Section K Climatic Injuries
- Nov 18, 2025
- 5 min read
Index
Introduction
Understanding Non-Freezing Cold Injuries (NFCI)
Signs and Symptoms
Clinical Management
Freezing Cold Injuries (FCI / Frostbite)
Signs and Symptoms
Management and Treatment
Hypothermia
Clinical Presentation
Treatment and Rewarming Strategies
Exertional Heat Illness
Heat Exhaustion
Heat Stroke
Emergency Management
Monitoring Heat Stress: Using a Wet Bulb Globe Temperature (WBGT) Monitor
Reporting Climatic Illness and Injury
Key Clinical Reflections and Practical Takeaways
Conclusion
1. Introduction
Working in extreme environmental conditions—whether in maritime, military, or remote settings—demands a rigorous understanding of climatic injuries. Cold and heat illnesses remain significant operational risks, often developing subtly before escalating rapidly into medical emergencies.
At Kraken Medical, we empower clinicians, medics, and operational teams with the knowledge and skills needed to identify, manage, and prevent these conditions. This article consolidates your CPD learning into a comprehensive, authoritative guide designed to support best practice and real-world clinical decision-making.
2. Understanding Non-Freezing Cold Injuries (NFCI)
Non-Freezing Cold Injuries occur when tissues are exposed to cold, wet conditions over prolonged periods without reaching freezing temperatures. NFCI is common in maritime environments, field operations, and prolonged outdoor activity.
Signs and Symptoms
NFCI typically evolves gradually. Key clinical indicators include:
Neurological Changes
Numbness and tingling in extremities (toes, fingers) are often the earliest signs.
Loss of dexterity, impaired fine motor function, and difficulty walking or gripping tools.
Skin and Tissue Changes
Pale, cold skin due to vasoconstriction and reduced perfusion.
Redness or swelling as circulation fluctuates.
Blisters, ulcers, or open sores in more advanced cases, particularly when progressing toward trench foot or chilblains.
Pain
From mild discomfort to deep, throbbing pain, often increasing during rewarming.
Prolonged Recovery
Sensation and normal colour may take hours or days to return, even after warmth is restored.
Management of NFCI
Early intervention is vital to prevent tissue damage and progression.
Rewarming
Gently rewarm the affected area using warm water or ambient warmth.
Avoid direct heat sources (radiators, fires), which risk burns.
Remove Wet Material
Replace all wet socks, gloves, and boots with dry, insulated alternatives.
Encourage Movement
Light, controlled movement helps stimulate blood flow and restore warmth.
Warm Fluids
Warm, non-caffeinated, non-alcoholic drinks support core temperature and circulation.
Avoid Tight Footwear
Restrictive boots impede perfusion and worsen the injury.
Pain Relief
Use over-the-counter analgesics as required, following clinical guidance.
Medical Review
Severe cases—blistering, persistent swelling, suspected infection—require prompt medical evaluation.
Prevention
Effective layering, moisture-wicking socks, regular movement, and limiting prolonged exposure remain the cornerstone of NFCI avoidance.
3. Freezing Cold Injuries (FCI / Frostbite)
Freezing Cold Injuries result from exposure to temperatures low enough to freeze skin and underlying tissues. Swift recognition and controlled management are essential to prevent long-term damage.
Signs and Symptoms
Skin and Tissue Indicators
Cold, pale, hard skin—a hallmark of ice crystal formation in tissues.
Bluish, grey, or waxy appearance in severe cases.
Neurological Symptoms
Numbness and tingling progressing to complete loss of sensation.
Joint stiffness as deeper tissues are involved.
Blisters
Clear or milky blisters may appear in superficial frostbite.
Dark, blood-filled blisters suggest deep tissue involvement.
Severe Complications
Gangrene and tissue necrosis in the most advanced cases.
Development of ulcers, persistent swelling, or chronic pain.
Management of FCI
Immediate Rewarming
Immerse affected tissues in warm water (40–42°C / 104–108°F) for 15–30 minutes.
Do not use dry heat or massage—this increases tissue damage.
Pain Management
Rewarming is painful. Ibuprofen or other analgesics may be required.
Wound Care
Do not burst blisters; they act as natural protective barriers.
Apply sterile dressings and keep the area dry.
Elevation
Reduces swelling and promotes perfusion.
