«BY ORDER OF THE AIR FORCE MANUAL 32-4005 SECRETARY OF THE AIR FORCE 30 OCTOBER 2001 Civil Engineer PERSONNEL PROTECTION AND ATTACK ACTIONS NOTICE: ...»
A188.8.131.52.3.1. Hypothermia may be difficult to recognize in its early stages of development. Things to watch for include unusually withdrawn or bizarre behavior, irritability, confusion, slowed or slurred speech, altered vision, uncoordinated movements, and unconsciousness. Even mild hypothermia can cause victims to make poor decisions or act drunk (e.g., removing clothing when it is clearly inappropriate).
A184.108.40.206.3.2. Hypothermia victims may show no heartbeat, breathing, or response to touch or pain, when in fact they are still alive. If hypothermia has resulted from submersion in cold water, cardiopulmonary resuscitation (CPR) should be started without delay.
However, when hypothermia victims are found on land, it is important to take a little extra time checking for vital signs to determine whether CPR is really required. Hypothermia AFMAN32-4005 30 OCTOBER 2001 81 victims should be treated as gently as possible during treatment and evacuation, since the function of the heart can be seriously impaired in hypothermia victims. Rough handling can cause life-threatening disruptions in heart rate. All hypothermia victims, even those who do not appear to be alive, must be evaluated by medical personnel. See Table A7.2.
for first aid procedures for hypothermia.
First Aid For Hypothermia.
FIRST AID FOR HYPOTHERMIA:
1. Prevent further cold exposure.
2. Remove wet clothing.
3. Initiate CPR, only if required.
4. Rewarm by covering with blankets, sleeping bags, and with body-to-body contact.
5. Handle gently during treatment and evacuation.
6. Refer for medical treatment immediately.
A220.127.116.11. Freezing cold injuries can occur whenever air temperature is below freezing (32oF).
A18.104.22.168.1. Frostnip involves freezing of water on the skin surface. The skin will become reddened and possibly swollen. Although painful, there is usually no further damage after rewarming. Repeated frostnip in the same spot can dry the skin, causing it to crack and become very sensitive. Frostnip should be taken seriously, since it may be the first sign of impending frostbite.
A22.214.171.124.2. Frostbite. When freezing extends deeper through the skin and flesh, the injury is frostbite. Skin freezes at about 28oF. As frostbite develops, skin will become numb and turn to a gray or waxy-white color. The area will be cold to the touch and may feel stiff or woody.
With frostbite, ice crystal formation and lack of blood flow to the frozen area damages the tissues. After thawing, swelling may occur, worsening the injury. Severely affected areas (often toes and fingers) may require amputation. See Table A7.3. for first aid procedures for frostbite.
First Aid For Frostbite.
FIRST AID FOR FROSTBITE (AND FROSTNIP, AS NEEDED):
1. Prevent further exposure.
2. Remove wet, constrictive clothing.
3. Rewarm gradually by direct skin-to-skin contact between the injured area and noninjured skin of the victim or a buddy.
4. Evacuate for medical treatment (foot injuries by litter whenever possible).
5. Do not: allow injury to refreeze during evacuation, rewarm a frostbite injury if it could refreeze during evacuation, rewarm frostbitten feet if victim must walk for medical treatment, rewarm injury over open flame.
A7.5.3. Risk factors. Susceptibility to cold injury (non-freezing, freezing or hypothermia) is affected by many factors.
A126.96.36.199. Poorly conditioned individuals are more susceptible to cold injury. They tire more quickly and are unable to stay active to keep warm as long as those who are fit.
A188.8.131.52. Dehydration. The body’s requirement for water is high during cold-weather. Even in cold weather, sweating due to heavy work and clothing can contribute to body water losses. In 82 AFMAN32-4005 30 OCTOBER 2001 cold, dry conditions, sweat may evaporate readily without the individual sensing it. Unless water intake exceeds body water losses, dehydration will result.
A184.108.40.206. Low body fat. Body fat is an excellent insulator against heat loss. Therefore, a very lean person may be more susceptible to the effects of cold, if clothing is inadequate or wet and/or the individual is relatively inactive such as during guard duty.
