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The simple – and complicated – task of shoveling snow

Army Sgt. 1st Class Joseph Seifridsberger shovels knee-deep snow to build a simulated hasty firing position during training exercise Ready Force Breach at Fort Drum, New York. (U.S. Army photo by Sgt. Andrew Carroll) Army Sgt. 1st Class Joseph Seifridsberger shovels knee-deep snow to build a simulated hasty firing position during training exercise Ready Force Breach at Fort Drum, New York. (U.S. Army photo by Sgt. Andrew Carroll)

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Mother Nature has spoken and the winter storm has arrived. Now it’s time for the hard part: clearing a driveway or sidewalk covered in snow. Depending on the temperature and amount of snow to be moved, such a task can be daunting, and without proper precautions, painful as well. There are, however, ways to clear snow safely.

According to Army Col. Cynthia Perry, a physician at Guthrie Ambulatory Health Clinic in Fort Drum, New York, an area accustomed to harsh, snowy winters, the most important consideration when preparing to shovel snow is dressing properly for the weather. Layers of clothing for warmth, non-skid shoes or boots to help prevent falls, and gloves to protect hands and fingers, are all part of the equation.

“Ensure you’re wearing layers that can be removed or loosened, if needed,” said Perry. “Cold injury to extremities makes us less stable, certainly less dexterous, and hampers coordination of fingers and feet, creating an environment for slips, trips, and falls.” Perry also advised wearing bright colors for visibility and making sure to tell someone that you will be outdoors shoveling to ensure if a mishap occurs, help is nearby.

“Snow shoveling is akin to a vigorous aerobic workout, so a person’s overall health is key to preventing injuries,” said Army Lt. Col. Michael S. Crowell, chief, Physical Therapy, Keller Army Community Hospital and the U.S. Military Academy at West Point. “Someone in good physical health year-round is going to have an easier time shoveling than someone who is in poor health or not a regular exerciser.”

Snow shoveling injuries can span a wide spectrum, from the nuisance of a sore back or shoulder to a life-threatening cardiac event.

“Many people’s bodies are unaccustomed to the physical exertion required to shovel snow,” said Perry, ‘but those with heart disease risk factors, such as uncontrolled blood pressure, or people who smoke have to be extra careful.” Perry suggested that trying to carry on a conversation while shoveling snow is an effective way to check exertion level. “If you find yourself out of breath, take a break.”

According to Crowell, another group can be vulnerable to cardiac or musculoskeletal snow-shoveling injuries. “Youth doesn’t make you invincible to injury,” he said. “I’ve treated young soldiers with wrist or collarbone fractures or other injuries that could be prevented with some common sense.”

The body’s ability to adjust to cold weather is another important injury risk, especially for those unaccustomed to such climates. “This is especially true for members of the military who often deploy to a variety of locations and climates,” says Crowell. “Even learning to walk on snow and ice is a skill.”

Some additional expert tips: Try not to scoop the snow; push it instead. Break shoveling into multiple short segments to minimize exposure to the cold and to give the body time to rest and recover. Or perhaps the best option of all: find a willing helper to do the shoveling for you.

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Five cold seasons: July 2012-June 2017, Active reserve component service members who were diagnosed with a cold weather injury

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1/18/2018
Did you know during the 5-year surveillance period, the 2,717 service members who were affected by any cold weather injury included 2,307 from the active component and 410 from the reserve component. Overall, Army members comprised the majority (61.6%) of all cold injuries affecting active and reserve component service members. Of all affected reserve component members, 71.7% (n=294) were members of the Army. Cold weather injuries During Basic Training Of all active component service members who were diagnosed with a cold weather injury (n= 2,307), 230 (10.0% of the total) were affected during basic training. Additionally, during the surveillance period, 60 service members who were diagnosed with cold weather injuries during basic training (2.6% of the total) were hospitalized, and most (93.3%) of the hospitalized cases were members of either the Army (n=32) or Marine Corps (n=24). Cold weather injuries during basic training pie chart: The Army (n=122) and Marine Corps (n=99) comprised 96.1% of all basic trainees who were diagnosed with a cold weather injury. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness Image of service member tracking in the snow is the infographic background graphic.

