Page 42 - JSOM Winter 2025

Low-Tech Solutions for
Military Prehospital Medication Storage in Arctic Circumstances

A Feasibility Study

Casper Matthias Fransen ; Benjamin Leslie Turner ;
2
1
Thijs Theodorus Cornelis Franciscus van Dongen, MD, PhD ; René Joosten, MD ;
4
3
Beau ; Rigo Hoencamp, MD, PhD 6
5

ABSTRACT
Introduction: Preventing temperature stress on medication Introduction
for prehospital medical care is a challenge, especially in re-
source-limited environments like the Arctic. Most medication Preventing temperature stress on medications for prehospital
used by military prehospital providers is intended for storage medical care is a major challenge. Within civilian prehospital
between 15 and 25°C—defined as “controlled temperature.” emergency medical services, maintaining temperature control
The primary objective of this study was to demonstrate the seems challenging to achieve, even under mild climatic con-
1,2
feasibility of storing medication within controlled parameters ditions. Multiday storage of medication and medical con-
by a lightweight, highly mobile, and self-supporting Role 1 sumables during prehospital medical support to arctic military
Medical Treatment Facility during cold weather operations. operations is even more challenging. Currently, there is very
Methods: Within a standard cooling container, we placed three little literature on evidence based best practices for storing
1L water bottles filled with boiling water, which were reheated medication under such conditions. Low-tech, easy-to-deploy
every morning. Over a period of 264 hours, we measured the solutions should be researched in order to help austere mil-
inside and outside temperatures of the container and analyzed itary prehospital providers be and stay effective on the artic
whether the inside temperature remained within the speci- battlefield. The primary objective of this study was to demon-
fied parameters using two TempTale 4 temperature loggers. strate that it is feasible to store medications within controlled
®
Results: We collected a total of 264 hours of data. The ambi- parameters by a lightweight, highly mobile and self- supporting
ent temperature was outside the controlled temperature range Role 1 Medical Treatment Facility while delivering medical
94.5% of the time (248.5 hours). We recorded a minimum support in northern Norway.
temperature of –12.5°C (9.5°F) and a maximum temperature
of 27.3°C (81.1°F). The temperature measured inside the cool- The Dutch Department of Defense pharmaceutical service (De-
ing container was within the controlled temperature range for fensie Farmaceutische Dienst – DFD) oversees and is responsi- 3
67.8% of the time (178.3 hours), with a minimum tempera- ble for the packaging, storage, and distribution of medications,
ture of 6.2°C (43.2°F) and a maximum temperature of 36.7°C which should be done in accordance with the guideline “Dis-
(98.1°F). Conclusion: The shift in focus to arctic military op- tribution practices” (“Goede distributiepraktijken” [GDP)] and
erations must be accompanied by efforts to optimize military Dutch Pharmacy requirements (Standaard Nederlandse Apoth-
arctic medical preparedness. During arctic warfare one of the eek Norm [NAN]).
biggest challenges is the low and uncontrollable temperature
which can create significant stress on medical equipment. The Most medications commonly used by military prehospital pro-
demonstrated low-tech, easy-to-deploy solution is a first step viders are intended for storage at a “controlled temperature,”
to keep medication within controlled parameters in a mini- which is between 15 and 25°C (59–77°F), according to DFD’s
mally equipped Role 1 Medical Treatment Facility without definition. The arctic military out-of-hospital environment is
reliance on running vehicles or electric/fuel-powered heating. notoriously “uncontrolled” with temperature being one of the
This method not only lowered the team’s logistical load but biggest challenging factors.
also reduced their thermal signature. This study paves the way
for more research toward robust medical readiness in arctic Cold environments with temperatures below the freezing
military operations. point (0°C/32°F) present challenges for certain medications,
especially those in aqueous solutions. In the past, this was
Keywords: arctic warfare; temperature stress; prehospital mitigated by keeping medication within constantly running
medical care; resource-limited environments; cold weather vehicles or by using electric or fuel-powered heating. How-
operations; medication storage; low tech; deep ops; Role 1 ever, these options consume a significant amount of electricity
1 Casper Matthias Fransen is affiliated with the Ministry of Defense, The Netherlands. Benjamin Leslie Turner is affiliated with the Ministry
2
3
of Defense, The Netherlands. Dr. Thijs Theodorus Cornelis Franciscus van Dongen is affiliated with the Ministry of Defense, The Netherlands
and the Defense Healthcare Organisation, Ministry of Defense, Utrecht, The Netherlands. Dr. René Joosten is affiliated with the Ministry of
4
5
Defense, The Netherlands and the Defense Healthcare Organisation, Ministry of Defense, Utrecht, The Netherlands. LCpl Beau is affiliated with
6
the Ministry of Defense, The Netherlands. Dr. Rigo Hoencamp is affiliated with the Ministry of Defense, The Netherlands, the Department of
Surgery, Alrijne Hospital, Leiderdorp, The Netherlands, the Defense Healthcare Organisation, Ministry of Defense, Utrecht, The Netherlands, and
the Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
40