CHAPTER 6

Hygiene and First Aid

6-1. GENERAL

The care of your body needs special attention in cold weather. Ensuring cleanliness in the field, particularly in the cold, is important. It is easy to let yourself go for long periods without bathing, but if you wish to be part of an effective combat force, you must keep clean.

6-2. HYGIENE TIPS FOR THE SOLDIER

Face, hands, armpits, and crotch should be washed daily. If water is not available, take a "bath" using cornstarch or rub your body briskly with a dry towel. The cornstarch removes excess oil and perspiration from skin and hair.

Shave regularly -- daily if water is available or every 2 to 3 days if water is in short supply. Shaving just before sleeping will allow the face maximum recovery time before going out into the cold, reducing the possibility of superficial frostbite.

Teeth should be cleaned daily. If a toothbrush is not available, a clean piece of cloth wrapped around a finger or a chewed twig may be used as a substitute.

Underwear should be changed at least twice a week. If it is not possible to wash your underwear, crumple it, shake it, and air it for at least 2 hours.

Ensure that all eating and cooking utensils are cleaned after each use.

In the dry arctic you will find the need to oil your unprotected and exposed skin once every week (with an oil such as suntan oil).

Figure 6-1. Mechanisms of heat loss from the body.

6-3. HYPOTHERMIA

Hypothermia is a lowering of the temperature of the body's inner core. This happens when the body loses heat faster than it can produce it. You must be able to recognize the symptoms of hypothermia and to treat the condition immediately.

PREVENTION

To prevent hypothermia, adhere to the following:

• Stay physically fit.
• Keep active.
• Use the uniform properly and keep it dry.
• Eat properly and often.
• Drink plenty of liquids, at least 3.5 quarts per day, when performing physically demanding work.
• Be prepared for and know how to deal with quick changes in the weather.
• Bivouac early before judgment is weakened by fatigue.

SYMPTOMS

Be aware of the following symptoms:

• Shallow breathing or absence of breathing.
• Faint or undetectable pulse.
• Victim is first cold, then stops shivering.
• Loss of feeling.
• Poor coordination; victim has trouble walking.
• Impaired speech.
• Confusion, withdrawn appearance, depressed, and/or uncoordinated. An uncaring attitude and/or glassy stare are also clues.

TREATMENT

The recommended treatment is as follows:

• Prevent any further heat loss.
• Get the victim out of the wind and into the best shelter available.
• Replace any wet clothing with dry, and place the victim in a sleeping bag, if one is available.
• Place as much insulation as possible between the victim and the ground.
• Add heat by the best available means to the victim's neck, groin, and sides of chest. This can be done by using a hot water bottle, Yukon stove, campfire, or your own body heat.
• Provide the victim with something warm and nutritious to drink if he is conscious. Calories may be added by using sugar in hot, sweet drinks.
• DO NOT massage the victim.
• DO NOT give alcohol to the victim.
• Evacuate the victim to the nearest medical treatment facility as soon as possible. This condition is life threatening until normal body temperature is restored.

6-4. FROSTBITE

Frostbite results when tissues freeze from exposure to temperatures below 32^oF. The degree of injury depends upon the wind-chill factor, length of exposure time, and proper protection. Persons with a history of cold injury are prone to frostbite. There may be a tingling, stinging, an aching sensation, or a cramping pain. The skin first turns red and then becomes pale gray or waxy white. Frostbite can be classified as superficial or deep.

WIND CHILL

The combination of wind and low temperatures creates a condition known as wind chill. For example, with the wind calm and a temperature of -20^oF there is little danger of wind chill. If the temperature is -20^oF and there is a wind of 20 knots, the equivalent chill temperature is -75^oF!

Under these conditions there is GREAT DANGER and your exposed skin can freeze within 30 seconds. You also create your own wind when you walk, run, or ski. As examples, walking creates a wind speed of about 5 mph and running 10 mph. Wind is also created by moving vehicles, aircraft propellers, and rotors. The wind-chill chart is provided to show how wind and temperature combine to create wind chill; use it. Cold injury can disable you like an enemy bullet.

Figure 6-2. Wind-chill chart.

PREVENTION

Frostbite is preventable if the individual soldier takes care of himself. It seldom occurs in people who are maintaining enough body heat. It is most commonly associated with an overall body heat loss resulting from poor equipment, reduced food intake, dehydration (water loss), overtiring, injury, or a combination of these factors. The feet, hands, ears, and exposed areas of the face are most easily hurt by frostbite and must receive constant care. The following are rules to help prevent frostbite:

• Do not wear tight boots and socks.
• Use the "buddy system" to check exposed areas, especially when wind is present.
• Carry extra socks and mitten liners.
• Do not stay still for long periods.
• Use caution when cold and wind are combined.
• Check feet during halts.
• Ensure that you eat well and have hot drinks as often as possible.