This infographic provides information on active and reserve component service members who were affected by any cold weather injury during the July 2012 – June 2017 cold seasons.

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Update: Cold Weather Injuries, Active and reserve components, U.S. Armed Forces, July 2012 – June 2017

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1/18/2018
The total number of cold weather injuries among active component service members in 2016 – 2017 cold season was the lowest since 1999. 2016 – 2017 versus the previous four cold seasons  •	A total of 387 members of the active (n=328) and reserve (n=59) components had at least one medical encounter with a primary diagnosis of cold weather injury. •	Rates tended to be higher among service members who were in the youngest age groups, female, non-Hispanic black, or in the Army. •	Cold weather injuries associated with overseas deployments have fallen precipitously in the past three cold seasons due to changes in military operations in Iraq and Afghanistan. There were just 10 cases in the 2016 – 2017 season.  •	Frostbite was the most common type of cold weather injury. Bar chart displays numbers of service members who had a cold injury (one per person per year), by service and cold season, active and reserve components, U.S. Armed Forces, July 2012 – June 2017. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

This infographic provides an update for cold weather injuries among active and reserve components, U.S. Armed Forces, July 2012 – June 2017.

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Cold weather injuries by military location, U.S. Armed Forces, July 2012 – June 2017

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1/18/2018
From July 2016 through June 2017, a total of 24 military locations had at least 30 incident cold weather injuries (one per person, per year) among active and reserve component service members.  The locations with the highest 5-year counts of incident injuries were: •	Fort Wainwright, AK (175) •	Bavaria (Grafenwoehr/Vilseck), Germany (110) •	Marine Corps Recruit Depot Parris Island/ Beaufort, SC (102) •	Fort Benning, GA (99) •	Fort Carson, CO (88) •	Marine Corps Base Quantico, VA (86) •	Fort Bragg, NC (78) Map displays the information above. 2016 – 2017 cold season During the 2016 – 2017 cold season, the numbers of incident cases of cold weather injuries were higher than the counts for the previous 2015-2016 cold season at seven of the 24 locations. The most noteworthy increase was found at the Army’s Fort Wainwright, where there were 48 total cases diagnosed in 2016 – 2017 , compared to just 16 during the 2015 – 2016 cold season. Bar chart shows annual number of cold weather injuries (cold season 2016 – 2017) and median number of cold weather injuries (cold seasons 2012 – 2016) at military locations with at least 30 cold weather injuries during the surveillance period, active component, U.S. Armed Forces, July 2012 – June 2017. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR Image in background includes  service members out in the snow.

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Incidence rates of cold weather injuries: Non-Hispanic black service members, five cold weather seasons, July 2012 – June 2017

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1/18/2018
Did you know for all of the services, overall rates of cold weather injuries were higher among non-Hispanic black service members than among those of other race/ethnicity groups? •	Rates of cold weather injuries among non-Hispanic black service members were two-times as high as those among non-Hispanic white or other race/ethnicity groups.  •	The rates of frostbite among non-Hispanic black service members were three-times those of the other race/ethnicity groups. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to www.Health.mil/MSMR  #ColdReadiness Image of non-Hispanic black service member in the snow displays.

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2016 – 2017 Cold Season, Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces

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1/18/2018
or the 2016 – 2017 cold season, the number of active component service members with cold weather injuries was the lowest of the last 18 cold seasons since the Medical Surveillance Monthly Report (MSMR) began reporting such data in the 1999-2000 cold season. Findings •	The overall incidence rate for cold weather injuries for all active component service members in 2016 – 2017 was 15% lower than the rate for the 2015 – 2016 cold season. •	The 2016 – 2017 rate was the lowest of the entire five year surveillance period. •	In the 2016 – 2017 cold season, the Army’s incidence rate of 41.0 per 100,000 person-years for active component soldiers was 18% lower than the Army’s lowest previous rate in 2012 – 2013. •	In the Navy, Air Force, and Marine Corps, the active component rate for 2016 – 2017 was only slightly higher than their lowest rates during the 2012—2017 surveillance period. Pie chart 1 (left side of infographic): Cold Weather Injuries, By Service, Active Component, 2016 – 2017 data •	Army 57.6% (n=189) •	Marine Corps 21.0% (n=69) •	Air Force - 13.1% (n=43) •	Navy – 8.2% (n=27) •	The sharp decline in the Army rate during the 2016 – 2017 cold season drove the overall decline for all services combined. Pie chart 2 (right side of infographic): Percentage distribution by service of cold weather injuries among reserve component service members during cold season 2016 – 2017  •	Army 72.9% (n=43) •	Marine Corps 13.5% (n=8) •	Air Force 13.5% (n=8) •	Navy (n= 0) •	For the 2016 – 2017 cold season, the overall rate of cold weather injuries for the reserve component and the rates for each of the services except the Air Force were lower than in any of the previous four seasons. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR

