The area involved is usually anesthetic (not sensitive to pain/physically
(3) Although there may be rapidly developing edema (abnormal
accumulation of fluid in body tissues) proximal (nearer the attachment of the extremity
to the body trunk) to the area of fourth degree injury, reaching a maximum within 6 to 12
hours, the injured area itself may show no significant increase in volume, but rapidly
progress to dry gangrene and mummification.
(4) In other fourth degree injuries, tissue injury slowly progresses, edema is
more prominent, and scab formation and gangrene may not be evident until two or three
weeks after the injury.
(5) Severe paresthesia (abnormal sensation of prickling, itching, etc.) may
appear 3 to 13 days after rewarming.
(6) The line of cold injury becomes apparent in an average of 36 days and
extends down to the bone between 60 to 80 days after injury.
a. Cold Injuries are Preventable. Successful prevention requires vigorous
command leadership and proper use of preventive measures which are inspected and
enforced. Prior planning, cold weather training, and the provision of proper clothing and
equipment are of primary importance. Specific preventive measures are directed
toward conservation of total body heat, avoiding unnecessary prolonged exposure of
personnel to cold, moisture, and activities favoring cold injury.
b. Meteorological Data. All commanders should be familiar with the utilization
of simple meteorological data such as humidity, temperature, wind, and ground surface
conditions which influence the risk of cold injury. Some weather conditions will require
shortening of the exposure time of individuals engaged in patrols, guard, or motor
movements in unheated vehicles despite the adequacy of their clothing and equipment.
These can frequently be anticipated by the utilization of meteorological data and
existing weather conditions to predict the hazard for the ensuing 12-hour period. Thus,
clothing may be provided for anticipated weather conditions and the periods of exposure
shortened, if indicated.
c. Cold Injury Control Officer. Each platoon and squad or comparable-sized
unit should have a Cold Injury Control Officer or Noncommissioned Officer. This
individual should be carefully selected on the basis of leadership, interest, and ability to
supervise others in simple but constant preventive activities. This officer's