ALARACT 104/2016 DTG: R 132323Z DEC 16 UNCLAS SUBJ/ALARACT 104/2016 -COLD WEATHER INJURY PREVENTION FOR 2016 - 2017 COLD WEATHER SEASON THIS ALARACT MESSAGE HAS BEEN TRANSMITTED BY JSP ON BEHALF OF HQDA//DASG-HSZ/DAMO-DASG// 1. REFERENCES. 1.A. AR 40-5/PREVENTIVE MEDICINE/25MAY07// 1.B. TC 4-02.1/FIRST AID /21JAN16// 1.C. TRADOC REGULATION 350-29/PREVENTION OF HEAT AND COLD CASUALTIES/18JUL16// 1.D. TB MED 508/PREVENTION AND MANAGEMENT OF COLD-WEATHER INJURIES/01APR05// 1.E. ATP 5-19/RISK MANAGEMENT/14APR14// 1.F. AR 385-10/THE ARMY SAFETY PROGRAM/27NOV13// 1.G. DA PAM 385-10/ARMY SAFETY PROGRAM/RAR 19JAN10// 1.H. DA PAM 385-40/ARMY ACCIDENT INVESTIGATIONS AND REPORTING/18MAR15// REFERENCES CAN BE FOUND AT HTTP://ARMYPUBS.ARMY.MIL/ OR OTHER ARMY-APPROVED SOURCE// 2. SITUATION. COLD WEATHER-RELATED INJURIES (CWI) REMAIN A SIGNIFICANT THREAT TO INDIVIDUAL HEALTH AND UNIT PERFORMANCE DURING TRAINING AND OPERATIONS. DURING THE 2015 - 2016 COLD WEATHER SEASON, THERE WERE 31 CWI REPORTED AMONG SOLDIERS, INCLUDING 21 CASES OF FROSTBITE, 2 CASES OF IMMERSION FOOT AND 8 CASES OF HYPOTHERMIA, EACH POTENTIALLY LIFE OR LIMB THREATENING CONDITION. 3. MISSION. COMMANDERS, SUPERVISORS, AND SERVICE MEMBERS (SM) AT ALL LEVELS WILL IMPLEMENT PROTECTIVE MEASURES AND UTILIZE PRINCIPLES OF RISK MANGEMENT TO PREVENT CWI TO SOLDIERS AND CIVILIANS DURING 2016-2017 COLD WEATHER SEASON, NOW THROUGH 31 MAY 17 (REFERENCES A (PARA 2-29) AND E (PARA 2-4)). 4. EXECUTION. 4.A. CONCEPT OF THE OPERATIONS.

4.A.1. USA COMMANDERS AND LEADERS WILL ENSURE ALL PERSONNEL ARE EDUCATED ABOUT THE PREVENTION, RECOGNITION AND TREATMENT OF CWI. 4.A.2. CWI AND OTHER INJURIES RELATED TO COLD WEATHER INCLUDE: 4.A.2.A. INJURIES DUE TO DECREASED TEMPERATURE (HYPOTHERMIA, FROSTBITE, NONFREEZING COLD INJURY). 4.A.2.B. INJURIES DUE TO USING HEATERS, ENGINES, AND STOVES (E.G., BURNS FROM FIRE, CARBON MONOXIDE POISONING, ETC.). 4.A.2.C. ACCIDENTS (I.E. SLIPS, TRIPS, FALLS) DUE TO IMPAIRED PHYSICAL AND MENTAL FUNCTION RESULTING FROM COLD STRESS; SNOW BLINDNESS/PHOTOKERATITIS AND SUNBURNS DUE TO OVEREXPOSURE OF EYES AND SKIN TO ULTRAVIOLET RADIATION, FREEZING TEMPERATURES AND DRYNESS. 