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Cold weather injuries during deployments, July 2012 – June 2017

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1/18/2018
During the 5-year surveillance period, 105 cold weather injuries were diagnosed and treated in service members deployed outside the U.S. of these, 39 (37%) were immersion injuries; 33 (31%) were frostbite; 16 (15%) were hypothermia; and 17 (16%) were “unspecified” cold weather injuries. Pie chart for cold weather injuries during deployments displays depicting the information above. Number of cold weather injuries bar chart: Of all 105 cold weather injuries during the surveillance period, 68% occurred during the first two cold seasons. Bar chart shows the number of cold weather injuries by year: •	2012-2013 cold season had 35 cold weather injuries •	2013-2014 cold season had 100 cold weather injuries •	2014 -2015 cold season had 13 cold weather injuries •	2015-2016 cold season had 11 cold weather injuries •	2016 – 2017 had 10 cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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Percentages of each Service’s cold weather injuries, 2016 – 2017 cold season

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Did you know when all cold weather injuries were considered, not just the numbers of individuals affected, frostbite was the most common type of cold weather injury, comprising 53% (n=177) of all cold weather injuries among active component service members in 2016 – 2017? •	In the Air Force and Army respectively, 60.9% and 58.9% of all cold weather injuries were frostbite, whereas the proportions in the Marine Corps (42.9%) and Navy (25.0%) were much lower. •	For the Navy, the 2016-2017 number and rate of frostbite injuries in active component service members were the lowest of the past 5 years. •	The number of immersion injury cases in 2016 – 2017 in the Marine Corps was the lowest of the 5-year surveillance period. Bar graph: Percentages of each Service’s cold weather injuries that were frostbite, 2016 – 2017 cold season •	Air Force (60.9%) •	Army (58.9%) •	Marine Corps (42.9%) •	Navy (25.0%) For all active component service members during the 2016 – 2017, the proportions of non-frostbite cold weather injuries were as follows: •	19.5% hypothermia •	17.7% immersion injuries •	9.9% Other & unspecified cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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Five cold seasons: July 2012 – June 2017, Cold injuries during deployments

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During the 5-year surveillance period, 105 cold injuries were diagnosed and treated in service members deployed outside of the U.S. Of these 105 cold injuries, 68% occurred in the first two cold seasons. Total no. of cold injuries, by season: •	35 cold injuries during cold season 2012 – 2013 •	36 during 2013 – 2014 •	13 during 2014 – 2015 •	11 during 2015 – 2016 •	10 during 2016 – 2017 The decrease in the number of cases is most likely a byproduct of: •	The dramatic decline in the number of service members deployed to Iraq and Afghanistan •	Changes in the nature of military operations there Access the full report in MSMR Vol. 24 No. 10 October 2017 at Health.mil/MSMR Pie Chart showing cold injuries during deployments: •	39 Immersion •	33 Frostbite •	17 unspecified  •	16 Hypothermia Background image shows service member walking in the snow.

