying symptoms of NFCI.

Diagnosis and Treatment of Non-Freezing Cold Injury

Early diagnosis and effective treatment of non-freezing cold injury are critical for mitigating long-term effects and ensuring the health and operational capability of military personnel.

Diagnosis of NFCI

• Medical history and symptoms: a thorough medical history, including recent exposure to cold and wet conditions, is essential. Healthcare providers should listen carefully to the individual's symptoms, particularly noting any prolonged cold exposure.
• Physical examination: a physical examination focusing on the affected areas can help identify signs of NFCI, such as skin discolouration, swelling or altered sensations.

Treatment of NFCI

• Immediate care: the first step is to gently rewarm the affected area. This should be done slowly to avoid further tissue damage. Avoid direct heat as it can exacerbate the injury.
• Pain management: managing pain is key. Over-the-counter pain relievers can be used, but more severe cases may require prescription medications.
• Foot and hand care: keep the affected areas clean, dry and elevated to reduce swelling. Soft, clean and warm socks and gloves can help protect the skin and aid in recovery.
• Medical follow-up: regular follow-up appointments are necessary to monitor the healing process and manage any ongoing symptoms.
• Rehabilitation: some individuals may require physical therapy to regain strength and mobility if the injury has led to muscle or joint problems.
• Preventing recurrence: education on avoiding future exposure and protecting against cold is essential for those who have experienced NFCI.