Human vulnerability and variability in the cold: Establishing individual risks for cold weather injuries

François Haman; Sara C S Souza; John W Castellani; Maria-P Dupuis; Karl E Friedl; Wendy Sullivan-Kwantes; Boris R M Kingma

doi:10.1080/23328940.2022.2044740

Human vulnerability and variability in the cold: Establishing individual risks for cold weather injuries

Temperature (Austin). 2022 May 29;9(2):158-195. doi: 10.1080/23328940.2022.2044740. eCollection 2022.

Authors

François Haman¹, Sara C S Souza¹, John W Castellani², Maria-P Dupuis¹, Karl E Friedl², Wendy Sullivan-Kwantes³, Boris R M Kingma⁴

Affiliations

¹ Faculty of Health Sciences, University of Ottawa, Ottawa,Ontario, Canada.
² Thermal and Mountain Medicine Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA.
³ Biophysics and Biomedical Modeling Division, Defence Research Development Canada-Toronto, Defence Research and Development Canada, Ontario, Canada.
⁴ Netherlands Organization for Applied Scientific Research, Department of Human Performance, Unit Defence, Safety and Security, Soesterberg, The Netherlands.

Abstract

Human tolerance to cold environments is extremely limited and responses between individuals is highly variable. Such physiological and morphological predispositions place them at high risk of developing cold weather injuries [CWI; including hypothermia and/or non-freezing (NFCI) and freezing cold injuries (FCI)]. The present manuscript highlights current knowledge on the vulnerability and variability of human cold responses and associated risks of developing CWI. This review 1) defines and categorizes cold stress and CWI, 2) presents cold defense mechanisms including biological adaptations, acute responses and acclimatization/acclimation and, 3) proposes mitigation strategies for CWI. This body of evidence clearly indicates that all humans are at risk of developing CWI without adequate knowledge and protective equipment. In addition, we show that while body mass plays a key role in mitigating risks of hypothermia between individuals and populations, NFCI and FCI depend mainly on changes in peripheral blood flow and associated decrease in skin temperature. Clearly, understanding the large interindividual variability in morphology, insulation, and metabolism is essential to reduce potential risks for CWI between and within populations.

Keywords: Cold survival; acclimation; adaptation; blood flow; energy metabolism.

Publication types

Review

Grants and funding

FH was supported by the Natural Sciences and Engineering Research Council of Canada;BK was supported by Ministerie van Defensie doelfinanciering V1907 5th Gen Stressors and ITP Cold Weather Operations.