Page 44 - JSOM Winter 2025

the team’s movement with the BV 206. While driving the BV Prehospital military medical teams should consider the im-
206, the internal heating system turns on and blows hot engine plications of our findings when developing solutions for the
air inside the vehicle. Because of this the difference between storage of medication under arctic prehospital circumstances.
the inner and outer temperatures of the cooling container di- However, further research is needed to explore the impact of
minished and the warm water bottles started overheating the different protocols and technologies and their effectiveness in
container. Another possible explanation is that the TempTale 4 various operational settings.
might have been too close to the warm water bottles.
Recommendation
Our data indicate that medication storage in this manner is still Further research should focus on temperature-controlled med-
not compliant with current regulations concerning the storage ication storage during arctic deployments. In our opinion this
of medications by the DFD. However, the temperature had been can be done by using smaller and better cooling containers
within the parameters for controlled temperature for almost and applying a stricter protocol. This protocol should at least
70% of the time. This indicates that a low-tech, easy-to-maintain specify when water bottles need to be reheated and where the
method of prehospital medication storage is within reach of temperature sensors should be positioned within the cooling
mandated requirements. Minor adjustments in our proof-of- container in a way that they are not accidentally heated by
concept protocol could lead to total thermal range coverage. the warm bottles. If operational circumstances allow, water
should be warmed twice a day and, if not possible, prefera-
A review of literature has shown the difficulties of keeping bly before night falls. It would also be beneficial to research
medication within a controlled temperature in civilian emer- this method when operating on small open mobility platforms
gency medical services (EMS). Nevertheless, existing litera- such as snowmobiles.
4–6
ture does not document any low-tech solutions for medication
storage in cold arctic conditions. Our study presents a novel Conclusion
way of using a cooling container to keep medication at storage
temperature without using electricity. Notably, our findings in- The shift in focus to arctic military operations must be ac-
dicate that the cooling container maintained a stable internal companied by efforts to optimize military arctic medical pre-
temperature for about 70% of the observed time, in a manner paredness. During arctic warfare, one of the biggest challenges
not previously reported. is the low and uncontrollable temperature which can create
significant stress on medical equipment. This demonstrated,
The main strength of our study resides in the operational con- low-tech, easy-to-deploy solution is a first step to keeping med-
text in which the research was conducted. A small medical ication within controlled parameters in a minimally equipped
team collected these data while executing a full mission profile Role 1 Medical Treatment Facility, without reliance on running
during a large-scale military cold weather exercise. The exten- vehicles or electric/fuel-powered heating. This method not only
sive duration of data collection, encompassing 264 hours of lowered the team’s logistical load but also reduced their ther-
continuous monitoring and yielding approximately 5,300 data mal signature. This research paves the way for more research
points, has resulted in a robust dataset for analysis. Another towards robust medical readiness in arctic military operations.
strength of this study lays in the possible application of similar
storage methods for other purposes, such as batteries used for Author Contributions
communication and optical equipment. This could potentially CMF designed this research, collected, and analyzed the data
help them stay at full capacity during freezing temperatures. and drafted the original manuscript. BLT analyzed the data
and edited the manuscript. TCFD reviewed and edited the
Limitations manuscript. RJ collected the data, reviewed, and edited the
There are potential limitations to our methodology. There was manuscript. LCpl Beau reviewed and edited the manuscript.
a pragmatic selection of the cooling container, solely based RH reviewed and edited the manuscript. All authors read and
on direct availability for the medical team in theater. Cool- approved the final manuscript.
ing/warming containers with better isolation specifications
might exist. No strict protocol dictating the rewarming of the Disclaimer
three Nalgene bottles was provided; instead, the team did so The opinions or assertions contained herein are the private
according to their battle rhythm every morning while making views of the authors and are not to be construed as official or
breakfast. Furthermore, the placement of the cooling container reflecting the views of the Dutch Department of Defense or
within one of the BV 206s significantly mitigated its exposure Dutch government. Five of the authors are employees of the
to arctic temperatures compared to a less sheltered position, Dutch government.
such as when operating on snowmobiles or being man-packed.
While a BV 206 is optimal, further research should also explore Disclosures
the feasibility of this method when operating in a more tem- The authors have nothing to disclose.
perature-exposed manner. Additionally, while the TempTale 4
is a reliable instrument, factors such as sensor calibration and Funding
placement (e.g., being too close to the hot water sources) could This research was supported by the Netherlands Ministry of
introduce random errors or systemic biases, potentially affect- Defense.
ing the accuracy of the recorded temperature data.
References
Despite these weaknesses, the strengths of our field-ready ap- 1. Helm M, Castner T, Lampl L. Environmental temperature stress
proach include the comprehensive data collection and detailed on drugs in prehospital emergency medical service. Acta Anaesthe-
analysis, suggesting that the potential errors are unlikely to siol Scand. 2003;47(4):425–429. doi:10.1034/j.1399-6576.2003.
account for any significant discrepancies in our findings. 00062.x

42 | JSOM Volume 25, Edition 4 / Winter 2025