4.A.3. COMMANDERS AND OFFICERS ARE RESPONSIBLE FOR PREVENTING CWI. UNIT NON-COMMISSIONED OFFICERS (NCOS) ARE ACCOUNTABLE FOR THE HEALTH AND SAFETY OF SM'S AND CIVILIANS. SM'S AND CIVILIANS ARE RESPONSIBLE FOR IMPLEMENTING PERSONAL PROTECTIVE MEASURES. 4.A.4. DURING COLD WEATHER EXPOSURES, ANY SM OR CIVILIAN WHO EXHIBITS UNEXPLAINED SHIVERING, EXHAUSTION, MEMORY LOSS, SLURRED SPEECH, DROWSINESS, LACK OF COORDINATION OR MENTAL STATUS CHANGES SHOULD BE PROVIDED APPROPRIATE FIRST AID AND EVACUATED TO THE CLOSEST MEDICAL TREATMENT FACILITY (MTF) AS QUICKLY AS POSSIBLE, OR IF MEDICAL CARE IS NOT AVAILABLE, BEGIN ACTIVE WARMING OF THE SM OR CIVILIAN BY GETTING THEM INTO A WARM ENVIRONMENT, REMOVING WET CLOTHING, AND KEEPING THEM WARM AND DRY UNTIL MEDICAL CARE IS AVAILABLE (REFERENCE B (CHAP 12-1)). 4.B. COORDINATING INSTRUCTIONS. 4.B.1. IN ACCORDANCE WITH REFERENCE A (PARA 2-29) COMMANDERS, OFFICERS, NCOS AND SUPERVISORS FOR ALL SM'S AND CIVILIANS THAT WILL BE EXPOSED TO COLD WEATHER, WILL: 4.B.1.A. ENSURE ALL SM'S AND CIVILIANS ARE TRAINED ON PROPER WEAR, UTILIZATION, CARE, AND MAINTENANCE OF ISSUED COLD WEATHER CLOTHING SYSTEMS AND EQUIPMENT. ENSURE ALL SM'S AND CIVILIAN COLD WEATHER CLOTHING IS CLEAN, DRY AND IN SERVICEABLE CONDITION (WITHOUT HOLES OR BROKEN FASTENERS). 4.B.1.B. ENSURE PERSONNEL SHOULD AVOID ALCOHOL AND TOBACCO USE IN COLD ENVIRONMENTS. BOTH INTERFERE WITH THE BODY'S ADAPTIVE RESPONSE TO COLD. ADDITIONALLY, ALCOHOL USE CAN IMPACT RECOGNITION OF THE SIGNS AND SYMPTOMS OF A DEVELOPING COLD INJURY IN ONESELF OR IN A BUDDY. HEAVY SMOKERS (>2 PACKS/DAY) HAVE A 30% INCREASED RISK OF FROSTBITE. SMOKING AND CHEWING TOBACCO WILL BE DISCOURAGED DURING COLD-WEATHER OPERATIONS. 4.B.1.C. ENSURE SOLDIERS PACK SUFFICIENT QUANTITIES OF PROTECTIVE CLOTHING AND EQUIPMENT SUCH AS SOCKS, PROPER HEADGEAR, EYEWEAR (I.E. SUNGLASSES, GOGGLES, FIELD EXPEDIENT CARDBOARD WITH NARROW SLITS FOR THE EYES), SUNSCREEN, LIP BALM, AND SKIN-CARE ITEMS TO

