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Lessons from history: morbidity of cold injury in the Royal Marines during the Falklands Conflict of 1982.

Golden FS, Francis TJ, Gallimore D, Pethybridge R - Extrem Physiol Med (2013)

Bottom Line: These contemporaneous records have now been identified and interrogated.The morbidity in the infantry units was significantly greater than that in the support troops (1,051 (76%) vs 454 (46%), p < 0.05).Although the passage of time has made retrospective interrogation of historical documents hard, the available data do appear to offer valuable historical and clinical insights.

View Article: PubMed Central - HTML - PubMed

Affiliation: Extreme Environments Laboratory, Department of Sport and Exercise Science (DSES), University of Portsmouth, Spinnaker Building, Cambridge Road, Portsmouth PO1 2ER, UK. golden_biomed@ntlworld.com.

ABSTRACT

Background: Environmental conditions in the Falklands Conflict of 1982 favoured the genesis of cold injuries. Immediately, post-war, cold injury morbidity and its contributory factors were assessed, in the personnel of UK 3 Commando Brigade (3 Cdo Bde).

Methods: A questionnaire survey of the 3,006 members of 3 Cdo Bde who landed on the islands was conducted within 6-10 weeks of the end of hostilities. Questions included those relating to features of cold injury, body morphology, age, symptoms experienced, past medical history and other possible contributory causes. Additionally, the unit medical team conducted a cursory examination. Data were sent to the Royal Navy Institute of Naval Medicine (INM), where the degree of likely cold injury was broadly classified ('asymptomatic' 'mild', 'moderate' or 'severe'). A sample (total 109) was then selected at random from each category and subsequently examined and tested at the INM (nerve conduction, photoplethysmography and thermography testing). Forty-seven non-cold exposed sailors acted as a control group. These contemporaneous records have now been identified and interrogated.

Results: Some 2,354 (78%) completed questionnaires were returned, revealing that 1,505 (64%) had experienced symptoms of non-freezing cold injury. The morbidity in the infantry units was significantly greater than that in the support troops (1,051 (76%) vs 454 (46%), p < 0.05). No evidence was found to support an influence of a number of factors, commonly believed to have an aetiological role in the production of cold injury. Whilst there was no significant relationship between past history and cold injury morbidity in the brigade as a whole, or within the infantry units alone, an association was identified in the collective infantry units (73%) and the support/headquarter units (59%) (p < 0.05).In comparison with uninjured sailors who acted as controls (n = 47), nerve conduction was impaired in 35% of those screened some months after returning to the UK, while the photoplethysmography and thermographic responses to a cold sensitivity test showed that most (including those classed by questionnaire as asymptomatic) had residual 'cold sensitivity'.

Conclusions: Although the passage of time has made retrospective interrogation of historical documents hard, the available data do appear to offer valuable historical and clinical insights. Cold injury affected the majority of those fighting in the cold temperate climate of the Falklands. The overwhelming environmental conditions meant that, for most, a past history of cold injury did not appear to represent a risk factor for subsequent injury, as is the case for less severe conditions. Importantly, even asymptomatic individuals when tested often showed physiological evidence of cold injury-perhaps predisposing them to subsequent elevation in risk.

No MeSH data available.


Related in: MedlinePlus

Thermographic feet images of uninjured participant (A) and NFCI patient (B) to cold air (10°C). Thermal scale on left side of picture: white/pale blue = coldest and red = warmest. Top right image: on initial exposure to cold air. Top left image: after 5 min of exposure and just prior to forced convective stimulus. Bottom left image: at the end of a 5-min forced convective stimulus. Bottom right image: at the end of a further 5 min of exposure to still air.
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Figure 2: Thermographic feet images of uninjured participant (A) and NFCI patient (B) to cold air (10°C). Thermal scale on left side of picture: white/pale blue = coldest and red = warmest. Top right image: on initial exposure to cold air. Top left image: after 5 min of exposure and just prior to forced convective stimulus. Bottom left image: at the end of a 5-min forced convective stimulus. Bottom right image: at the end of a further 5 min of exposure to still air.

Mentions: In this figure, trace A is the result from an uninjured individual who demonstrates an immediate vasoconstriction response to the cold stimulus in both toes, with that in the stimulated right foot being more pronounced. There is a corresponding, short-duration reflex constrictor response in the thumb. Following 2 min of cooling, the re-warming stimulus is commenced and the pulse amplitude returns to control levels within approximately 2 min. Trace B is from a cold-injured RM with residual symptoms; the rate of onset of vasoconstriction is slow but intense. Although the reflex constrictor response in the thumb is present, it is much less marked than that seen in uninjured individuals. On re-warming, the amplitude of the signal has not returned to the resting level after half an hour (only the first 4 min are shown in the figure). In the non-cold-stimulated contralateral foot, a cold vasoconstrictor response is present but both delayed in onset and less marked than that in uninjured individuals (Figure 2).


