With the Arctic region warming in more ways than one, the implications for the Army are critical. As rising global temperatures melt the polar ice caps, access to critical resources at the top of the globe increases. This unprecedented access to precious resources will invariably lead to near-peers such as the U.S., its allies and Russia coming in close contact.
As more military assets surge into the region, creating an escalating security dilemma, the possibility for conflict rises exponentially. The U.S. Army is not yet positioned to deal with the medical implications of such a conflict.
In 1996, the eight nations with a footprint above 66 degrees north latitude—Canada, Denmark, Finland, Iceland, Norway, Russia, Sweden and the U.S.—established the Arctic Council. Formed to foster cooperation and coordination among its members, the need for unanimous consensus has paralyzed its effectiveness as a governing body.
Tensions Escalate
Varying views on the management of new fishing grounds and access to the nearly 90 billion barrels of oil and 1,600 trillion cubic feet of natural gas have left the U.S. and its allies in disagreement with Russia. Coupled with access to new shipping lanes that have the potential to decrease global shipping times by five weeks, bypassing the infamously crowded Strait of Malacca, it’s no wonder that Arctic tensions have escalated.
In 2005, realizing the emerging importance of the Arctic region, the Army shifted the several thousand troops of the 4th Brigade Combat Team (Airborne), 25th Infantry Division, from Hawaii to Alaska. Rounded out with several thousand more troops in 2022, the result was the reactivation of the 11th Airborne Division. Along with members of the Alaska Army National Guard, the two forces comprise the premier Arctic ground component capabilities in the U.S. arsenal.
These units are mirrored on the other side of the Bering Strait by a Russia that possesses over 50% of the area inside the Arctic Circle and a growing military presence. With two dozen military bases, and working to refurbish more than another 50, Russia conducted 17 Arctic exercises in 2022, including a joint Russia-Chinese operation. The year before, the former Soviets stood up the Northern Fleet as their fifth military district, the equivalent of a DoD geographical combatant command. Relations are likely to keep growing colder, even as the Arctic continues to warm up.
Harsh Environment
The adverse effects of cold on physical performance have long been understood, even as our Neanderthal forefathers stood around fires for warmth. Scientific research has shown that when exposed to arctic conditions, human performance drops during the first three minutes. In combat, these may well be the most critical minutes of someone’s life, whether an Arctic soldier is leaving an aircraft under a parachute or running down the ramp of a Stryker vehicle to the sound of guns. Being in good shape has shown to have little to no effect on decreased performance in cold weather, or on decreasing the effects of hypothermia.
In fact, the reverse is true; increased fat has been shown to insulate the body and help keep hypothermia at bay. At those same temperatures, research also has shown that doctors and other professionals become more prone to errors, with potentially life-altering consequences. The importance of checklists, similar to those used by airline pilots when hundreds of lives are on the line, has begun to find its way into health care, and they should be fully embraced in surgical procedures in austere conditions.
Soldiers’ prolific use of caffeine in the form of energy drinks and coffee, as well as nicotine in cigarettes, chewing tobacco and vaping, constricts blood vessels. This, in turn, puts soldiers at greater risk of a cold-weather injury due to the narrowing of blood vessels that provide warm blood to extremities. Voiding or urinating in arctic field conditions requires exposure to below-freezing temperatures. Therefore, soldiers will often decrease their oral fluids, leading to lower-circulating blood volume and a subsequent increased risk of cold injury.
Hydration is as critical to survival as warmth. Educating soldiers to avoid (or at least limit) nicotine and caffeine before and during cold-weather field exercises is important. In light of scientific research, consideration should be given to relax certain physical standards for Arctic soldiers. Weight waivers would not be a new practice, with them already allowed for soldiers who score 540 points or more on the Army Combat Fitness Test.
Additionally, awareness should be raised regarding devices like the female urinary diversion device. Already a mandatory packing item for women attending the U.S. Army Ranger School, with practice, the device allows women to urinate from a standing or squatting position with minimal environmental exposure.
Also, Army National Guard troops in Alaska, who may live in smaller communities across the state, may have limited access to critical preventive health care. This is particularly true given the geographical size of the state, which may decrease access to regular health care provided to active-duty soldiers stationed there.
Vast Distances
The U.S. military and the public have become accustomed to unprecedented survival rates in combat, in large part due to a robust evacuation chain. Trauma care in Iraq and Afghanistan set a high bar, with survival rates near 95% during the first eight years of the wars. The vast distance of the Arctic region makes evacuation of casualties problematic and jeopardizes sustainability of those rates.
Sister services can help cut down on transport to critical lifesaving surgical care. The U.S. Air Force can establish remote landing strips for aircraft equipped with skids. The U.S. Navy can play a critical role with deployment of the USNS Mercy or Comfort, 500-bed hospital ships capable of trauma resuscitative services, operating rooms and rehabilitative services.
Anyone who has taken a cellphone out in the cold and watched the battery rapidly drain understands the effects of cold on critical, battery-powered medical equipment. From cardiac monitors and automated blood pressure machines to surgical lights and patient warmers, nothing is immune to the harsh conditions of the Arctic Circle.
But the cold Arctic winter is not omnipresent. During the summer, the sun is available 20 hours a day. Portable solar panels on trucks and tents may begin to solve power and charging issues. Backpackers from the Appalachian Trail to Nepal have realized the utility of manportable recharging panels. Devices like these can be used to convert solar energy to warmth for the hands of a surgeon performing a critical operation on a fellow soldier.
The standard Army field hospital is overly cumbersome, needing 13 Air Force C-17 Globemaster II aircraft just to transport its 32-bed modules into a theater. A full hospital center and the two subordinate 120-bed field hospitals require a total of 46 C-17s. Small electronic intravenous pumps that deliver lifesaving blood are often protected in padded containers that are 10 times their size, compounding the transport problem.
Consolidating Care
Being able to consolidate multiple critical care instrumentation into smaller, mobile sets would increase mobility (and subsequently, survivability), lower transportation requirements and decrease power needs. The MOVES SLC portable life support system is one such product, combining cardiac monitoring, oxygen delivery and suction in a 37-pound litter attachment. Already utilized and airdropped by special operations medical forces and proven during field training with the 2nd Cavalry Regiment, this or like devices should become the new standard as soon as possible. The U.S. Army Futures Command’s Medical Capability Development Integration Directorate is making great strides in working to decrease the size of Army field hospitals. Future capabilities may include a smaller division-level hospital.
As the ice of the Arctic Circle thaws and presents new opportunities, challenges will arise as nations compete for finite resources. The Army must be prepared to fight—and save lives—on this unforgiving tundra and unique battlefield.
The tyranny of distance will present challenges for evacuation, while the harsh conditions could decrease survivability. While solutions exist to mitigate many of these issues, the Army must be proactive in implementing them. Otherwise, ultimately, soldiers will pay for lack of action in blood.
Col. Michael Wissemann is the deputy commander for nursing for U.S. Medical Activity-Bavaria, Germany. Previously, he was deputy commander and chief nurse, 531st Hospital Center, Fort Campbell, Kentucky. He deployed to Kosovo, Iraq and Kuwait.