Page 82 - JSOM Spring 2023

Cold Weather Injury in a Special Operations Aviation Crew Member

A Case Report

Sean M. Clerkin, SOCM- ATP ; Nick T. Carlson, SOCM-ATP ;
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Brit Long, MD ; David H. Taylor, PA-C ; Rachel E. Bridwell, MD *
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ABSTRACT
As arctic warfare becomes a center focus within Special Oper- in a Special Operations non-rated crewmember while attend-
ations, cold weather injury looms as both a medical and opera- ing the Arctic Isolation Course in Fairbanks, Alaska.
tional threat. While cold weather injury can range from pernio
to hemodynamically unstable systemic hypothermia, the more Case Presentation
minor injuries are far more common. However, these present A 27-year-old active-duty left hand dominant Special Oper-
a challenge in austere medical care and can drastically impact ations non-rated crewmember male presented to the emer-
mission capability. We present a case of a Special Operations gency department (ED) with a chief complaint of frostbite to
crew chief with cold weather digital injury while at the Arctic the third and fourth fingers of the left and right-hand follow-
Isolation Course in Alaska and his subsequent clinical course. ing exposure during an arctic field exercise. He was properly
Prevention remains the key for mitigating these injuries, while wearing the Army issued cold weather Fire Resistant Environ-
the decision to rewarm must be made with both medical and mental Ensemble (FREE) with commercial issued cold weather
tactical factors in mind as refreezing incurs significant morbid- mittens with leather palms. He reported removing his outer
ity. Other components of prehospital treatment include active layer mittens and wearing issued wool inserts while building
rewarming, ibuprofen, aloe vera, and pain control. a shelter and collecting firewood. The temperature during the
first day of the field exercise ranged from –16°C to –22.7°C,
Keywords: arctic warfare; cold injury; frostbite; rewarm; with a maximum low for the week of –36.7°C. At approxi-
Alaska; hypothermia; austere mately 2000 hours local time, he felt minor pain and tingling
in his fingers but decided to wait until morning to see if it went
away. During morning cold weather injury checks conducted
by cadre, the Servicemember showed signs of cold injury on
Introduction
fingers three and four of his left and right hands. He was re-
There are a variety of cold weather injuries that can affect moved from the course, temporarily placed in a rewarming
servicemembers operating in arctic conditions including hypo- tent for 1–2 hours, and transferred to the emergency depart-
thermia, immersion foot, chilblains, and frostbite. From 2019 ment (ED) for evaluation.
to 2020 a total of 415 Service members were treated for cold
weather injuries, with frostbite accounting for 49.9% of inju- Upon evaluation in the ED, his vital signs included temperature
ries. The number of cold weather injuries rose from 419 in 36.9°C temporal, heart rate 74 beats per minute, respiratory rate
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2020 to 539 in 2021, with frostbite accounting for 61.1% of 18 beats per minute, blood pressure 153/79mmHg, and SpO
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reported injuries. Frostbite is a freezing, cold weather injury 99% on room air. He denied significant numbness or pain in
that commonly effects distal appendages and areas of exposed affected extremities. He had no history of previous cold weather
tissue with decreased perfusion. When tissue temperatures drop injury, but he experienced a prior episode of heat exhaustion
below –4°C, ice crystals can form within tissue. During rapid during another Army school. His third and fourth fingers bilat-
freezing from a high temperature gradient with thermal con- erally were pale, stiff to the touch, and without blisters, and he
ductivity, intracellular ice crystals form while a slower freez- denied loss of sensation. The patient’s fingers were re-warmed in
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ing generates extracellular crystals. This process can lead to 38°C water for 30 minutes. After this, his fingers were no longer
protein and lipid derangement, electrolyte shifts, inflammation, stiff to touch with grossly normal sensation. He was prescribed
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thrombosis, and cellular death. The process of thawing gen- ibuprofen 800mg every eight hours and instructed to follow up
erates a ischemia-reperfusion state, spurring the inflammation with his primary provider (Figure 1).
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cascade. During cold weather operations, even with proper
wear of cold weather equipment, Servicemembers are at risk for Upon evaluation by the battalion flight surgeon ten days after
debilitating cold weather injuries. We present a case of frostbite the injury, the patient developed hemorrhagic blisters (Figure 2).
*Correspondence to rachel.e.bridwell.mil@socom.mil
1 SSG Sean M. Clerkin and SSG Nick T. Carlson are advanced tactical paramedics affiliated with the Army Special Operations Aviation Com-
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mand, Fort Bragg, NC. Maj Brit Long is a physician affiliated with the Department of Emergency Medicine, San Antonio Uniformed Services
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Health Education Consortium, Fort Sam Houston, TX. CPT Rachel E. Bridwell is a physician and MAJ David H. Taylor is a physician assistant
affiliated with the Army Special Operations Aviation Command, Fort Bragg, NC.
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