What is a Non-Freezing Cold Injury in the Armed Forces?

Non-freezing cold injuries (NFCIs) are a reality for service personnel operating in cold and wet conditions. These injuries can affect performance and potentially end military careers if not managed properly. Understanding NFCIs, spotting the early signs, and knowing how to prevent them are vital for anyone exposed to cold environments 

Here, JMW provides a straightforward look at what NFCIs are, their causes, and practical steps for prevention to help maintain the health and effectiveness of military personnel.

What Are Non-Freezing Cold Injuries?

Non-freezing cold injuries occur when exposure to cold, damp conditions does not lead to freezing of the tissues, but instead causes damage over time. This type of injury is common among service personnel who find themselves in cold and wet environments, Unlike freezing cold injuries, which are immediate and often visibly apparent, NFCIs develop gradually and can be deceptive in their initial stages.

The primary cause of NFCIs is prolonged exposure to cold and wet conditions, where temperatures are above freezing but still cold enough to reduce blood flow to extremities, such as the feet and hands. This reduced blood flow can lead to tissue damage without actual freezing occurring. Early symptoms include numbness, a sensation of pins and needles, and skin that appears red initially before turning pale. If left unaddressed, these symptoms can progress to more severe conditions, including persistent pain, sensitivity to cold, and in some cases, long-term nerve damage.

The long-term effects of NFCIs can be significant, affecting not just the physical wellbeing of service personnel but also their ability to perform their duties effectively. In severe cases, individuals may face medical discharge from the armed forces. Recognising the early signs of NFCIs and taking immediate action is needed to prevent long-term damage and ensure service members can continue their duties effectively.

Prevalence in the Armed Forces

Non-freezing cold injuries are prevalent among service personnel, primarily due to the nature of military operations which often expose individuals to harsh, cold environments for extended periods. The unique demands of military training and operations, particularly those conducted in cold and wet conditions, significantly increase the risk of NFCIs among soldiers. However, NFCIs are preventable. 

The incidence of NFCIs within the armed forces is a concern, with reported cases highlighting the injury's impact on both individual service members and unit effectiveness. These injuries can lead to significant time lost from training and operational duties, affecting the overall readiness of military units. 

Risk Factors for NFCIs

The risk of developing non-freezing cold injuries among service personnel is influenced by several key factors, primarily related to environmental exposure and individual susceptibility. Understanding these risk factors is crucial for implementing effective prevention strategies.

1. Exposure to cold and wet conditions: the most significant risk factor for a non-freezing cold injury is prolonged exposure to cold, damp environments. Military operations and training exercises often take place outdoors, where service members are subjected to cold and wet conditions without adequate protection or the opportunity to dry off and warm up. This exposure is particularly risky during activities that involve limited movement, reducing blood circulation to the extremities and increasing the likelihood of NFCIs.
2. Inadequate personal protective equipment (PPE): proper gear is essential for protecting against the cold. Inadequate or improperly used clothing and footwear that do not keep moisture away from the skin can greatly increase the risk of NFCIs. Service members without access to appropriate cold-weather gear, or those who do not use their gear correctly, are at a higher risk.
3. Previous cold injuries: individuals who have previously experienced cold injuries, including NFCIs, are more susceptible to future incidents. Previous injuries can lead to increased sensitivity to cold and reduced ability to tolerate exposure, making it easier for a non-freezing cold injury to develop under similar conditions.
4. Poor physical condition: physical fitness plays a role in an individual's ability to withstand cold. A lower level of physical fitness can lead to reduced blood circulation, making it harder to keep extremities warm in cold conditions. Additionally, individuals with less body fat may have less natural insulation against the cold, increasing their vulnerability to NFCIs.
5. Lack of acclimatisation: acclimatisation to cold environments can help reduce the risk of NFCIs. Service personnel who are suddenly exposed to cold conditions without adequate time to acclimatise may be at greater risk. Gradual exposure helps the body adapt to the cold, improving its ability to maintain warmth and circulation.
6. Dehydration and nutritional deficiencies: proper hydration and nutrition are critical for maintaining body heat and energy levels in cold environments. Dehydration and a lack of essential nutrients can impair the body's ability to generate heat, increasing the risk of NFCIs.

