by Jon E. Lewis
There are a number of factors that may lead to hypothermia.
1 Lack of food: Food provides the energy for the body to produce heat. To combat cold, the calorific value of the food needs to be increased. Lack of food will lower the ability to cope with cold.
2 Poor clothing: In cold weather, you need extra clothing. Multiple layers that trap air are the most effective way of retaining body heat. You lose a lot of heat through your head and feet, so make sure you have proper headgear and footwear.
3 Dirty clothing: Wet, damp and dirty clothing is a poor insulator and increases heat loss. Keep your clothes clean, and remove damp or wet clothing during rest periods and dry it out. This apples particularly to footwear, socks must be changed and boots allowed to dry as much as possible.
4 Alcohol: Alcohol causes the blood vessels in the skin to dilate which increases heat loss. Alcohol may make you feel warmer, but in reality it has the opposite effect.
Treatment
The casualty should be warmed slowly. Change any wet clothes and place him in a warm environment in a bed or sleeping bag. It may be necessary for someone else to get in as well to provide gentle heat. Cover his head to reduce heat loss. Moderately hot, sweet drinks will provide energy and gradually raise the temperature. DO NOT GIVE ALCOHOL. Evacuate the casualty as soon as possible.
Snow blindness
This is a temporary blindness caused by direct and reflected light. Snow is a very good reflector and will exacerbate the effects of the sun. The eyes become sensitive to glare, blinking increases and the eyes begin to water and feel irritable. Sight begins to have a pinkish tinge and eventually the vision is covered by what appears to be a red curtain. At the same time the pain increases, so it can be a very frightening condition. Fortunately, the eyes will recover, given time, if they are covered with pads and rested. It can be avoided altogether by wearing proper sunglasses.
Sunburn
Just as the light effects of the sun on the eyes are increased in snow, so are the tanning effects on exposed skin. You may need to use cream, especially on your lips.
Frostbite
Frostbite is what happens when body tissues freeze, and it is your extremities that are most vulnerable to attack. Unfortunately the onset of frostbite can often go unnoticed until it is too late. The freezing prevents body fluids reaching the affected tissues and they will eventually die. When this happens they will slowly turn black and drop off, but the damage is done long before this stage is reached. In the early stages the affected parts are cold, firm, numb and marble white. It is essential to recognize frostbite at this stage to avoid lasting damage.
Treatment
Use body heat to warm the affected part, while encasing the whole body in a sleeping bag. Hot drinks may be given and the casualty should then be evacuated.
DO NOT:
1 Rub the injured part.
2 Expose the injured part to fire or similar heat.
3 Exercise the injured part.
Frostbite can be prevented if the proper clothing is worn, especially on the hands and feet, which are the parts most at risk.
Immersion foot
Immersion foot, also known as trench foot, is caused by a lack of blood circulation and prolonged exposure to wet conditions. There are three stages.
1 The feet become white, numb and cold.
2 The feet become red, hot and painful.
3 The feet can become swollen, develop cellulitis (a form of inflammation) and eventually gangrene.
Prevention
You can take various measures.
1 Keep your circulation going by exercise.
2 Do not restrict your circulation with tight trousers or with tight binding round the bottom of trousers.
3 Keep your feet as dry as possible.
4 Change socks daily and use powder on your feet.
5 Keep your feet clean.
Properly cared-for feet should give you little trouble.
Treatment
1 Remove boots and socks and warm and dry the casualty’s feet, handling them gently. Do not rub or massage them or expose them to fire.
2 Elevate the feet.
3 Put the casualty into a sleeping bag.
4 Give hot drinks
5 Give Paracetamol
6 Evacuate the casualty as a stretcher case.
HEALTH IN HOT CLIMATES
A lot of military training is still carried out overseas. Years ago, troops went out by sea, and the long voyage would give them time to acclimatize to the tropical environment. Nowadays, flying out means that you can be deposited in a tropical country without any period of acclimatization. Heat related illnesses can be a danger even without exceptionally hot weather. Strenuous training when unfit in warm weather can cause it – and heat exhaustion can kill.
BODY TEMPERATURE
The body temperature must be maintained close to its norm of about 37°C to say healthy, in addition to heat from the sun, and reflected heat from the sun, and reflected heat from the ground and surrounding objects, any physical activity produces heat. To maintain the normal body temperature, this heat must be lost. This is done by sweating, which causes heat to be released from the body as it evaporates. In a climate where the temperature is over 30°C a man may lose 10–15 litres of sweat a day, even without exerting himself. This amount of water needs to be replaced.
In addition to the water loss, there will be salt lost in your sweat. If the body is not acclimatized, this loss can be serious and can result in heat cramps. Salt added to food should be sufficient to replace this, but it should not be added to water without medical advice. There is however a safe alternative which can be added to your water bottle. This is Dioralyte, a compound of the minerals and salts lost through sweating.
Prevention of heat illness
It is much easier to prevent heat illness than to treat it.
