PFC podcast 265: Challenges in Arctic TCCC

Feb 9, 2026

Emily Johnston, a cold‑weather medicine clinician who helped write Arctic trauma guidelines, walks through delivering care in extreme cold. She highlights hypothermia and frostbite threats. Short talks cover airway and hemorrhage challenges, cutting insulation strategically, nutrition for rescuers and patients, and new frostbite treatments like iloprost.

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ADVICE

Use The Arctic CPG As An Add-On

Use the Arctic CPG as an adjunct to existing TCCC protocols rather than a replacement.
Add cold-specific considerations (gear management, provider protection, concurrent hypothermia risk) at each treatment stage.

ADVICE

Cut Windows Not Windows Of Exposure

Cut small insulated "windows" in clothing to apply tourniquets or IVs instead of stripping the casualty naked.
Mark each window (e.g., red tape with TQ/time or IV/size) before re-insulating so interventions remain visible.

ADVICE

Premark Cut Spots For Rapid Access

Predefine high-and-tight cut spots on garments or oversew designated areas to permit rapid tourniquet placement.
Keep windows as small as practicable while allowing hand access to limit heat loss.

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In this episode of the PFC Podcast, Dennis and Emily Johnston delve into the critical topic of cold weather medicine, specifically focusing on the newly submitted Cold Weather Clinical Practice Guidelines (CPG) for the Arctic. Emily emphasizes the importance of these guidelines as adjuncts to existing protocols, highlighting the unique challenges posed by extreme cold environments, such as the constant threat of hypothermia and frostbite. She explains how the guidelines are designed to enhance existing trauma care practices by incorporating specific considerations for operating in frigid conditions, ensuring both the caregiver and the casualty are adequately protected and treated.

The conversation also touches on practical strategies for managing injuries in cold weather, including the use of tourniquets and the importance of maintaining body heat. Emily shares insights on nutrition for both rescuers and patients in extreme cold, emphasizing the need for high-calorie, easily consumable foods. The episode concludes with a discussion on the latest advancements in frostbite treatment, including the use of ibuprofen and isoprost, and the significance of timely intervention in preserving tissue viability. Overall, this episode serves as a vital resource for medical professionals operating in cold environments, providing them with essential knowledge and tools to improve patient outcomes.

Takeaways

Hypothermia and frostbite are constant threats in extreme cold.

Nutrition is crucial; high-calorie foods are essential for survival.

Timely intervention is key in frostbite treatment.

Patient packaging must be done carefully to prevent heat loss.

Chapters

00:00 Introduction to Cold Weather Medicine

01:10 Understanding the Need for an Arctic CPG

10:14 Nutrition in Extreme Cold Environments

27:06 Advancements in Frostbite Treatment

35:15 Patient Packaging and Communication in Cold Environments

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