Chapter 2

Severe cases
2-90. If the victim is unconscious or appears dead without any obvious injury, prevent further heat loss.
Rapid rewarming of an unconscious victim may create problems and should not be attempted. It is best to
evacuate as soon as possible. At all times, the victim should be handled gently so as not to cause the cold
blood from the extremities to rush to the heart. Do not allow the victim to perform any physical activity.
Immediately transport the victim to the nearest medical facility. Field reheating is not effective and may be
hazardous. Provide artificial respiration if breathing stops. If no pulse is detectable, be aware that in
hypothermia there is often effective circulation for the victim’s hypothermic state. In such a case, cardiac
compression (such as CPR) may be fatal. The exception is acute hypothermia with near drowning.

Breathing warm, moist air is the fastest way to warm the inside of the body. If breathing steam is
not possible, place tubing under the rescuer’s shirt so the victim will still breathe warm, moist
air. This process can be done while on the move. In addition to breathing moist, warm air the
victim must be gradually rewarmed using external heat sources. Padded hot water bottles or
heated stones should be placed in the armpits.

If conscious, the victim can be given warm, sweet drinks.

The Hibler Pack is an improvised method of rewarming hypothermic victims in the field. This is
used to heat the body core first so the vital organs are warmed and not the extremities. As the
body warms up the warm blood will eventually warm all parts of the body. First lay out a
blanket or sleeping bag and place a poncho or space blanket inside of it. The poncho or space
blanket should go from the base of the skull to the base of the butt. This keeps the sleeping
bag/blanket dry and acts like a vapor barrier. Lay the hypothermic patient inside the sleeping
bag/blanket. Using a stove, warm some water until it is hot to the touch (but not hot enough to
burn the patient) and completely dampen any absorbable materials (such as T-shirt, towel, BDU
top, and so on). Place the warm, wet items inside a plastic bag or directly in the armpits and
chest of the patient. After the warm, wet item has been placed on the patient, wrap the patient
tightly inside the poncho/space blanket and the blanket/sleeping bag. Continually check the
temperature of the wet material and keep it warm.

All bodily systems in hypothermia are brittle so treat the victim gently. As these attempts are
being made, try to evacuate the victim. Severe complications may arise as the body temperature
rises, which may result in cardiac arrest even though the victim seems to be doing well.

Immersion or Trench Foot
2-91. This is damage to the circulatory and nervous systems of the feet that occurs from prolonged
exposure to cold and wet at above freezing temperatures. This can happen wearing boots or not. A Soldier
may not feel uncomfortable until the injury has already begun.
Contributing Factors
2-92. Factors that contribute to immersion or trench foot are—

Stepping into water that comes over the boot tops.

Not changing socks often enough.

Improper hygiene.

Prolonged exposure (three to five days).
Symptoms
2-93. Symptoms of immersion or trench foot include the sensation of tingling, numbness, and then pain.
The toes are pale, and feel cold and stiff. The skin is wet and soggy with the color turning from red to
bright red, progressing to pale and mottled, and then grayish blue. As symptoms progress and damage
appears, the skin becomes red and then bluish or black. Swelling may occur. Because the early stages of
trench foot are not painful, Soldiers must be constantly aware to prevent it.

2-18

TC 3-97.61

26 July 2012