Challenges of Military Health Service Support in Mountain Warfare

Lechner, Raimund; Küpper, Thomas; Tannheimer, Markus

doi:10.1016/j.wem.2018.01.006

Cited by 15 publications

(12 citation statements)

References 33 publications

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“…Accidental hypothermia has been recognised since ancient times [ 6 ]. Throughout history, hypothermia has been a disease of war and disasters such as avalanches, earthquakes and tsunamis [ 7 , 8 , 9 ]. Nowadays in developed countries, primary hypothermia affects mainly people who live, work, and recreate outdoors putting themselves at risk in cold environments and homeless people.…”

Section: Epidemiologymentioning

confidence: 99%

Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

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Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.

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Section: Epidemiologymentioning

confidence: 99%

Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

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“…Cold exposure affects civilians and soldiers in general. However, similar to altitude exposure, soldiers (and civilians in war zones) are more affected and impaired by cold than civilians outside conflict areas ( Table 2 ) [ 14 ]. That is why some authors combine mountain and cold weather warfighting as one entity [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Military leaders inexperienced in cold weather often underestimate its effects [ 14 ]. High altitudes are always associated with reduced temperature.…”

Section: Discussionmentioning

confidence: 99%

Analysis of tourniquet pressure over military winter clothing and a short review of combat casualty care in cold weather warfare

Lechner

Beres

Oberst

et al. 2023

International Journal of Circumpolar Health

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Cold weather warfare is of increasing importance. Haemorrhage is the most common preventable cause of death in military conflicts. We analysed the pressure of the Combat Application Tourniquet® Generation 7 (CAT), the SAM® Extremity Tourniquet (SAMXT) and the SOF® Tactical Tourniquet Wide Generation 4 (SOFTT) over different military cold weather clothing setups with a leg tourniquet trainer. We conducted a selective PubMed search and supplemented this with own experiences in cold weather medicine. The CAT and the SAMXT both reached the cut off value of 180mmHg in almost all applications. The SOFTT was unable to reach the 180mmHg limit in less than 50% of all applications in some clothing setups. We outline the influence of cold during military operations by presenting differences between military and civilian cold exposure. We propose a classification of winter warfare and identify caveats and alterations of Tactical Combat Casualty Care in cold weather warfare, with a special focus on control of bleeding. The application of tourniquets over military winter clothing is successful in principle, but effectiveness may vary for different tourniquet models. Soldiers are more affected and impaired by cold than civilians. Military commanders must be made aware of medical alterations in cold weather warfare.

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“…We have developed a definition that tries to capture the specifics of mountain warfare and refer to that in this article. 5 Pierce mentions that "conflicts increasingly occur in a mountain / cold weather environment", and according to the United Nations Food and Agricultural Organization, "mountain people are affected by conflict disproportionately to their numbers and the land they occupy" and "it is an alarming fact that in the last 50 years conflicts in mountain regions have greatly increased. Violent conflicts are now almost twice as likely to occur at high altitude".16,31 Mountains roughly cover one fourth of the earth and account for only 10 percent of its population.25 There are many reasons for this imbalance.…”

Section: Specific Characteristics and Key Factors Of Mountain Warfarementioning

confidence: 99%

“…Although, any incidence of losses due to mountainous environments is difficult to determine exactly due to accumulation of many factors, the large proportion of casualties due to environmental triggered diseases and non-battle injuries is well documented. 5 The main enemies of the soldier in mountain warfare are altitude, cold and terrain -not the hostile forces. But this knowledge is not implemented with the necessary consistency, resulting in high but largely avoidable casualty numbers.…”

Section: Specific Characteristics and Key Factors Of Mountain Warfarementioning

confidence: 99%

History of mountain warfare

Tannheimer

Lechner

2023

Health Prom Phys Act

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Mountain warfare has thousands of years of history and presents numerous challenges to military operations. History proves, that this environment has decreased combat strength, caused more casualties than the enemy in some operations and influenced war tactics significantly. Mountain warfare has an increasing frequency due to withdrawal areas for hostile forces, being home of ethnic minorities, being origin of many water supplies and being a natural frontier between countries. Mountains influence all warfighting functions, but especially movement and manoeuvre (mobility) and force protection (health support). To overcome the hardships of mountain warfare, special mountain units including support elements are mandatory, especially for health service support.

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Challenges of Military Health Service Support in Mountain Warfare

Cited by 15 publications

References 33 publications

Accidental Hypothermia: 2021 Update

Accidental Hypothermia: 2021 Update

Analysis of tourniquet pressure over military winter clothing and a short review of combat casualty care in cold weather warfare

History of mountain warfare

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