SYMPTOMS OF SUPERFICIAL FROSTBITE

Redness occurs, followed by powdery flaking of the skin. Affected areas of dark-skinned soldiers may appear dull and grayish. Blister formation occurs 24 to 30 hours after exposure, followed by flaking of superficial skin.

SYMPTOMS OF DEEP FROSTBITE

Common symptoms are as follows:

• Loss of feeling occurs in the affected area, leaving it pale yellow and waxy looking.
• When the frostbitten area thaws, it is painful.
• Frozen tissue may feel solid or "wooden" to the touch.
• When exposed to inside temperatures, blisters may appear in 12 to 36 hours.
• Discoloration (red-violet) appears 1 to 5 days after the injury.
• Gangrene usually results.

TREATMENT FOR FROSTBITE

Determine whether the frostbite is superficial or deep. If the exposure time was short, the frostbite will probably be superficial. If the exposure time was long, the frostbite will probably be deep.

The following is a recommended treatment for frostbite:

• Move the casualty to a warm and sheltered area.
• Do not rub the frostbitten area with snow or apply cold water soaks.
• Do not rewarm the affected area by massaging or exposing it to open fire.
• Rewarm the face, nose, or ears by placing your hands on the frozen area. Rewarm frostbitten hands by placing them under clothing and against the body.
• Close the clothing to prevent further loss of body heat.
• Rewarm the feet by removing the boots and socks. Place the bare feet under the clothing and against the abdomen of a buddy. Once the feet are warmed, put on dry socks and boots, if available. If the victim must wear the wet socks and boots, he should exercise his feet by wiggling his toes.
• Loosen tight clothing and remove jewelry.
• Improve circulation by exercise.
• Do not allow the victim to use alcohol or tobacco. Alcohol increases loss of body heat; tobacco causes narrowing of blood vessels in the arms and legs.
• Reassure the victim.
• Protect frozen tissue from further cold or trauma, and evacuate the casualty to the nearest medical treatment facility.

Deep frostbite is most common and harmful to the feet and less common to the hands and ears. When deep frostbite does occur, the victim should be moved to a sheltered area and evacuated to a medical treatment facility immediately. If possible, do not allow the victim to walk if his feet are frozen and avoid treating or thawing the affected area. Thawing of deep frostbite in the field increase pain and invites infection, greater damage, and gangrene. Do not try to thaw deep frostbite; let the physician do it.

6-5. DEHYDRATION

Dehydration can cause serious physical problems and make you more susceptible to other problems, such as frostbite and hypothermia.

PREVENTION

The following are suggestions to prevent dehydration:

• The minimum daily liquid requirement for personnel performing demanding physical work in the cold is 3.5 quarts per day.
• By the time you feel thirsty you are already dehydrated. Drink whenever possible, particularly during halts.
• Ensure that canteens are full before any type of movement.
• During periods when water is scarce, do not drink coffee in large quantities. It will pass through you quickly. Water should be the first choice.
• Check your urine spots in the snow. Dark yellow or brown indicates dehydration.

SYMPTOMS

Common symptoms are as follows:

• Red indicates a severe condition needing immediate medical evacuation to the nearest medical treatment facility.
• Lack of appetite.
• Dry mouth, tongue, and throat.
• Stomach cramps and/or vomiting.
• Headaches.

TREATMENT

Recommended treatment is as follows:

• Keep the victim warm.
• Give him plenty of liquids.
• Make him rest.

6-6. CARBON MONOXIDE POISONING

Whenever a stove, fire, gasoline heater, or internal combustion engine is used indoors, there is danger of carbon monoxide poisoning. Fresh air in living and working quarters is vital. Carbon monoxide is a deadly, odorless gas.

PREVENTION

The following are suggestions to prevent carbon monoxide poisoning:

• Use stoves and laterns in well-ventilated areas and tents.
• Ensure that stoves and lanterns are functioning properly.
• Do not let personnel warm themselves by engine exhaust.
• Always have windows cracked in vehicles with a heater in use.
• Use a tent guard or shut the stove off when sleeping.

SYMPTOMS

Common symptoms are as follows:

• Headache, dizziness, confusion, yawning, weariness, nausea, and ringing in the ears.
• Bright red color on lips and skin.
• Victim may become drowsy and collapse suddenly.
• If personnel are found unconscious in an enclosed shelter, carbon monoxide poisoning should be suspected.

