Introduction: Freezing cold injuries (FCI) are a common risk in extreme cold weather operations. Although the risks have long been recognised, injury occurrences tend to be sparse and geographically distributed, with relatively few cases to study in a systematic way. The first challenge to improve FCI medical management is to develop a common nomenclature for FCI classification. This is critical for the development of meaningful epidemiological reports on the magnitude and severity of FCI, for the standardisation of patient inclusion criteria for treatment studies, and for the development of clinical diagnosis and treatment algorithms. Methodology: A scoping review of the literature using PubMed and cross-checked with Google Scholar, using search terms related to freezing cold injury and frostbite, highlighted a paucity of published clinical papers and little agreement on classification schemes. Results: A total of 74 papers were identified, and 28 were included in the review. Published reports and studies can be generally grouped into four different classification schemes that are based on (1) injury morphology; (2) signs and symptoms; (3) pathophysiology; and (4) clinical outcome. The nomenclature in the different classification systems is not coherent and the discrete classification limits are not evidence based. Conclusions: All the classification systems are necessary and relevant to FCI medical management for sustainment of soldier health and performance in cold weather operations and winter warfare. Future FCI reports should clearly characterise the nature of the FCI into existing classification schemes for surveillance (morphology, symptoms, and appearance), identifying risk-factors, clinical guidelines, and agreed inclusion/exclusion criteria for a future treatment trial.

Freezing cold injuries (FCI) are a common risk in extreme cold weather warfare operations. The Norwegian Armed Forces (NAF) have the expertise and capabilities in education and training for warfighting capabilities in the Arctic. Nevertheless, a substantial number of Norwegian soldiers sustain freezing cold injuries annually. The aim of this study was to describe the FCI in the NAF, the associated risk factors and clinical associations. The subjects for the study were soldiers registered with FCI in the Norwegian Armed Forces Health Registry (NAFHR) between January 1st 2004-July1st 2021. The soldiers answered a questionnaire regarding background, activities at the time of injury, description of the FCI, risk factors, medical treatment and any sequelae from their FCI. FCI in the NAF were most frequently reported among young conscripts (mean20.5 years). Hands and feet are most often injured (90.9%). Only a minority (10.4%) received medical treatment. The majority (72.2%) report sequelae. Extreme weather conditions was the most important risk factor (62.5%). Most soldiers had the knowledge to avoid FCI, but they were injured anyway. It is concerning that only one in 10 injured soldiers received medical treatment after diagnosed with FCI, increasing the risk of FCI sequelae.

A common effort for both military and civil healthcare is to achieve knowledge-based health care in cold weather injuries and fatal accidents in harsh arctic environment. The Cold Weather Operations Conference in November 2021, having more than 300 participants from 20 countries, was addressing the prevention and treatment of injuries and trauma care in cold weather conditions and the challenges for military prehospital casualty care. The intention of the programme was to stimulate further research and systematic knowledge-based clinical work. The abstracts from the conference present cold weather research and clinical experience relevant for readers of the International Journal of Circumpolar Health.

Freezing cold injury (FCI) is a localized injury caused by prolonged exposure to sub-zero temperatures, posing a significant health risk to military personnel operating in extreme climates. This study aimed to explore how FCI affects the health and lives of soldiers in the Norwegian Armed Forces (NAF), addressing the broader context of its impact on military readiness and the personnel’s well-being. Sixteen participants with a history of grade 2 FCI were recruited through the Norwegian Armed Forces Health Registry and interviewed. Systematic content analysis was used to identify key themes related to the causes and consequences of FCI, as well as the influence of military culture. The findings indicate that FCI results from interacting environmental, behavioural, and systemic factors. Environmental contributors included cold exposure and limited opportunities to eat or drink. Behavioural and individual contributors included reduced awareness of bodily cues in cold conditions and the need to remove gloves for weapon handling under time pressure. Systemic contributors, particularly military cultural norms emphasizing strict discipline and toughness, were perceived to discourage early symptom reporting and the use of preventive measures. Most participants (11/16) reported long-term consequences, including chronic physical discomfort, functional limitations, and negative impacts on their careers and daily lives. This study highlights the significant short- and long-term consequences of FCI, which extend beyond physical harm to affect soldiers’ overall health, functioning, and career progression. The findings emphasize the need for targeted preventive measures to mitigate the risks of FCI and protect military personnel in extreme climates.

Freezing cold injuries (FCIs) remain a recurrent challenge in cold-weather military operations despite preventive routines and extensive institutional experience in the Norwegian Armed Forces (NAF). A previous published qualitative study examined the causes and consequences of FCIs and the possible influence of military culture. The present secondary analysis examined the same interviews to address a prevention-oriented research question: what did injured soldiers believe could have been done differently to reduce the incidence of FCIs? Three themes emerged from the analysis: (1) translating FCI education into practice, (2) communication and preventive routines, and (3) participant suggestions for preventive actions. Despite receiving formal training, participants described difficulties with applying FCI knowledge and protocols under operational pressure. Their accounts suggest that prevention depends not only on general awareness but also on whether preventive knowledge and routines can be effectively applied under operational conditions.