Acclimatization
A period of acclimatization helps the body to adjust to the heat; the main effect is to reduce the salt loss in the sweat to about half its previous levels. The blood vessels on the skin dilate, so increasing the amount of heat loss. This normally takes about three weeks.
Fluid intake
No-one can be trained to do without water; it’s dangerous and will make you ill. Obviously, your liquid intake does not have to be restricted to pure water. Fruit juices and tea are just as good. Be careful with alcoholic drinks, since alcohol is a diuretic and causes you to pass more fluid as urine than you take in. It is possible to raise your body fluid levels before an arduous exercise by drinking more than normal (but not alcohol) in the 12 to 24 hours before the start of the exercise.
Shelter
Your shelter should be light in colour to reflect the heat, and should allow air to circulate and provide shade.
General health
Your general health is important. Personal hygiene is essential, and you must pay particular attention to your skin and feet. If you’re overweight your body will be less able to respond effectively to heat; strenuous physical activity can cause heat illness even in temperate climates for those who are unfit or unused to it.
HEAT ILLNESSES:
Sunburn
Sunburn is a form of superficial burn that can be prevented. One day in the sun will not give you a tan, but it could give you serious burns. Wear clothes that cover as much of your skin as possible, and do not spend too much time in the sun; half an hour on the first day is more than enough.
Prickly heat
Some people are more susceptible than others to this irritable condition of the skin. Your skin needs to be kept very clean, but soap can make it worse, so rinse it off thoroughly after washing. Hair must also be regularly washed but well rinsed. Loose clean clothing should be worn, including clean underclothes.
Heat cramps
Heat cramps are caused by a lack of salt in the body. They can happen in any part of your body and can be quite severe, but are easily prevented by ensuring that there is adequate salt in y
our diet. If they do occur, seek medical advice.
Heat exhaustion
This can happen when you’re working hard in relatively high temperatures and is more likely to happen if you’re overweight or unfit; excessive sweating causes abnormal fluid and salt loss, leading to circulatory failure. This results in
1 Headache nausea and dizziness
2 Pale clammy skin
3 Weak, rapid pulse progressing to hot, flushed, dry skin and full bounding pulse.
4 Cramps.
The casualty will have the signs of shock plus heat cramps. The body temperature may be normal or slightly raised. If not treated the casualty may become unconscious.
Treatment
Lie the casualty down in a cool place. Remove as much of their clothing as possible and give them frequent drinks of water to which salt has been added; half a teaspoon of salt or sodium bicarbonate to a litre. Get them to drink as much as you can and get medical help as soon as possible. In combat, if the casualty is unconscious, insert the rectal drip set to restore the fluid balance, since at least 60 per cent of water is absorbed by the colon.
Heatstroke
Heatstroke is a very serious condition that if not recognized and treated quickly can result in severe brain damage and death. The heat regulating mechanism of the body ceases to work and the temperature keeps on rising. The brain literally cooks. The signs of heatstroke include:
1 Disturbed behaviour
2 Delirium, partial loss of consciousness and coma
3 Tiredness, headache and irritability
4 Nausea and vomiting
5 Reduced or absence of sweating
6 Strong, bounding pulse
7 Hot, flushed and dry skin
The casualty’s temperature must be reduced by whatever means are possible. He should be moved into a cool dry place and have his clothing removed and then sponged down with tepid water, or if possible wrapped in a wet sheet. In both cases, fan the body to assist cooling. Give frequent small drinks of water. Get him proper medical help without any delay.
FIRST AID IN COMBAT
If you get hit, sort yourself out if you can. Otherwise, whoever gets to you first will help you. In a tactical situation lightly wounded men can carry on fighting after being given first aid, and must be encouraged to do so.
Each section contains a combat medic who is trained in combat first aid; he is however, primarily a rifleman and may well become a casualty himself. So you must not only know the life-saving techniques, but must be practised in their use. There is nothing worse than watching one of your mates die because you don’t have the skill or the knowledge to save him.
Dealing with a casualty while in contact with the enemy will be covered in the orders issued before every operation. But the following applies in general to various phases of war.
The attack
Once you are across the effective fire line, winning the firefight and fire-and-manoeuvring forward, you cannot afford to stop. If someone gets hit and you are near him there is a strong temptation to go and help, especially if he is making a lot of noise. The result is that more and more people are drawn into casualty handling, less fire goes down on the enemy and his fire gets heavier and more accurate.
As more people get hit, you lose the firefight and the attack fails. Withdrawing from the EFL is as expensive as fighting through, so you might as well remove the source of injury by killing the enemy and let your reserve platoons give first aid as they move up behind you.
Patrols
Casualties incurred on the route out will be left with a guard, if your patrol has sufficient strength and the standby patrol tasked to collect them. If you’re on the route back, you take your casualties with you. If you’re in contact with the enemy, you must take your casualties back with you as you break contact. If you are going to leave them, you must be 100 per cent sure that they are dead.
