Hypothermia and local cold injuries in combat and non-combat situations - The Israeli experience

Introduction: Cold weather has been recognized in the Israel Defense Forces (IDF) as a potential medical and operational threat to the soldier. Although regulations have been issued to cope with this situation, every year about 20 cases of hypothermia (Tcore < 35°C) and peripheral cold injuries are reported. Methods: This study was aimed at following cold weather injuries (Cl) in the IDF in the period 1994-2001. 136 cases were reported to our institute during this period. All patients were from the general population of young (20 ± 2 yr), male soldiers in the IDF. All were classified a priori as healthy, active subjects. Results: Of these patients, 51% were diagnosed with mild hypothermia and 49% with peripheral Cl. Among those soldiers who suffered from peripheral Cl, less than 5% were diagnosed with frostbite. Most of the cases (76%) occurred in the winter months; however, 10% occurred in the spring, 13% in autumn, and 2 cases (1%) were reported in the summer. The majority of all Cl cases occurred during routine scheduled training (51%), and 15% occurred during routine duties. Of the cases, 34% occurred during combat operations (mainly ambushing and surveillance). Discussion: The present study provides data on Cl cases in an army where the awareness of the hazards involved in hostile environments is extensive, and in which detailed regulations aimed to prevent these injuries are common practice. The Israeli experience indicates that Cl is preventable in most instances by following a few simple regulations and providing proper education to the soldiers and their commanding officers.