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Update: Exertional Rhabdomyolysis Active Component, U.S. Armed Forces, 2012 – 2016

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Rhabdomyolysis is characterized by the rapid breakdown of overworked intracellular muscle, skeletal muscle cells and the release of toxic fibers into the bloodstream. It is a significant threat to U.S. military members during physical exertion, particularly under heat stress. This report summarizes numbers, rates, trends, risk factors and locations of occurrences for exertional heat injuries, including exertional rhabdomyolysis for 2012-2016. In 2016, there were 525 incident diagnoses of rhabdomyolysis between 2013 and 2016 rates increased 46.2 percent – 69.7 percent of cases occurred during May through September. Risk factors for exertional rhabdomyolysis include being male, younger than 20 years of age, black, non-Hispanic, low level of physical fitness, prior heat injury and exertion during warmer months. Additional information about the causes and prevention of exertional rhabdomyolysis can be found in the MSMR at www.Health.mil/MSMR

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Update: Exertional Hyponatremia U.S. Armed Forces, 2001-2016

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Exertional Hyponatremia occurs during or up to 24 hours after prolonged physical activity. It is defined by a serum, plasma or blood sodium concentration below 135 millequivalents per liter. This infographic provides an update on Exertional Hyponatremia among U.S. Armed Forces, information on service members at high risk. Exertional hyponatremia can result from loss of sodium and/or potassium as well as relative excess of body water. There were 1,519 incident diagnoses of exertional hyponatremia among active component service members from 2001 through 2016. 86.8 percent were diagnosed and treated without having to be hospitalized. 2016 represented a decrease of 23.3 percent from 2015. In 2016, there were 85 incident diagnoses of exertional hyponatremia among active component service members and 77.6 percent of exertional hyponatremia cases affected males.  The annual rate was higher among females. Service members age 40 and over were most affected by exertional hyponatremia. High risk service members of exertional hyponatremia were: •	Females •	Service members aged 19 years or younger •	White, non-Hispanic and Asian/ Pacific Islander service members •	Recruit Trainees •	Marine Corps members Learn more at www.Health.mil/MSMR

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Although regular exercise is good for the body, too much physical activity can do more harm than good. Rhabdomyolysis is the rapid breakdown of overworked muscle cells, following the release of toxic fibers into the bloodstream, causing many complications during physical exertion. This infographic provides information about the symptoms of Rhabdomyolysis, prevention and treatment.  How to avoid: •	Thoughtfully plan out your exercise routines •	Drink adequate amounts of fluid •	Minimize your workout time in extreme heat conditions How to treat: •	IV fluids/ fluid replacement •	Urinary Alkalization •	Blood transfusion  Symptoms of Rhabdomyolysis •	Difficulty in arm motion / trouble lifting objects •	Muscle weakness, muscle swelling and leg fatigue •	Fever, confusion, loss of consciousness •	Nausea and vomiting •	Dark colored urine or lack of urine  Learn more at Health.mil/MSMR

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During a July 2011-2016 five-year surveillance period, overall incidence rates of cold injuries among U.S. service members declined for the two most recent winters after having peaked in winter 2013-2014. That year much of the eastern U.S. experienced colder-than-average weather attributed to a weakening of the polar vortex. More facts to know: •	For the Navy and Air Force, the rates of all cold injuries in 2015-2016 were the lowest of any year of the surveillance period. •	The 2015-2016 rates for the Army and Marine Corps were lower than the rates for the previous two years but still higher than the rates for the first two years of the surveillance period.  At war, the numbers of cold injuries associated with service in Iraq and Afghanistan have fallen precipitously in the past four cold seasons. The 11 cases in the most recent year are the fewest in the surveillance period.  For more information on cold injuries among U.S. Armed Forces, read the Medical Surveillance Monthly Report at www.Health.mil/AFHSB

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Human Physiologic responses to cold exposure preserve core body temperature, but those responses may not be sufficient to prevent hypothermia if heat loss is prolonged. This infographic offers helpful information on preserving core body temperature to counter the threat from cold environments. Physiologic responses include: •	Constriction of the peripheral (superficial) vascular system – may result in non-freezing injuries or hasten the onset of actual freezing of tissues (frostbite) •	Minimizing loss of body heat •	Protecting superficial tissues Protection includes:	 •	Nutrition •	Shelter •	Physical Activity •	Protective Clothing Learn more about preserving core body temperature by reading the Medical Surveillance Monthly Report at www.Health.mil/AFHSB

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12/14/2016
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