This book is included in the Outdoor Survival - Bio-Regional Environments section.
Foreword
Earth’s environments have always influenced the planning and conduct of military operations.
Past campaigns have been impacted by heat, cold, and altitude, as well as the changes in
barometric pressure that divers face in special operations. During the 20th century alone, US armed
forces have been involved in terrestrial military operations in hot climates in the North African
campaign and Pacific theater operations during World War II, the Vietnam and Persian Gulf wars,
and military and humanitarian operations in Panama, Haiti, Grenada, Rwanda, and Somalia. Our
major military operations involving cold climates during the past century include World War I and
World War II, the Korean War, and most recently in Bosnia and Kosovo. Medical Aspects of Harsh
Environments, Volume 1, treats the major problems caused by fighting in heat and cold.
The topics of Medical Aspects of Harsh Environments, Volume 2, are the effects of altitude, especially
as experienced in mountain terrain and by aviators, and the complex interactions between humans
and the special environments created by the machines used in warfare. Our warfighters were
exposed to mountain terrain during World War II, the Korean War, in military and humanitarian
efforts in South America, and most recently in the Balkans. Military action has also occurred in some
of the environments considered “special” (e.g., on and below the water’s surface) in every war that
this country has fought, whereas other special environments (e.g., air—flights not only within
Earth’s atmosphere but also beyond it, in space) have become settings for the havoc of war only as
a result of 20th-century technology. The second volume also contains a discussion of the personal
environment within the protective uniforms worn by service members against the fearsome
hazards of chemical and biological warfare. This microenvironment—created by the very encapsulation
that protects the wearer—is in some ways different from but in others similar to all closely
confined, manmade environments (e.g., the stresses that divers face in coping with the changes in
barometric pressure). Whatever the environment, this point needs to be kept in mind: indifference
to environmental conditions can contribute as much to defeat as the tactics of the enemy.
Medical Aspects of Harsh Environments, Volume 3, emphasizes the need for a preventive approach
to decrease attrition due to harsh environments, such as predicting the likelihood of its occurrence
and stimulating awareness of how specific factors (e.g., gender, nutritional status) are sometimes
important determinants of outcome. The third volume concludes with reproductions of two of the
classics of environmental medicine: the lectures given by the late Colonel Tom Whayne on heat and
cold injury, respectively, at the Army Medical School in 1951; for decades these have been
unavailable except as mimeographed handouts to students attending specialized courses.
Military and civilian experts from the United States and other countries have participated as
authors of chapters in this three-volume textbook, Medical Aspects of Harsh Environments. The
textbook provides historical information, proper prevention and clinical treatment of the various
environmental illnesses and injuries, and the performance consequences our warfighters face when
exposed to environmental extremes of heat, cold, altitude, pressure, and acceleration. The contents
are unique in that they present information on the physiology, physical derangements, psychology,
and the consequent effects on military operations together in all these harsh environments. This
information should be a valuable reference not only for the physicians and other healthcare
providers who prepare our warfighters to fight in these environments but also for those who care
for the casualties. Military medical personnel must never forget that harsh environments are great,
silent, debilitating agents for military operations.
Lieutenant General James B. Peake
The Surgeon General
U.S. Army
Washington, DC; December 2001
Preface
On 1 July 1941, as part of Hitler’s attack of the Soviet Union, the XXXVI Corps of the German army
crossed the Finnish–Soviet border and began what was planned as a rapid advance some 50 miles
to the east, where lay the strategically important railroad that linked the Arctic Ocean port of
Murmansk with the Russian hinterland to the south. The German soldiers in their heavy woolen
uniforms were greeted not only by determined Soviet resistance, but also by an unexpected enemy:
the day was hot, with temperatures in the high 80s (°F), and there were swarms of ferocious
mosquitoes. During the next 3 weeks the temperature rose above 85°F on 12 days and twice reached
97°F, and it was soon obvious that military operations were possible only in the relative cool of the
“night.” By the end of July, after advancing only 13 miles, the attack was called off, with the XXXVI
Corps being denounced as “degenerate” by the German high command. Higher commanders obviously
never considered that low combat effectiveness might result from the hazardous environmental
factors: the heat, insects, and 24 hours of constant light. After all, who would have thought that heat
stress might impair combat operations occurring 30 miles north of the Arctic Circle.
