Medical Encounters During a Joint Canadian/U.S. Exercise in the High Arctic (Exercise Arctic Ram)

Abstract

The Arctic Ram Exercise was conducted in February 2016, near Resolute Bay on Cornwallis Island in Nunavut, Canada, to demonstrate the ability of the Canadian Armed Forces (CAF) to rapidly deploy to the arctic as an immediate response team. This report describes medical problems experienced by the 187 CAF and 28 U.S. forces involved in the exercise. Sixty-six airborne soldiers performed tactical static line jumps and linked up with soldiers on the ground for the exercise. Medical events were recorded by medics on the drop zone and by medical personnel at the Unit Medical Station in Resolute Bay. Average temperature during the exercise was −21°C and wind chill was −44°C. Two U.S. soldiers were injured in association with the jump and an additional 62 patients presented at the clinic during the exercise for an overall medical event incidence of 30%. The incidence of frostbite was 17%. At the end of the exercise, a physician actively examined CAF soldiers in one unit (n = 126) and found that 21% had experienced frostbite. The incidence of frostbite was high in this exercise compared to past cold-weather military operations, likely related to the very low temperatures and wind chills.

Human performance research for military operations in extreme cold environments

“…25 In one study of 215 US and Canadian soldiers in a joint Arctic exercise at -21 • C (with windchill of -44 • C) that included airborne operations, the incidence of self-reported frostbite was 17%, and with physician assessment, as high as 21%. 26 Sullivan-Kwantes and Moes conducted a subsequent project relating PPE selection and risks of CWI, comparing issued and non-issued PPE worn by Canadian Armed Forces (CAF) in the Arctic. A total of 511 military personnel completed a survey to document the type of clothing selected and worn by deployed CAF members.…”

“…High rates of CWI and under-reporting of CWI is common in current Arctic exercises. 28,29 Reasons for underreporting varied and included pride, not realizing they had an injury, and intentionally hiding the injury to avoid being pulled from operations. 17 One consideration for the future is to include temperature and moisture sensing in some of the protective equipment to both alert novices to prompt action required as well as to continue to gain insights into how to improve the clothing, gloves, boots, and face protection.…”

The new cold war

“…Finger or toe amputation may be the outcome if medical care and medical evacuation times are inadequate. 2 There is a clear need to have experienced medical professionals trained in the diagnosis and treatment of cold weather injuries while in the field, because managing any medical incident is a challenge in isolated conditions with limited medical supplies, medical equipment, and the potential of long evacuation times 2 can be catastrophic.

Figure 5.

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Finger cold-induced vasodilation test does not predict subsequent cold injuries: A lesson from the 2018 Canadian Forces Exercise

“…Incidences of cold weather injuries (CWI), including frostbite and frostnip (precursor tissue injury to frostbite) during military operations has been a medical issue that dates back decades, and continues to be a challenge for Canadian Armed Forces members participating in Arctic field exercises during the winter months [1][2][3][4]. CAF units deployed to the north often face extreme cold weather, frequently experiencing daily lows approaching −35°C and below, with wind chill equivalent temperatures lower than −60°C [5].…”

“…Since 2016, data has been collected on the health risks and human performance challenges on Arctic exercises and notably, a high incident rate of cold weather injuries [3] was found. Many modifiable risk factors can contribute to CWI, such as inadequate protective clothing (which has not improved markedly over this time frame for CAF members in Arctic deployments), as well as behavioral factors (e.g., successful clothing layering knowledge, energy conservation strategies, and CWI symptom reporting).…”