Non-freezing cold injury, lessons from history for future prevention

Abstract

Living, operating and training in adverse and exposed environmental situations place humans at risk of climatic injury including non-freezing cold injury. Non-freezing cold injury has caused, and continues to cause, significant problems to both civilians and military personnel exposed to cold. This article reviews the impact of this condition through history and identifies lessons that can be drawn for prevention based on historical and contemporary evidence.

Novel dry cryotherapy system for cooling the equine digit

“…Potential complications of dermatitis, cellulitis, tissue necrosis, limb oedema and softening of the hoof wall have been anecdotally reported in horses with continuous immersion methods 12. Similar complications including dermal lesions, pain and oedema known as non‐freezing cold injury or ‘immersion foot’ have been reported in military and homeless populations that experience prolonged exposure to cold wet environments 22–24. Although the focal temperature at the surface of the cryotherapy pack during the initial 5–10 minutes of this cryotherapy method was potentially quite low (below 7.65°C±2.6°C observed at 10 minutes), no complications associated with focal tissue damage were observed in this study.…”

“…12 Similar complications including dermal lesions, pain and oedema known as non-freezing cold injury or 'immersion foot' have been reported in military and homeless populations that experience prolonged exposure to cold wet environments. [22][23][24] Although the focal temperature at the surface of the cryotherapy pack during the initial 5-10 minutes of this cryotherapy method was potentially quite low (below 7.65°C±2.6°C observed at 10 minutes), no complications associated with focal tissue damage were observed in this study. Dry applications offer the advantage of avoiding direct skin contact with ice and prolonged immersion in water and allowing regular inspection of the limb with cryotherapy pack replacement, while achieving significant decreases in HWST.…”

Can iloprost be used for treatment of cold weather injury at the point of wounding in a forward operating environment? A literature review

“…Glennie and Whitaker have reviewed the significance of NFCI within military populations and the issues associated with its long-term impact [ 14 , 31 ]. From a historical perspective, iloprost had not been considered as a potential treatment.…”