The German experience in northern Finland was anything but unique; military history is full of
examples where weather conditions influenced the outcome of military campaigns. In fact, the
earliest recorded instance of weather’s having a direct effect on the outcome of a battle dates back
to the Old Testament:
And it came to pass, as they fled from before Israel, and were in the going down to Beth-horon, that the Lord cast down great stones from heaven upon them unto Azekah, and they died: they were more which died with hailstones than they whom the children of Israel slew with the sword.
The mission of the US Army Research Institute of Environmental Medicine, Natick, Massachusetts,
is both to understand how soldiers react to military environmental and occupational stresses
and to devise materiel and doctrinal solutions that are protective and therapeutic. The publication
of the three volumes of Medical Aspects of Harsh Environments will ensure that both healthcare
providers and military line commanders do not repeat the mistakes of countless commanders of the
past who have underestimated the threats that harsh environments pose to their soldiers. I strongly
recommend that all commanders and healthcare personnel become acquainted with the volumes of
the Textbooks of Military Medicine dealing with harsh environments to better protect and preserve
our sons and daughters during their deployments around the world.
The volumes of Medical Aspects of Harsh Environments became a reality because of the dedication
and hard work of Kent B. Pandolf, PhD, and Robert E. Burr, MD, then a Lieutenant Colonel, Medical
Corps, US Army, the specialty editors of this three-volume textbook. Dr. Burr was primus inter pares in
the group that performed the critically important tasks of deciding on the subject matter and finding
appropriate authors; when Dr. Burr left the Army, Dr. Pandolf brought the project to fruition. This first
volume, which deals with hot and cold environments, owes its completion to the willingness of its
section editors—C. Bruce Wenger, MD, PhD, and Robert S. Pozos, PhD—well-known experts in the
fields of heat and cold stress, respectively, to perform the seemingly endless tasks necessary to
assure the scientific accuracy of the text. In addition, the specialty and section editors wish to thank
Rebecca Pincus for her invaluable help during this book’s formation. The forthcoming second and third
volumes deal with mountains and special operations environments, and sustaining health and performance
during military operations. It is not too much to hope that the labors of the volumes’ editors
and many authors will lighten the burdens of our military personnel in the years to come.
Brigadier General Russ Zajtchuk
Medical Corps, US Army, Retired
Editor in Chief, Textbooks of Military Medicine
December 2001; Washington, DC
TABLE OF CONTENTS Foreword by The Surgeon General Preface Section I: Hot Environments 1. Introduction to Heat-Related Problems in Military Operations 2. Human Adaptation to Hot Environments 3. Physical Exercise in Hot Climates: Physiology, Performance, and Biomedical Issues 4. Psychological Aspects of Military Performance in Hot Environments 5. Pathophysiology of Heatstroke 6. Prevention of Heat Illness 7. Clinical Diagnosis, Management, and Surveillance of Exertional Heat Illness 8. Exertional Heatstroke in the Israeli Defence Forces 9. Practical Medical Aspects of Military Operations in the Heat Section II: Cold Environments 10. Cold, Casualties, and Conquests: The Effects of Cold on Warfare 11. Human Physiological Responses to Cold Stress and Hypothermia 12. Human Psychological Performance in Cold Environments 13. Prevention of Cold Injuries 14. Clinical Aspects of Freezing Cold Injury 15. Nonfreezing Cold Injury 16. Treatment of Accidental Hypothermia 17. Cold Water Immersion 18. Military Medical Operations in Cold Environments Pictorial Atlas of Freezing Cold Injury Abbreviations and Acronyms Index
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