Combat Casualty Care in Arctic or Extreme Cold Environments: Considerations for the Army Health System.

The Department of the Army's 2021 strategy to "Regain Arctic Dominance" highlights the operational necessity of sustaining combat readiness in Arctic or extreme cold environments (AoECE). Presented are five scenarios inspired by casualties that illustrate capability gaps and best practices as the Army Health System applies tactical combat casualty care (TCCC) in austere, frigid climates: (1) adapting TCCC to the AoECE as a unique environment; (2) technological limitations in the prevention and treatment of hypothermia; (3) freezing cold injury (FCI) and non-freezing cold injury (NFCI) treatment and the institutional need for a cold injury center; (4) a proposal for a FCI rule-out pathway to preserve the fighting force; (5) carbon monoxide poisoning and logistical constraints. These scenarios emphasize the need for research, procurement, and doctrine tailored specifically to the AoECE, as environmental exposure and equipment capability will be a decisive factor in casualty survivability and force regeneration.