Non-freezing cold injury (NFCI): What is it and why does it matter to military personnel?

Non-Freezing Cold Injury (NFCI) within the military sparked public interest last year following coverage in the media alleging the highest claim settlement figures to date. In this blog, I explain what legal help is available to those suffering from Non-Freezing Cold Injuries.

In the Ministry of Defence paper, ‘Synopsis of causation cold injury’, Dr Adrian Roberts states that Non-Freezing Cold Injury (NFCI) is a condition caused by body tissue being subjected to prolonged cooling temperatures which are above freezing. There are two types of NFCI’s, chilblains and trench foot, which is occasionally referred to as immersion foot or immersion hand.

NFCI is commonly associated with military personnel, who often develop this injury through training or deployment. Although the military arranges cold weather training annually, there have been recent talks of the Royal Marines placing more of a focus on cold weather training following a decline in this type of training in previous years due to concentrating on operation tours in Afghanistan. In addition to this, NATO held an exercise called Trident Juncture 18 in Norway towards the end of last year which was reportedly the largest military exercise since 2002.

One of many objectives of Trident Juncture 18 was to prepare the military to operate in challenging condition; this includes cold and wet environments. With an increase in cold weather training, it is vital that military personnel are provided with adequate training and equipment to ensure that they reduce the possibility of developing NFCI and are aware of the symptoms of NFCI in order to identify and treat promptly.

NFCI is triggered by repeat exposure to cold or wet environments for a significant length of time and not being able to satisfactorily dry off the affected area. This is much more than having wet hands and feet for a short period; soldiers in the First World War were often exposed to the type of conditions that can cause NFCI for days, weeks, months or even years. Although damage is caused during exposure to such conditions, NFCI becomes more visible and apparent once the individual returns to a warmer environment. The affected area will often become inflamed and swelling of the skin may occur. In addition to the visible changes, individuals may also experience a burning and painful sensation to the affected area once they enter or return to warmer conditions.

What are Chilblains?

Chilblains are red swellings on the skin that are often itchy. They can occur after the skin has been exposed to cold or wet conditions for short periods. The most commonly affected areas for chilblains are the fingers, ears and face. When the individual returns to a warm environment they may experience the skin area become swollen and darker in colour. These symptoms may not appear for several hours and may persist for a number of hours following exposure. The skin will often feel tender, itchy and painful. Chilblains are unlikely to cause permanent damage.

What is Trench Foot?

Trench Foot is a more serious condition and may occur when an individual has been exposed to cold or wet conditions for a period of 3 to 12 hours or more. The longer the duration of exposure, the more severe the injury is likely to be. In addition to cold and wet conditions, damp footwear, or footwear that is too tight can increase the severity of trench foot.

Trench Foot commonly affects the hands, feet and occasionally the genitals. An individual with trench foot may experience cold or numbness, shooting pains, swelling, redness, bleeding, darkening of the skin and sensitivity to a specific area. Unlike chilblains, trench foot can cause long-lasting or permanent damage.

According to Ken Zafren, Clinical Professor of Emergency Medicine of Stanford University Medical Center, non-freezing cold injury (NFCI), specifically Trench Foot, progresses through four stages. The first stage is during cold exposure where there is a loss of sensation. The second stage is following exposure where the skin changes colour and swelling can occur, this stage can last a few hours but may persist for as long as several days. The third stage is intense pain and can last for days or in some cases weeks. The last stage is the skin being sensitive to cold and can cause chronic pain; this stage can last for a few weeks, persist for years, or be permanent.

It is important that the affected parts of the body are kept clean and dry in order to reduce the likelihood of developing trench foot. It is also vital that wet or damp clothing is changed regularly, internal footwear is dried daily and steps are taken to dry footwear and clothing overnight. If it is suspected that an individual is suffering from trench foot they are encouraged to remove wet clothing and footwear gently, elevate affected areas and avoid popping blisters or walking if the feet are affected. Failure to follow these steps may increase tissue damage and consequently, the severity of the injury.

Due to the direct link between NFCI and wet and cold conditions, it is recognised that those susceptible to NFCI include military or ex-military personnel. The reason for this is that military personnel frequently spend many hours outdoors in the kind of cold and wet conditions which can easily lead to NFCI. Chilblains and trench foot have been an issue for the military dating back to the First World War. More than 100 years later they continue to cause problems, even though we know much more about trench foot than we did then.

In many cases, the risk of military personnel sustaining an NFCI can be reduced and even prevented by taking simple steps. Reduction of the risks in this way does not mean preventing military personnel from training in realistic conditions. However, it can be achieved by controlling and, if necessary, limiting the duration of exposure and switching the type of activity in extreme weather conditions. It can also be achieved by ensuring the proper protective clothing is provided and worn – providing jungle issue boots for an exercise in Arctic conditions is not sufficient. The MoD should also provide proper education and training to personnel on NFCI, to include the need for frequent foot-care routines in appropriate conditions. Finally, the MoD should refer individuals suffering from the symptoms of NFCI to medical officers promptly and ensure that sufferers are not required to continue with exercises that will exacerbate the injury until they have recovered.

NFCI is not a trivial condition and may have a long-lasting impact on military personnel. Sufferers may experience being medically downgraded or discharged from duty. It may also halt career progression, resulting in loss of earnings and career opportunities and in some cases, mean military personnel are medically discharged from the armed forces. Military and ex-military personnel may not only experience the physical effects of NFCI but it may also impact on their mental wellbeing, resulting in mental health problems such as anxiety and depression.

There is often a misconception that this is a self-inflicted injury, caused through failure to follow instructions and take proper steps to deal with the onset of NFCI. It is hard to see how an individual can be criticised, especially when they are not provided with the correct kit for the conditions in which they are deployed.

Individuals that believe they suffer from or have been diagnosed with NFCI may wish to seek legal advice in relation to a potential claim for personal injury. NFCI is a condition that can often be easily prevented, but the long-term consequences for someone with NFCI can be severe. If you believe you have been affected by NFCI you should consider speaking with a specialist solicitor who can advise you on your rights.