• Eric M Vinceslio, Zane Fayos, Aaron Bernadette, and Jan-Michael Van Gent.
• 3d Medical Battalion, Unit 38445, FPO, AP, Okinawa 96373, Japan.
• Mil Med. 2020 Dec 30; 185 (11-12): e2039-e2043.

IntroductionCold weather injuries require prompt warm water immersion therapy, which proves to be a difficult task in the cold austere environment. Current guidelines recommend 104 °F water immersion, but producing and maintaining large volumes of warm water is challenging in sub-freezing temperatures. We describe a novel process of utilizing a sous vide immersion circulator to maintain warm fluids for immersion therapy and efficient fluid rewarming in a cold forward-deployed setting for the treatment of cold weather injuries in an effort to bridge the gap between current medical guidelines and practices.Materials And MethodsLarge water cans were warmed to 104 °F with the immersion circulator. A thermometer was inserted into a 1-inch steak, frozen to 30 °F, and placed in a basin with only the warmed water while the internal temperature was monitored until physiologic temperature was achieved. The time to this endpoint was recorded. A 1-L bag of normal saline and a 450-mL bag of whole blood were also separately warmed by the same technique. The temperature of the normal saline was monitored at 0-, 5-, 7-, 8-, 9-, and 10 -minute intervals. The process was similarly repeated, measuring the whole blood temperature at 0-, 5-, 7-, and 10-minute intervals.ResultsAmbient internal tent temperatures averaged 54 °F; outdoor temperatures were consistently sub-freezing. The 5-gallon cans of water at ambient temperature heated to 104 °F in 15 minutes. The water temperature remained constant for 3 weeks with the circulator running. The frozen steak started at 30 °F and reached 98 °F in 52 minutes and 45 seconds. The bag of normal saline and whole blood, refrigerated to 39 °F, achieved temperatures of 102 °F and 94 °F respectively after 10 minutes.ConclusionA heating immersion circulator device is a lightweight, flameless, and inexpensive way to consistently heat large volumes of water for treatment of cold weather injuries, hypothermia, and whole blood rewarming in a cold austere environment.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by US Government employees and is in the public domain in the US.

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