Avoid Smoking and Alcohol
Both constrict vessels and impair recovery.
Medical Intervention
Severe frostbite may require debridement, infection control, and specialist care.
4. Hypothermia
Hypothermia occurs when core body temperature drops below 35°C (95°F). Its progression can be subtle but becomes life-threatening if untreated.
Clinical Presentation
Early Symptoms
Shivering, pale or cool skin
Numbness, tingling in extremities
Fatigue, mild confusion
Moderate Symptoms
Slurred speech, increasing confusion
Poor coordination, stumbling
Intense, uncontrollable shivering
Severe Symptoms
Violent or diminishing shivering (shivering may stop—an ominous sign)
Slow pulse and breathing
Paradoxical undressing due to confusion
Loss of consciousness, potential arrhythmias
Risk of organ failure and cardiac arrest
Treatment and Management of Hypothermia
Remove from Cold
Move to a warm, sheltered environment immediately.
Replace Wet Clothing
Dry layers are essential to halt further heat loss.
Insulate
Wrap in blankets, jackets, or insulated materials.
Provide Warm Fluids
Warm drinks help raise core temperature—avoid caffeine and alcohol.
Rewarming Techniques
Passive rewarming: Using the body’s own heat in mild cases.
Active external rewarming: Warm packs to the neck, chest, groin, and armpits; supervised warm-water immersion at safe temperatures.
Avoid Rapid Rewarming
Hot water and heating pads risk burns and dangerous afterdrop.
Monitor Closely
Track consciousness, breathing, and pulse.
Seek Medical Support
All moderate to severe cases require clinical oversight.
5. Exertional Heat Illness (Heat Exhaustion & Heat Stroke)
Exertional Heat Illness arises when heat production exceeds the body’s ability to cool itself. It is a major risk during high-intensity work in warm environments.
Heat Exhaustion – Signs and Symptoms
Weakness, dizziness
Nausea, vomiting
Headache
Heavy sweating, clammy skin
Rapid heart rate
Management
Move to a shaded or cool area
Encourage rest
Provide cool fluids
Remove excess clothing
Use fans, misting, or cool compresses
Heat Stroke – A Medical Emergency
Heat stroke occurs when thermoregulation fails and core temperature rises above 40°C (104°F).
Signs and Symptoms
Hot, dry skin or profuse sweating (varies)
Altered mental state (confusion, agitation)
Loss of consciousness
Seizures
Rapid, strong pulse
Nausea, vomiting
Management
Call emergency medical services immediately
Rapid cooling through immersion, cool packs, or air-conditioned environments
Monitoring airway, breathing, circulation
Do not give fluids if consciousness is impaired
Prevention
Hydration
Acclimatisation
Avoid strenuous work in peak heat
Frequent breaks and shaded rest
Light, breathable clothing
6. Using a Wet Bulb Globe Temperature (WBGT) Monitor
Monitoring environmental heat stress is vital afloat and in field operations.
Operation
Ensure proper calibration
Place in representative area shielded from direct sunlight
Measure Wet Bulb, Dry Bulb, and Globe Temperature
Interpreting WBGT
<24°C: Low risk
24–26°C: Moderate
26–27°C: High
>27°C: Very high
Actions Based on Readings
Adjust work/rest cycles
Increase hydration
Implement cooling strategies
Modify work intensity
Accurate WBGT records support informed decision-making and safety planning.
7. Reporting Climatic Illness and Injury
A structured reporting process ensures early intervention and enhances safety culture.
Reporting Essentials
Provide immediate care
Document environmental conditions, clinical signs, and events
Notify the chain of command
Record through formal medical channels
Maintain confidentiality
Analyse trends for prevention
Retain documentation for audits and long-term planning
8. Key Clinical Reflections and Practical Takeaways
Early recognition saves tissue and lives—especially with frostbite, hypothermia, and heat stroke.
Moisture, wind, and immobility drastically increase cold injury risk.
Heat illness prevention is far more effective than treatment.
WBGT monitoring is a powerful tool for operational safety.
Clear reporting and good documentation support better organisational learning.
9. Conclusion
Climatic injuries pose significant operational and clinical challenges. Whether dealing with cold injury, hypothermia, or heat stress, timely recognition and evidence-based management are crucial.
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