David W. DeGroot and Laura A. Pacha**


Cold is a physical hazard that may affect workers, both indoors and outdoors, virtually anywhere in the world. Workers at greater risk include construction workers, farmers, fishermen, utility workers, lumberjacks, soldiers, petroleum workers, police, firefighters, postal workers, butchers, and cold storage workers. For the purpose of this chapter, an extreme cold environment exists when ambient temperature is <0°C/32°F.1

Cold injuries may be either freezing (frostbite) or nonfreezing (trench/immersion foot and hypothermia) and localized or systemic. While they occur sporadically in civilian populations, in both occupational and recreational settings, cold injuries have been a significant problem in military campaigns throughout history. The armies of Xenophon (400 BC), Hannibal (218 BC), and Napoleon (1812–1813) experienced significant numbers of cold injuries.2 Despite numerous advances in our understanding of thermoregulation during cold stress, and in the development of protective clothing, cold injuries continued to affect military operations in the twentieth century, notably in the trench warfare of World War I (hence the immersion foot synonym trench foot), the German experience in Russia during World War II, and the British experience in the Falkland Islands in the 1980s.3 The incidence or frequency of cold injury in the civilian sector is much more difficult to determine; unlike ...

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