A220.127.116.11. Alcohol, and to a lesser extent caffeine, cause the blood vessels in the skin to dilate which may accelerate body heat loss. Also, alcohol and caffeine increase urine formation, leading to dehydration, which can further degrade the body’s defenses against cold. More importantly, alcohol blunts the senses and impairs judgment, so the individual may not feel the signs and symptoms of developing cold injury. Nicotine decreases blood flow to the skin, and therefore smoking or chewing tobacco can increase susceptibility to frostbite.
A18.104.22.168. Inadequate nutrition compromises the body’s responses to cold. More energy is expended during cold weather, due to wearing heavy cold-weather gear and the increased effort required for working or walking in snow. In addition, the body uses more calories keeping itself warm when the weather is cold, which also contributes to the increased energy requirement.
A22.214.171.124. Inactivity. Duties where individuals remain relatively inactive (or movement is restricted) for prolonged periods can increase the risk of cold injury. Sick, injured, and wounded individuals are very susceptible to cold injuries.
A7.5.4. Wind. For any given air temperature, wind increases the potential for body-heat loss, skin cooling, and decreased internal body temperature. Wind increases heat loss from skin exposed to cold air, in effect lowering the temperature. The wind-chill index integrates windspeed and air temperature to provide an estimate of the cooling power of the environment and the associated risk of cold injury.
The wind-chill is the equivalent still-air (i.e., no wind) temperature at which the heat loss through bare skin would be the same as under the windy conditions.
A126.96.36.199. Table A7.4. depicts the Equivalent Chill Temperature for wind speeds and air temperatures. To find the equivalent chill temperature in the table, find the row corresponding to the wind speed, and read across until reaching the column corresponding to the air temperature.
A188.8.131.52. Wind-chill temperatures obtained from weather reports do not take into account “man-made” wind (e.g., riding in an open vehicle, propeller/rotor-generated wind). Man-made winds worsen the wind-chill effect of natural wind. Individuals can be subject to dangerous wind-chill, even when natural winds are low.
AFMAN32-4005 30 OCTOBER 2001 83
Table A7.4. Wind Chill Chart 1,2
A7.5.5. When assessing weather conditions for personnel operating in mountainous regions or for flight personnel in aircraft, altitude may need to be considered if weather measurements are obtained from stations at low elevations. Temperatures, wind-chills, and the risk of cold injury at high altitudes can differ considerably from those at low elevations. In general, it can be assumed that air temperature is 3.6°F lower with every 1000 feet above the site at which temperature was measured.
A7.5.6. Metal objects, liquid fuels, and solvents that have been left outdoors in the cold can pose a serious hazard. Both can conduct heat away from the skin very rapidly. Fuels and solvents remain liquid at very low temperatures. Skin contact with fuel, solvents or metal at below freezing temperatures can result in nearly instantaneous freezing. Fuel handlers should use great care not to allow exposed skin to come into contact with spilled fuel or the metal nozzles and valves of fuel delivery systems.
A7.5.7. Prevention of Cold Injuries. Shelter from the elements is secondary only to defending against enemy actions.
A184.108.40.206. Personnel should be allowed to seek relief periodically from potentially dangerous cold stress situations (extreme cold; wind-chill; wet cold) by taking breaks in sheltered or heated areas, consuming warm beverages and hot food, and replacing wet clothing with dry clothing.
A220.127.116.11. When outdoors, keep personnel busy and physically active. Plan carefully to avoid unnecessary periods where personnel are left standing in the open.
A18.104.22.168. Be prepared for sudden weather changes.
84 AFMAN32-4005 30 OCTOBER 2001 A22.214.171.124. Use a buddy system and frequent self-checks, especially when individuals are performing sedentary or low intensity tasks, or duties require removal of gloves.
A126.96.36.199. Eat more food than normal. Caloric intake requirements will be 25 to 50% higher during cold-weather operations than in warm or hot weather.
A188.8.131.52. Prevent Dehydration. Thirst alone is not a good indicator of adequate fluid intake. Personnel must be taught to consume liquids even when they are not thirsty. The optimum amount of water needed to prevent dehydration for any individual can not be predicted precisely due to individual physiology, climate, and physical activity, but there are “rule of thumb” guidelines for planning daily water consumption and supply needs in cold environments.
A184.108.40.206.1. All water (and ice cubes) consumed must be from a medically approved source to prevent waterborne illnesses. Individuals should carry as much water as possible when separated from medically approved water sources. Snow and ice may be melted to use as drinking water in emergencies, but it must be disinfected before consumption.