MEET MISSION REQUIREMENTS. USE PROTECTIVE CLOTHING (LOOSE AND IN LAYERS) AND EQUIPMENT PROPERLY. 4.B.1.D. ENSURE PERSONNEL ARE PROPERLY TRAINED IN RECOGNIZING AND PREVENTING CWI. SEE REFERENCES C AND D FOR ADDITIONAL TRAINING INFORMATION. 4.B.1.E. ENSURE SM USE THE BUDDY SYSTEM AND EVACUATE PERSONNEL TO THE CLOSEST MTF IF CWI SYMPTOMS DEVELOP. 4.B.1.F. ENSURE OFFICERS, NCOS AND MEDICAL PERSONNEL RECOGNIZE AND APPROPRIATELY RESPOND TO CWI. CONDUCT BUDDY CHECKS TO RECOGNIZE AND PREVENT CWI. ENSURE EACH SM REMAINS ALERT FOR CHANGES IN HIS/HER COWORKERS' PHYSICAL AND MENTAL STATUS THAT MAY REPRESENT EARLY SYMPTOMS OF CWI. 4.B.1.G. ENSURE ONLY ARMY APPROVED HEATERS ARE USED AND PERSONNEL ARE TRAINED ON HOW TO USE THEM PROPERLY. MORE INFORMATION CAN BE FOUND HTTPS://PHC.AMEDD.ARMY.MIL/PHC%20RESOURCE%20LIBRARY/GUIDANCE_ON_THE_USE_OF_HEATERS_INSIDE_TENTS_FS-55-007-0114.PDF. 4.B.1.H. ENSURE THEY IDENTIFY PERSONNEL WITH PREVIOUS CWI AND/OR PREDISPOSING MEDICAL CONDITIONS OR SUSCEPTIBLE POPULATIONS, WHEN PLANNING FOR TRAINING AND OPERATIONS. 4.B.2. CWI REPORTING. 4.B.2.A. NON-DEPLOYED MILITARY TREATMENT FACILITIES SHOULD COORDINATE WITH THEIR SUPPORTING PREVENTIVE MEDICINE (PM) ORGANIZATION FOR REPORTING CWI. PM PERSONNEL SHOULD REPORT CWI TO US ARMY PUBLIC HEALTH CENTER (USAPHC) USING THE DISEASE REPORTING SYSTEM INTERNET (DRSI). INFORMATION ON DRSI IS AVAILABLE AT HTTP://PHC.AMEDD.ARMY.MIL/TOPICS/HEALTHSURV/DE/PAGES/DRSIRESOURCES.ASPX AND FROM THE DRSI HELPDESK (EMAIL: DISEASE.EPIDEMIOLOGY@AMEDD.ARMY.MIL, COM: 410-417-2377, DSN: 867-2377). 4.B.2.B. DEPLOYED PERSONNEL SHOULD REPORT CWI AS OUTLINED IN THEIR MEDICAL ANNEX. 4.B.2.C. ENSURE ALL CWI ARE REPORTED TO THE US ARMY COMBAT READINESS CENTER(USACRC)IAW AR 385-10 (REFERENCE F (PARA 3-2) G (PARA 8-4) AND H). 4.B.3. ADDITIONAL RESOURCES AND GUIDANCE ARE AVAILABLE TO LEADERS AND MEDICAL PERSONNEL AS FOLLOWS: 4.B.3.A. THE USAPHC WEBSITE AT HTTP://PHC.AMEDD.ARMY.MIL/TOPICS/DISCOND/CIP/PAGES/DEFAULT.ASPX PROVIDES COMPREHENSIVE INFORMATION ON CWI INJURY PREVENTION; THE WEBSITE HTTPS://PHC.AMEDD.ARMY.MIL/TOPICS/DISCOND/CIP/PAGES/COLDCASUALTIESINJURIES.ASPX PROVIDES INFORMATION ON COLD WEATHER CASULTY AND INJURY PREVENTION, IDENTIFICATION AND TREATMENT.

