Combat health support in an arctic environment.

Extreme cold weather environments threaten the success of military operations and present specific challenges to combat health support planners. Cold weather operations can severely constrain field medical treatment and evacuation. The incidence of disease and nonbattle injury also increases in an arctic environment. In parts of Alaska, temperatures routinely drop to 50 degrees below zero during the winter months, which provides a perfect environment for the 172d Infantry Brigade (Separate)--the Snow Hawk Brigade--at Fort Wainwright, Alaska, to practice special tactics, techniques, and procedures for evacuating and treating casualties in an arctic environment.

Medical Treatment

Treating seriously injured casualties in extreme cold weather conditions is very difficult. Medical personnel on the front lines must balance the casualty's need for medical stabilization against the risks of hypothermia and frostbite. Medics in maneuver battalions must assess a patient without removing the casualty's clothing, because removing clothing in subzero temperatures can lead to further injury to the patient.

Another challenge for the arctic medic is intravenous (IV) fluid replacement. Veins constrict in extreme cold temperatures, which makes establishing an IV line difficult. Exposing the patient to the cold may lead to hypothermia, and the IV line will quickly freeze if left exposed to the outside air. Once a medic stabilizes a casualty, he must rapidly evacuate the casualty to a warm treatment tent, where an IV line can be established if needed.

One technique used by the Snow Hawk Brigade to keep casualties warm is to place them in military evacuation bags. Lined with 13 pounds of insulating material, the military evacuation bags were designed for moving injured soldiers in an extreme cold weather environment. Double zipper openings allow easy entry and exit of casualties.

The 172d Infantry Brigade's medical company keeps incoming casualties warm in a heated triage tent. As casualties are unloaded from a ground or air ambulance, they are moved immediately to a heated general purpose (GP) medium tent, which is heated by two medium space heaters (H-45) or arctic space heaters. Both heaters run on diesel fuel and are used with attached thermoelectric farts that circulate heat down to the tent floor, improving heat distribution and conserving fuel. The use of a triage tent allows the triage officer to remove the casualty's clothing to assess injuries without further injuring the patient because of exposure to the cold. Once triaged, the casualty can be moved into the treatment tent for treatment by a physician.

Another major concern for combat health support planners in arctic conditions is keeping medical supplies and equipment from freezing. IV fluids and liquid medications are of no value when they are frozen,

and many medications become unusable even if they are thawed later. Essential medical equipment such as blood analyzers will not operate when frozen. Medical logisticians must ensure that medications and medical equipment are stored in heated areas of vehicles and tents at all times to prevent freezing.

Ground Casualty Evacuation

Evacuating casualties from the points of injury to casualty collection points (CCPs) is a challenge in an arctic environment. The first hurdle is finding the casualties on the arctic battlefield. Since soldiers usually are dressed in camouflage whites, casualties blend in with the snow and can be difficult to find. Alaska's ice fog and lack of daylight during the winter months can further impede search efforts.

Generally, the use of standard litter bearers is not feasible in deep snow because movement is slow and litter bearers fatigue quickly. This puts the soldiers at risk for overexertion and potential cold weather injury. Therefore, units in the 172d Brigade use both the Skedco litter and the ahkio (Alaskan sled) for casualty evacuation.

The Skedco litter, which is found in most light infantry units, is made from a special plastic that is both flexible and durable. The casualty is placed on the Skedco litter ,and dragged through the snow by a litter team. The litter also is equipped for hoist by helicopter, which may be essential when maneuver battalions are operating in restrictive terrain.

