Combat health support in an arctic environment

Army Logistician, Sept-Oct, 2003 by Brett H. Venable

Extreme cold weather environments threaten the success of military operations and present specific challenges to combat health support planners. Cold weather operations can severely constrain field medical treatment and evacuation. The incidence of disease and nonbattle injury also increases in an arctic environment. In parts of Alaska, temperatures routinely drop to 50 degrees below zero during the winter months, which provides a perfect environment for the 172d Infantry Brigade (Separate)--the Snow Hawk Brigade--at Fort Wainwright, Alaska, to practice special tactics, techniques, and procedures for evacuating and treating casualties in an arctic environment.

Medical Treatment

Treating seriously injured casualties in extreme cold weather conditions is very difficult. Medical personnel on the front lines must balance the casualty's need for medical stabilization against the risks of hypothermia and frostbite. Medics in maneuver battalions must assess a patient without removing the casualty's clothing, because removing clothing in subzero temperatures can lead to further injury to the patient.

Another challenge for the arctic medic is intravenous (IV) fluid replacement. Veins constrict in extreme cold temperatures, which makes establishing an IV line difficult. Exposing the patient to the cold may lead to hypothermia, and the IV line will quickly freeze if left exposed to the outside air. Once a medic stabilizes a casualty, he must rapidly evacuate the casualty to a warm treatment tent, where an IV line can be established if needed.

One technique used by the Snow Hawk Brigade to keep casualties warm is to place them in military evacuation bags. Lined with 13 pounds of insulating material, the military evacuation bags were designed for moving injured soldiers in an extreme cold weather environment. Double zipper openings allow easy entry and exit of casualties.

The 172d Infantry Brigade's medical company keeps incoming casualties warm in a heated triage tent. As casualties are unloaded from a ground or air ambulance, they are moved immediately to a heated general purpose (GP) medium tent, which is heated by two medium space heaters (H-45) or arctic space heaters. Both heaters run on diesel fuel and are used with attached thermoelectric farts that circulate heat down to the tent floor, improving heat distribution and conserving fuel. The use of a triage tent allows the triage officer to remove the casualty's clothing to assess injuries without further injuring the patient because of exposure to the cold. Once triaged, the casualty can be moved into the treatment tent for treatment by a physician.

Another major concern for combat health support planners in arctic conditions is keeping medical supplies and equipment from freezing. IV fluids and liquid medications are of no value when they are frozen,

and many medications become unusable even if they are thawed later. Essential medical equipment such as blood analyzers will not operate when frozen. Medical logisticians must ensure that medications and medical equipment are stored in heated areas of vehicles and tents at all times to prevent freezing.

Ground Casualty Evacuation

Evacuating casualties from the points of injury to casualty collection points (CCPs) is a challenge in an arctic environment. The first hurdle is finding the casualties on the arctic battlefield. Since soldiers usually are dressed in camouflage whites, casualties blend in with the snow and can be difficult to find. Alaska's ice fog and lack of daylight during the winter months can further impede search efforts.

Generally, the use of standard litter bearers is not feasible in deep snow because movement is slow and litter bearers fatigue quickly. This puts the soldiers at risk for overexertion and potential cold weather injury. Therefore, units in the 172d Brigade use both the Skedco litter and the ahkio (Alaskan sled) for casualty evacuation.

The Skedco litter, which is found in most light infantry units, is made from a special plastic that is both flexible and durable. The casualty is placed on the Skedco litter ,and dragged through the snow by a litter team. The litter also is equipped for hoist by helicopter, which may be essential when maneuver battalions are operating in restrictive terrain.

When conducting operations in deep snow, the ahkio is the best platform for manual casualty evacuation. The ahkio is a fiberglass sled designed to carry up to 200 pounds of equipment for an infantry squad. Normally, an arctic infantry squad uses the ahkio to carry their 10-man tent, stove, fuel, water, and other equipment. The sled weighs 38 pounds, measures 88 inches by 24 inches by 8 inches, and has three rails on the bottom that help keep the sled moving in a straight line. When used to evacuate a casualty, the top of the ahkio is padded with one or more sleeping mats. The casualty is placed in an evacuation bag or sleeping bag before being positioned on the ahkio. A poncho or other suitable vapor barrier then is placed on the outside of the casualty's sleeping bag to prevent heat loss. The litter team evacuates the casualty by dragging the ahkio through the snow. The ahkio is small enough that it can be loaded into a small unit support vehicle (SUSV) or helicopter if necessary.