Generally recce patrols will not be large enough to take many casualties and go on with the mission. Fighting patrols are intended for combat and are therefore large enough to take casualties.
Defence
If someone in a four-man main battle trench gets hit, one of the others gives first aid while the remaining two continue to fire. If however, the enemy has closed to within grenade chucking distance, it’s not a good idea for anyone to stop firing.
Do not move around the position to help other trenches unless you have dug communication trenches. Forward slope positions are very difficult to move casualties back from, compared to reverse slope. The best approach is to carry out immediate first aid in situ and make the casualty as comfortable as possible in the shelter bay until rounds stop flying.
Internal security
The terrorist or insurgent uses casualties to create more casualties; he will aim to injure or kill one man or unit to draw the remainder into an ambush command-detonated mines or a sniper. Watch out!
THE FOUR BS
When carrying our first aid, remember the four Bs – Breathing, Bleeding, Breaks and Burns. You must deal with breathing first, because if a casualty has an obstructed airway and cannot breathe he will die, however well you treat his other injuries.
The human brain starts to suffer permanent damage after about four minutes without oxygen, so you must get a casualty breathing again as quickly as you can.
Check his mouth
A casualty with an obstructed airway may have stopped breathing completely but you are more likely to find him choking. First, look into the casualty’s mouth and extract anything obstructing his throat. You must not be squeamish; remove whatever is there, even if it is covered with blood or vomit. Be positive and don’t fiddle about.
THE FOUR BS
First of all decide which casualty to treat first. The order of priority of injuries to treat is
1. Stoppage of breathing
2. Bleeding wounds
3. Broken bones
4. Burns
This is the rule of the four Bs – Breathing, Bleeding, Breaks and Burns. Remember also that the casualty who is making the most noise is rarely the most seriously injured; don’t make the mistake of treating a broken leg while a head injury case quietly dies.
Obstructing tongue
Sometimes the tongue can fall back and block the throat. You clear the casualty’s airway by extending his neck; with him flat on his back, tilt his head right back. If he doesn’t start to breathe then you must resuscitate him; otherwise, treat him as an unconscious casualty.
There are five main causes of an obstructed airway.
1. Suffocation
2. Teeth, including false teeth
3. Swelling of the mouth or throat
4. Blood, water or vomit
5. Bone or tissue injuries
The unconscious casualty
You must place an unconscious casualty in such a position that no further harm will come to him. An unattended, unconscious casualty can easily die by choking to death on his own vomit. To keep his airway clear, place him in the recovery position.
If the casualty is unconscious, tuck his nearside hand under his body and the other over his chest. Cross the far foot over the nearer one. Then, supporting his head with one hand, grasp his clothing on his hip and roll him towards you.
Check that his airway remains clear and make sure that he cannot roll right over onto his front and that his neck stays extended. By placing him in this position his airway will stay clear even if he vomits and he will not swallow his tongue.
WHEN YOU COME ACROSS A CASUALTY
1 LOOK
2 LISTEN
3 THINK
4 ACT
Check his pulse every 15 minutes and examine the rest of his body for obvious injuries. Remember that anyone with neck or spinal injuries cannot be moved, and you will need further assistance. Casevac an unconscious casualty as soon as you can, and never leave him alone.
For all casualties
1. Assess the tactical situation; do not endanger yourself. If the enem
y are still in business continue firing, keep under cover and look out for falling masonry, mines, booby traps etc. If a vehicle is involved, switch off the fuel supply.
2. Assess the casualty; check him out completely and remove him from danger if possible. At least drag him into cover, and give protection if necessary from chemical weapons.
3. Deal with priorities – remember the four Bs
4. Reassure the casualty, no matter how revolting his injury, and tell him what you are doing while you work on him.
5. Try to keep him warm and dry
6. Give morphine only for pain
7. Never leave the casualty alone
8. Take the casualty’s ammo and any specialist equipment he may be carrying
RESUSCITATION TECHNIQUES
Exhaled Air Resuscitation (EAR)
The best way to get a casualty breathing again is to use the Exhaled Air Resuscitation (EAR) method. This is best learned on the Ressusi Anne type of dummy; do not practise on another person.
CAUTION
These techniques can harm a casualty if improperly performed. The information given here is for familiarisation only and formal training should be obtained before you attempt to use them.
Is he asleep?
First make sure that the casualty is indeed not breathing. This may seem obvious but there have been cases of people trying to resuscitate someone who is simply asleep. Look carefully at the casualty.
1 Is he/she unconscious?
2 Can you wake him up?
3 If not is his chest moving?
Do not spend too long making up your mind; every moment is vital. Follow the procedure given here, and make sure the casualty’s chest is rising each time you blow. If it isn’t, you are not doing it correctly.
1 Pulse: Check the casualty’s pulse at his carotid artery. If his heart has stopped you will need to perform cardiac compression as well as resuscitation,
2 Airway: To perform resuscitation, place the casualty on his back and extend his neck by tilting his head back. Check his airway and remove any obstructions.