When conducting operations in deep snow, the ahkio is the best platform for manual casualty evacuation. The ahkio is a fiberglass sled designed to carry up to 200 pounds of equipment for an infantry squad. Normally, an arctic infantry squad uses the ahkio to carry their 10-man tent, stove, fuel, water, and other equipment. The sled weighs 38 pounds, measures 88 inches by 24 inches by 8 inches, and has three rails on the bottom that help keep the sled moving in a straight line. When used to evacuate a casualty, the top of the ahkio is padded with one or more sleeping mats. The casualty is placed in an evacuation bag or sleeping bag before being positioned on the ahkio. A poncho or other suitable vapor barrier then is placed on the outside of the casualty's sleeping bag to prevent heat loss. The litter team evacuates the casualty by dragging the ahkio through the snow. The ahkio is small enough that it can be loaded into a small unit support vehicle (SUSV) or helicopter if necessary.

Evacuating casualties from a CCP to a battalion aid station or from the battalion aid station to the medical company also can be a daunting task. On the arctic battlefield, infantry soldiers often are dismounted, on skis or snowshoes. Therefore, CCPs may be located in very restrictive terrain that is unreachable by most wheeled vehicles.

In the Snow Hawk Brigade, medical units overcome this challenge with the help of the SUSV. The SUSV is a lightweight tracked vehicle specifically designed for off-road movement in the snow. It is capable of evacuating four litter patients or eight ambulatory patients at a time. Each infantry battalion medical platoon is authorized four front-line ambulances and four SUSVs that are used to evacuate casualties from company CCPs back to battalion aid stations. In the 172d Support Battalion, C Company is authorized 12 front-line ambulances and 7 SUSVs. These vehicles are used for evacuating casualties from battalion aid stations to the medical company in the brigade support area. For medical evacuation operations on unimproved roads, front-line ambulances equipped with tire chains are used. For medical evacuation operations in deep snow and off-road terrain, however, the SUSV is the vehicle of choice.

The subzero temperatures in Alaska greatly increase ambulance maintenance requirements. Ambulance engines often are left running to avoid freezing, which increases fuel consumption. In addition, the ambulances require special arctic lubricants and a special grade of fuel called diesel fuel arctic. Maintenance on the patient compartment heaters is an important part of command maintenance. In extremely cold weather, heaters are essential to en route care of a casualty; an ambulance without a functional patient-compartment heater must be deadlined.

AEROMEDEVAC Operations

Medical evacuation by air (AEROMEDEVAC) is the preferred method of evacuating critically injured casualties from forward ambulance exchange points to the medical company in the brigade support area. When conducting AEROMEDEVAC missions in an arctic environment, soldiers must take special precautions to minimize "whiteout" when establishing a landing zone. ("Whiteout" is a term used to describe blowing snow caused by the rotor wash of a helicopter when it is landing or taking off.) When establishing a landing zone, soldiers must attempt to find a spot with firmly packed snow that is free of obstacles.

For the litter team on the ground, visibility can be severely restricted by whiteout during a helicopter landing, Litter bearers should wear goggles to protect their eyes from flying debris caused by the rotor wash. In addition, there is always a risk of frostbite from the wind chill produced by the helicopter's rotating blades. When loading a casualty into a helicopter, no part of his skin should be exposed for any length of time under the rotor blast of a helicopter. Exposed skin can freeze in seconds and result in unnecessary cold weather injuries.

Mastering combat health support operations on the arctic battlefield requires special training and equipment. In Alaska, the 172d Infantry Brigade (Separate) conducts realistic training each winter in an arctic environment. Medical units in the Snow Hawk Brigade have proven that they are "arctic tough" and up to the challenge. ALOG 

CAPTAIN BRETT H. VENABLE IS THE COMMANDER OF C COMPANY, 172D SUPPORT BATTALION, 172D INFANTRY BRIGADE (SEPARATE), AT FORT WAINWRIGHT ALASKA. HE HAS A BACHELOR'S DECREE IN BIOLOGY FROM OLD DOMINION UNIVERSITY IN VIRGINIA AND IS A GRADUATE OF THE ARMY MEDICAL DEPARTMENT OFFICER BASIC COURSE, THE MEDICAL LOGISTICS MANAGEMENT COURSE, AND THE COMBINED LOGISTICS CAPTAINS CAREER COURSE.