Prevention Strategies

Preventing NFCIs within the armed forces requires a multifaceted approach that addresses both environmental and personal factors. Here are key strategies to minimise the risk of NFCIs among service personnel:

1. Proper clothing and gear: ensure all service members have access to high-quality cold-weather gear that provides insulation while allowing moisture to escape. Layering clothing, using waterproof footwear, and changing wet clothes promptly can significantly reduce the risk of NFCIs. Educate personnel on how to dress appropriately for cold and wet conditions, emphasising the importance of keeping extremities warm and dry.
2. Education and awareness: conduct regular training sessions on the risks, symptoms and prevention of NFCIs. Service members should be able to recognise the early signs of these injuries in themselves and their comrades. Increased awareness can lead to early detection and treatment, reducing the severity and long-term impact of NFCIs.
3. Hygiene and foot care: emphasise the importance of good hygiene practices, particularly foot care, to prevent NFCIs. Keeping feet clean, dry and warm, using moisture-wicking socks, and changing socks regularly can help prevent conditions like trench foot, a common type of NFCI.
4. Maintaining body temperature: implement strategies to help service members maintain their body temperature in cold environments. This includes active warming techniques, such as movement exercises during breaks, and passive warming methods, like using thermal blankets or heated shelters during rest periods.
5. Acclimatisation: gradually expose service personnel to cold conditions to allow their bodies to acclimatise. This process can enhance physiological responses to cold, such as improved blood flow to extremities, which reduces the risk of NFCIs.
6. Rotation and rest: develop and enforce rotation schedules that limit the time individuals spend exposed to cold and wet conditions. Regular breaks in warm, dry environments allow service members to recover from cold exposure and reduce the risk of NFCIs.
7. Nutrition and hydration: promote a diet rich in calories and nutrients essential for generating body heat and maintaining energy levels in cold environments. Encourage regular hydration to support overall health and resilience to cold stress.

Treatment and Recovery

The treatment and recovery process for a non-freezing cold injury involves both immediate care and longer-term management strategies to ensure the best possible outcome for affected service personnel. Key aspects of this process include:

1. Immediate care: the first step in treating NFCIs is to remove the individual from the cold environment and begin the rewarming process. This should be done gradually to avoid thermal shock and further tissue damage. Affected areas should be dried and warmed gently, avoiding direct heat, as this can exacerbate the injury. Elevating the injured limbs can also help reduce swelling.
2. Medical evaluation: early and thorough medical evaluation is key. Healthcare professionals can assess the severity of the NFCI and recommend appropriate treatment, which may include pain management, infection prevention, and measures to improve circulation in the affected areas.
3. Ongoing monitoring: NFCIs require careful monitoring to assess healing and prevent complications. Follow-up appointments with healthcare providers are essential for tracking recovery and adjusting treatment plans as necessary.
4. Physical therapy: in cases where NFCIs have affected mobility or caused significant pain, physical therapy may be recommended. Physical therapists can develop personalised exercise programmes to restore function, improve circulation and reduce discomfort.
5. Education on cold injury management: part of the recovery process includes educating the affected individual on managing sensitivity to cold, which is a common long-term effect of NFCIs. Strategies may include avoiding cold exposure, using protective clothing, and recognising the signs of potential re-injury.
6. Gradual re-exposure to cold: for service personnel returning to duty, gradual re-exposure to cold conditions can be necessary to acclimatise the body and reduce the risk of recurrent NFCIs. This should be done under medical supervision and with appropriate precautions.
7. Support services: recovery from NFCIs can be both a physical and psychological process. Access to support services, including counselling, can help individuals cope with the impact of their injuries and adjust to any limitations they may face.
8. Cold injury clinics: specialised cold injury clinics play a vital role in the treatment and recovery of NFCIs. These clinics offer comprehensive care, including access to experts in cold-related injuries, advanced treatment options, and research into effective recovery techniques.