Prediction and Prevention of Frostbite

Occurrence of frostbite: Among teenagers, the annual incidence of frostbite in Finland was 4.1% in boys and 2.4% in girls. Lifetime experience of frostbite was 44 % among men entering their military service. In Finland during the 6 to 12 month military service the prevalence of frostbite was 1.9 % and sequelae of hand frostbite were present in 63 %. Prediction of frostbite: Individual risk factors of frostbite (95 % CI) are Raynaud’s phenomenon, (OR 1.66 – 3.87), hand vibration (OR 1.07 4.03) and current smoking (OR 1.02 – 3.15). Development of frostbite is associated with fatigue, low physical activity, dehydration and use of alcohol.During military service independent risk factors for developing face and ear frostbite were the following: not wearing a hat with earflaps or a scarf, applying protective ointment, and travelling in an open vehicle. Prevention of frostbites: Screening before military service by e.g. a questionnaire assessing Raynaud’s phenomenon, hand vibration and current smoking enables to identify personnel that are susceptible to frostbites. These persons may be either excluded from field operations, or be given special training on how to protect themselves. Education of officers and physicians is essential in order to be able to plan and train for winter manoeuvres. Protection from frostbites: Each individual should be aware of the early signs indicating an increased risk of frostbite and know how to protect themselves. Appropriate selection and use of winter clothing protects from frostbites. Wind-proof, dry and not too tight clothing should be preferred. Exercise leading to exhaustion should be avoided. During periods of inactivity, the metabolic heat production should be increased by muscular work if possible, or alternatively use additional clothing or seek shelter. Adequate nutrition and hydration protects against frostbites. It is not recommended to use ointments or wash the face with strong detergents prior to the cold exposure. Smoking should be avoided, as it increases the risk of developing frostbite. Frostbites related to contact cooling may be prevented by coating metal surfaces or using contact gloves. 1.0 INTRODUCTION It is important to recognise cold weather injuries (CI) in military operations and especially in military health care. Frostbite, trench foot and hypothermia have been a common problem in warfare in different modern conflicts and in various armies [1]. Among Israeli soldiers, peripheral injuries accounted for 55 % and hypothermia for 45 % of all CIs [2]. In Finland in peacetime land operations frostbite contributes to the majority of these injuries in Finland. Trench foot injuries related to poor hygiene are completely missing from the Finnish registers. However, non-freezing cold injuries, causing temporary peripheral neuropathy, are possible also in peace-time military winter training [3] The risk of such temporary nonfreezing cold injuries should also be recognised. Contact with metal or other materials of high conductance are nowadays a remarkable cause of militaryrelated frostbites in Finland [4]. There is evidence that individuals do not recognise the high risk of frostbite related to contact with cold materials and lack the experience of how to properly manage this situation. Hassi, J.; Mäkinen, T.M.; Rintamäki, H. (2005) Prediction and Prevention of Frostbite. In Prevention of Cold Injuries (pp. KN1-1 – KN1-10). Meeting Proceedings RTO-MP-HFM-126, Keynote 1. Neuilly-sur-Seine, France: RTO. Available from: http://www.rto.nato.int/abstracts.asp. Prediction and Prevention of Frostbite KN1 2 RTO-MP-HFM-126 Frostbites requiring hospitalisation are often associated with long treatment periods and are both demanding and costly. The majority of frostbites result in various long-lasting post-symptoms, causing commonly limitations in performance [5]. 2.0 OCCURRENCE OF FROSTBITES The occurrence of frostbites in civilian life has previously been mainly reported from referral or tertiary care hospitals [6] demonstrating very low frequencies: 0.001 0.0016 % [7, 8]. In the Finnish hospital register, covering all types of hospitals, the incidence rate was 0.0025 %. The annual incidence for having a frostbite increased markedly by increasing age and was very low in women (Fig 1) [9].