Lessons from history: morbidity of cold injury in the Royal Marines during the Falklands Conflict of 1982.

Golden FS, Francis TJ, Gallimore D, Pethybridge R - Extrem Physiol Med (2013)

Thermographic feet images of uninjured participant (A) and NFCI patient (B) to cold air (10°C). Thermal scale on left side of picture: white/pale blue = coldest and red = warmest. Top right image: on initial exposure to cold air. Top left image: after 5 min of exposure and just prior to forced convective stimulus. Bottom left image: at the end of a 5-min forced convective stimulus. Bottom right image: at the end of a further 5 min of exposure to still air.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3750324&req=5

Figure 2: Thermographic feet images of uninjured participant (A) and NFCI patient (B) to cold air (10°C). Thermal scale on left side of picture: white/pale blue = coldest and red = warmest. Top right image: on initial exposure to cold air. Top left image: after 5 min of exposure and just prior to forced convective stimulus. Bottom left image: at the end of a 5-min forced convective stimulus. Bottom right image: at the end of a further 5 min of exposure to still air.
Mentions: In this figure, trace A is the result from an uninjured individual who demonstrates an immediate vasoconstriction response to the cold stimulus in both toes, with that in the stimulated right foot being more pronounced. There is a corresponding, short-duration reflex constrictor response in the thumb. Following 2 min of cooling, the re-warming stimulus is commenced and the pulse amplitude returns to control levels within approximately 2 min. Trace B is from a cold-injured RM with residual symptoms; the rate of onset of vasoconstriction is slow but intense. Although the reflex constrictor response in the thumb is present, it is much less marked than that seen in uninjured individuals. On re-warming, the amplitude of the signal has not returned to the resting level after half an hour (only the first 4 min are shown in the figure). In the non-cold-stimulated contralateral foot, a cold vasoconstrictor response is present but both delayed in onset and less marked than that in uninjured individuals (Figure 2).

Bottom Line: These contemporaneous records have now been identified and interrogated.The morbidity in the infantry units was significantly greater than that in the support troops (1,051 (76%) vs 454 (46%), p < 0.05).Although the passage of time has made retrospective interrogation of historical documents hard, the available data do appear to offer valuable historical and clinical insights.

View Article: PubMed Central - HTML - PubMed

Affiliation: Extreme Environments Laboratory, Department of Sport and Exercise Science (DSES), University of Portsmouth, Spinnaker Building, Cambridge Road, Portsmouth PO1 2ER, UK. golden_biomed@ntlworld.com.

ABSTRACT

Background: Environmental conditions in the Falklands Conflict of 1982 favoured the genesis of cold injuries. Immediately, post-war, cold injury morbidity and its contributory factors were assessed, in the personnel of UK 3 Commando Brigade (3 Cdo Bde).

Methods: A questionnaire survey of the 3,006 members of 3 Cdo Bde who landed on the islands was conducted within 6-10 weeks of the end of hostilities. Questions included those relating to features of cold injury, body morphology, age, symptoms experienced, past medical history and other possible contributory causes. Additionally, the unit medical team conducted a cursory examination. Data were sent to the Royal Navy Institute of Naval Medicine (INM), where the degree of likely cold injury was broadly classified ('asymptomatic' 'mild', 'moderate' or 'severe'). A sample (total 109) was then selected at random from each category and subsequently examined and tested at the INM (nerve conduction, photoplethysmography and thermography testing). Forty-seven non-cold exposed sailors acted as a control group. These contemporaneous records have now been identified and interrogated.

Results: Some 2,354 (78%) completed questionnaires were returned, revealing that 1,505 (64%) had experienced symptoms of non-freezing cold injury. The morbidity in the infantry units was significantly greater than that in the support troops (1,051 (76%) vs 454 (46%), p < 0.05). No evidence was found to support an influence of a number of factors, commonly believed to have an aetiological role in the production of cold injury. Whilst there was no significant relationship between past history and cold injury morbidity in the brigade as a whole, or within the infantry units alone, an association was identified in the collective infantry units (73%) and the support/headquarter units (59%) (p < 0.05).In comparison with uninjured sailors who acted as controls (n = 47), nerve conduction was impaired in 35% of those screened some months after returning to the UK, while the photoplethysmography and thermographic responses to a cold sensitivity test showed that most (including those classed by questionnaire as asymptomatic) had residual 'cold sensitivity'.

Conclusions: Although the passage of time has made retrospective interrogation of historical documents hard, the available data do appear to offer valuable historical and clinical insights. Cold injury affected the majority of those fighting in the cold temperate climate of the Falklands. The overwhelming environmental conditions meant that, for most, a past history of cold injury did not appear to represent a risk factor for subsequent injury, as is the case for less severe conditions. Importantly, even asymptomatic individuals when tested often showed physiological evidence of cold injury-perhaps predisposing them to subsequent elevation in risk.

No MeSH data available.


Related in: MedlinePlus