TREATMENT

Adhere to the following for proper treatment:

• Move the victim to open air.
• Keep the victim still and warm.
• If the victim is not breathing, administer mouth-to-mouth resuscitation.
• Administer cardiopulmonary resuscitation, if necessary.
• Immediately evacuate the victim to the nearest medical treatment facility.

6-7. SNOW BLINDNESS

Snow blindness is caused by ultraviolet and ultrablue rays of the sun being reflected from a snow-covered surface into the eyes. This condition can occur even in cloudy weather. In fact, it is more likely to occur in hazy, cloudy weather than in sunny weather.

Figure 6-3. Snow blindness.

PREVENTION

Prevention is easy; wear your issued sunglasses. If sunglasses are not available, make slitted glasses from cardboard, thin wood, tree bark, or similar material.

SYMPTOMS

Common symptoms are as follows:

• A scratchy, sandy feeling under your eyelids.
• Redness and watering of the eyes.
• A headache.

TREATMENT

Adhere to the following for proper treatment:

• Blindfold the patient using a dark cloth.
• Reassure the patient.
• Evacuate the patient to a medical treatment facility.

6-8. SUNBURN

Sunburn is a serious hazard because of the reflective qualities of the snow, especially at higher elevations.

PREVENTION

Require soldiers to use a sunscreen and lip balm.

SYMPTOMS

Redness of skin with slight swelling is one symptom of sunburn. Prolonged exposure to the sun may cause pain and blistering and, in severe cases, chills, fever, and headaches.

TREATMENT

Soothing skin creams may be helpful if the swelling is not severe.

6-9. TENT EYE

Tent eye is an inflammation of the eye caused by fumes from stoves and lanterns used in a poorly ventilated tent or shelter. It is prevented by proper ventilation of tents or shelters. The treatment is fresh air.

6-10. TRENCH FOOT/IMMERSION FOOT

Trench foot and immersion foot are injuries caused by the prolonged exposure of skin to cold or wet conditions. In extreme cases, the skin dies and amputation of the foot or leg may be necessary.

PREVENTION

The following helps prevent trench foot or immersion foot:

• Change to dry socks at least twice daily.
• Dry and massage your feet regularly with foot powder.
• Wear VB boots and change socks regularly.
• If leather boots are worn, dry them whenever possible.

SYMPTOMS

In early stages, the feet and toes are cold, numb, and still, and walking becomes challenging. The feet swell and become painful.

TREATMENT

In early stages, keep the feet dry, clean, and exposed to the air. In later stages, evacuate the victim to a medical facility.

6-11. CONSTIPATION

At very cold temperatures, personnel tend to put off the natural urge to have a bowel movement, resulting in constipation. This can be a painful casualty producer.

PREVENTION

Eat fresh or canned fruit and eat regularly. Drink plenty of liquids. Try to have a daily bowel movement at your normal time.

SYMPTOMS

Some common symptoms are stomach cramps, dizziness, and headaches.

TREATMENT

Prevention is the best treatment. If symptoms persist, get medical help.

6-12. DIARRHEA

Diarrhea can be treated by drinking tea leaves with water.

6-13. HEAT CRAMPS

Heat cramps are caused by an excessive loss of salt in the body. This loss of salt causes muscles to spasm, and they are unable to relax. After prolonged physical activity in a cold-wet environment, the signs and symptoms of heat cramps could appear in the arms, legs, and/or stomach. It is possible to experience heat cramps in cold-weather environment when undergoing extreme physical exertion.

SYMPTOMS

The soldier experiences muscle cramps in his arms, legs, and/or stomach. He is pale and has wet skin and is experiencing dizziness and extreme thirst.

TREATMENT

Have the soldier drink one fourth of a canteen of water. Give the soldier one canteen of water with one packet of salt stirred in. Have him drink the canteen of salted water over a 30-minute period. If cramping of muscles continues, evacuate the soldier to the nearest medical treatment facility.

6-14. HEAT EXHAUSTION

Heat exhaustion is caused by dehydration and loss of body salt from extreme physical activity in a cold-wet environment. It is possible to experience heat exhaustion in a cold-weather environment when undergoing extreme physical exertion.

SYMPTOMS

The soldier may feel dizzy, weak, and/or faint. The skin feels cool and moist to the touch. He may feel nauseated or have a headache.

TREATMENT

The following is a recommended treatment for heat exhaustion:

• Have the soldier drink one canteen of water to relieve the symptoms.
• If he complains of cramps, give him one canteen of water with one packet of salt stirred in. Have him drink the salt solution over a 30-minute period.

• Loosen all tight-fitting clothes.
• Elevate the feet above the level of the heart.
• If the soldier is unable to drink water due to an upset stomach or if the symptoms have not improved within 20 minutes, evacuate the soldier to the nearest medical treatment facility.

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