4.B.3.B. US ARMY TRAINING AND DOCTRINE COMMAND (USATRADOC) PUBLISHED GUIDANCE TO COMMANDERS FOR PREVENTION OF COLD CASUALTIES IN TRADOC REGULATION 350-29, PREVENTION OF HEAT AND COLD CASUALTIES, 18 JUL 16, AT HTTP://WWW.TRADOC.ARMY.MIL/TPUBS/REGS/TR350-29.PDF (REFERENCE C). 4.B.3.C. US ARMY COMBAT READINESS CENTER (USACRC) LAUNCHED THE 2016-2017 AUTUMN/WINTER SAFETY CAMPAIGN TO PROVIDE INFORMATION TO SM'S, FAMILY MEMBERS, AND CIVILIANS ON UNDERSTANDING THE HAZARDS OF COLD WEATHER ACTIVITIES AND HOW EDUCATION AND INFORMATION CAN GUIDE THEM SAFELY THROUGH THE FALL/WINTER SEASONS. INFORMATION ON THE USACRC AUTUMN/WINTER SAFETY CAMPAIGN "READY OR NOT?" IS AVAILABLE AT: HTTPS://SAFETY.ARMY.MIL/MEDIA/SEASONALSAFETYCAMPAIGNS/AUTUMNWINTER2016-17.ASPX. 4.B.3.D. THE PERFORMANCE TRIAD IS A COMPREHENSIVE PLAN TO IMPROVE READINESS AND INCREASE RESILIENCE THROUGH PUBLIC HEALTH INITIATIVES AND LEADERSHIP ENGAGEMENT. THE PERFORMANCE TRIAD IS THE FOUNDATION FOR ARMY MEDICINE'S TRANSFORMATION TO A SYSTEM FOR HEALTH. THE SYSTEM FOR HEALTH MAINTAINS HEALTH THROUGH FITNESS AND ILLNESS/INJURY PREVENTION. 4.B.3.D.1. THE FOCUS OF THE PERFORMANCE TRIAD IS ON OPTIMAL SLEEP, ACTIVITY, AND NUTRITION. 4.B.3.D.1.A. SLEEP: INADEQUATE SLEEP AND SLEEP DEPRIVATION CAN REDUCE THE BODY'S PHYSIOLOGICAL ABILITY TO RESIST COLD STRESS AND LEAD TO BEHAVIORAL PATTERNS THAT INCREASE SUSCEPTIBILITY TO COLD INJURY. 4.B.3.D.1.B. ACTIVITY: ADEQUATE EXERCISE INCREASES BLOOD FLOW TO EXTREMITIES AND IMPROVES OVERALL CARDIOVASCULAR FITNESS LEADING TO IMPROVED RESISTANCE TO COLD STRESS. 4.B.3.D.1.C. NUTRITION: DEHYDRATION AND MALNUTRITION DEGRADES PHYSIOLOGIC COLD STRESS TOLERANCE. COLD WEATHER EXPOSURE INCREASES ENERGY REQUIREMENTS BY 25-50%. ENSURE ALL PERSONNEL CONSUME ADEQUATE CALORIES AND MAINTAIN HYDRATION FOR OPTIMAL PERFORMANCE IN THE COLD. 4.B.3.D.2. INFORMATION ON THE PERFORMANCE TRIAD IS AVAILABLE AT: HTTP://ARMYMEDICINE.MIL/PAGES/PERFORMANCE-TRIAD.ASPX. 5. SUSTAINMENT. N/A. 6. COMMAND AND SIGNAL/POCS: 6.1. OTSG/MEDCOM: LTC DUNCAN GILLIES, PREVENTIVE MEDICINE STAFF OFFICER, DSN 471-7029, COMMERCIAL 210-221-7029, EMAIL: DUNCAN.A.GILLIES.MIL@MAIL.MIL. 6.2. APHC/MEDCOM: MAJ DAVID DEGROOT, INJURY PREVENTION PROGRAM. DSN 867-2854 COM: 410-417-2854, EMAIL: USARMY.APG.MEDCOM-APHC.MBX.INJURYPREVENTION@MAIL.MIL. 6.3. USARIEM: DR JOHN CASTELLANI, RESEARCH PHYSIOLOGIST, DSN 256-4953, COM: 508-233-4953, EMAIL: JOHN.W.CASTELLANI.CIV@MAIL.MIL.

6.4. HQDA AOC-CAT: SURGEON, DSN: 223-4821, COM: 703-693-4821, EMAIL: USARMY.NCR.HQDA-OTSG.MBX.MEDCOM-OPS-CENTER@MAIL.MIL. 7. EXPIRATION DATE: 03 NOV 17.