A220.127.116.11.2. Plain water is the beverage of choice, and personnel will be more likely to drink sufficient water if it is palatable. Whenever possible, provide cool (60-70 oF) water.
A18.104.22.168.3. It is much better to drink small amounts of water frequently than to drink large amounts occasionally. A general recommendation for personnel in cold-weather operations is to consume about four canteens (four quarts) of water each day if sedentary, and at lease five to six canteens (five to six quarts) of water each day if active.
A22.214.171.124. Cold-weather clothing protection is based on the principles of insulation, layering, and ventilation. By understanding these principles, personnel can vary their clothing to regulate protection and stay comfortable.
A126.96.36.199.1. Wearing clothing in multiple layers allows the wearer to remove or add clothes to adjust the insulation to changes in environment or workload as well as to the individual’s own needs and preferences.
A188.8.131.52.2. Feet, hands, and exposed skin must be kept dry. Feet are particularly vulnerable, and extra foot care is required for cold-weather operations. Whenever possible, socks should be changed when they become wet from rain, snow, or sweat and the feet dusted with antifungal powder (NSN 6505-01-008-3054).
A184.108.40.206.3. Table A.7.5 “Guidance for Cold Weather,” provides general guidance for daily operations and training in cold weather.
Guidance 1,2 for Cold Weather.
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A8.1. To estimate how much time it will take to perform a task or operation while in MOPPs 3 and 4:
A8.1.1. Determine the appropriate column for the outside temperature.
A8.1.2. Find the work rate using the activity examples as a guide (e.g. light, moderate, and heavy).
A8.1.3. Find the task time multiplier by reading across the work rate line and down the temperature column.
A8.1.4. Example: A rapid runway repair team is working while the outside temperature is 60o F. The task normally takes 2½ hours to complete. By using the chart, rapid runway repair is listed as a heavy work rate under the activities examples. Also, by using the outside temperature (60 F) for that work rate (heavy), the task time multiplier can be found. In this case, the task time multiplier is 2.1. Take the task time multiplier and multiply it by the time it normally takes to do the job (2.1 x 2 ½ hours = 5.25 hours).
Therefore, the time it takes to do the job in MOPP 4 is 5 ¼ hours AFMAN32-4005 30 OCTOBER 2001 87
SUSTAINING HEALTH AND PERFORMANCE IN A HOT ENVIRONMENTA9.1. Introduction. Operating in a hot environment degrades physical performance and places personnel at risk for heat illnesses. Successfully functioning in a hot environment depends on understanding the factors contributing to heat stress, knowing and implementing the preventive measures, and maintaining constant observation of personnel for risk factors and signs of heat illness.
A9.2. Common Heat Illnesses.
A9.2.1. Heat rash (“prickly heat”) is a skin rash most commonly found when there is unrelieved exposure to humid heat and the skin stays wet continuously with unevaporated sweat. Heat rash can be avoided by keeping skin clean and allowing it to dry between heat exposures.
A9.2.2. Sunburn. Sunburn is painful and can impair body heat loss by reducing the ability to sweat, degrading performance and increasing the risk of heat casualties.
A9.2.3. Heat syncope. Fainting while standing erect and immobile in heat, caused by pooling of the blood in dilated vessels and the lower parts of the body. Lack of acclimatization is a predisposing factor.
A9.2.4. Heat cramps are painful muscle spasms primarily in the abdomen, legs, and arms, due to excessive salt and water losses. Heat cramps most often occur in individuals who are not acclimatized to the heat. Heat cramps can be avoided by acclimatization, and maintaining proper nutrition and hydration.
A9.2.5. Heat exhaustion occurs during work in the heat and appears as marked fatigue and weakness, nausea, dizziness, fainting, vomiting, elevated body temperature, and mild changes in mental function (e.g., disorientation, irritability). Heat exhaustion is caused by lack of acclimatization, and failure to replace water and/or salt lost in sweat. Heat exhaustion can be avoided by allowing workers to acclimatize, supplementing dietary salt only during acclimatization, and drinking ample water frequently throughout the work day.
A9.2.6. Heat stroke is a medical emergency caused when the body stops sweating, leading to loss of evaporative cooling and a dangerous rise in core temperature. It can include all of the signs and symptoms of heat exhaustion, but is more severe and can be fatal. The victim is usually disoriented or unconscious. One heat casualty is usually followed by others.