SEPTEMBER 22, 2025 – U.S. armed forces prepare military medical teams to provide care anywhere at any time, even in one of the harshest and most isolated places on Earth: the Arctic.
From extreme weather changes to limited communications and infrastructure, the Arctic poses unique challenges for troops and medical personnel. Senior leaders and health experts agree that medical and operational readiness is vital in the region as its strategic importance grows.
Why the Arctic matters
The Arctic spans three continents and encompasses eight nations, seven of which are NATO members. New trade routes have opened in the region — enabling faster global shipping and easier access to untapped resources. It can be described as a region of extremes: extreme cold, extreme seasonal changes in daylight, extreme winds, and extreme terrain.
For the U.S. military, an Arctic presence secures national defense, maritime access, and humanitarian support, while also addressing environmental concerns, said U.S. military medical experts.
Medical operations in Arctic environments were topics at two major Military Health System conferences this year, in April at the 2025 MHS Annual Conference and in August at the 2025 MHS Research Symposium.
“While the Arctic was once envisioned as a neutral zone where research and conservation could promote deeper international cooperation, multiple developments since then have turned it into a site of competition,” said Air Force Col Gabriel DiNofrio, Deputy Command Surgeon, U.S. Northern Command, during the 2025 MHS Conference.
Medical care in the extreme cold
Operating in the Arctic pushes medical systems and equipment to their limits. Cold affects every aspect of care, from supplies to personnel.
“When everything freezes — blood, tubing, and medical machines — how do you provide medical care in this environment?” asked Army Col. Manuel Menéndez, Special Operations Forces North Command surgeon, at the 2025 MHS Conference. Most medical equipment is not designed for extreme cold. Batteries drain quickly, plastics become brittle, adhesives don’t stick, and medications can freeze before use.
“Plastics freeze and snap. Fluids will flash-freeze,” said Marine Capt. Jeffrey Feinberg, Marine Forces Europe Africa command surgeon. “For all those super great things we have, the batteries are going to last a fraction of the time.”
Andres Martinez Murillo, a biomedical engineer at Naval Medical Research Unit – San Antonio, stressed the importance of reliable gear and equipment at the 2025 MHS Research Symposium. “It is important to know that our medical equipment works in these Arctic conditions. Storage and the materials used to make these materials need to improve to withstand the extreme cold.”
His team at NAMRU-SA is studying the effects of cold weather on military equipment and developing solutions. They discovered that commonly used medical items, such as stethoscopes and medical tubing, crack in extreme cold weather.
Exposure injuries can rise sharply in the Arctic. Hypothermia and frostbite can appear within minutes, and half of frostbite cases never fully recover. “Even mild hypothermia triples the risk of death after injury.” Feinberg said.
Lack of familiarity
One of the biggest challenges for U.S. troops, according to Feinberg, is inexperience with Arctic conditions.
“We are not used to cold climates. We don’t have a lot of people who can inherently look at that and go, those are the wrong shoes,” Feinberg said. “When we first take a force up there, they don’t know what right looks like.”
Menéndez agreed, “You have to be out there. You have to experience the environment, and then you learn a lot of lessons.”
DiNofrio highlighted three key readiness focus areas: “Understanding what is required physically, how to move people and equipment without freezing, and how to provide medical care in this environment.”
The critical role of gear
The first line of defense is what service members wear. Layered clothing, insulated boots, and protective gloves are essential.
“Every time you don’t have to take your gloves off to do something, that’s a personal win,” said Jeffrey B. Phillips, a senior research scientist at the Florida Institute for Human & Machine Cognition, said at MHS Research Symposium. “Gloves that allow dexterity while preserving heat can mean the difference between staying effective or suffering frostbite.”
Boots must resist moisture and allow movement in snow and ice. Service members also depend on insulated layers that trap body heat without restricting motion. When combined, this gear forms personal heat protection that allows survival long enough to fight, move, and provide care.
The military is also implementing cold-weather gear in exercise drills. Menéndez discussed the success of experiments at a 2025 training exercise, including the use of nanofibers on socks and gloves to assess insulation and the use of biosensors on operators to monitor heart rate, body temperature, and exertion.
Training and readiness
To close gaps in training and mission readiness, U.S. forces are relying on realistic exercises that mimic Arctic conditions.
Special Operations Command North has piloted a program, Special Operations Forces Arctic Medic, that teaches service members how to stay warm, move patients, and deliver care without leaving thermal or electronic signatures. Lessons include skiing during storms to avoid detection, carrying blood inside clothing to prevent freezing, and creating “heat bubbles” to protect patients, according to Menéndez.
In one exercise, medics performed real surgery on perfused cadavers aboard a moving train in Alaska, guided in real time by surgeons at Brooke Army Medical Center in Texas. The test showed how augmented reality and satellite communications can bridge gaps in expertise far from hospitals.
Mental readiness also matters — extended periods of darkness, isolation, and extreme cold can strain morale. Several speakers at the conferences emphasized buddy checks, nutrition, and realistic expectations to help service members adjust to their new environment.
Working with international partners vital to mission success
International collaboration is critical in the Arctic, spanning multiple nations. Evacuations often require patient transfers across agencies and allies.
Exercises such as Arctic Edge, the Norwegian military-led Cold Response, and Joint Viking allow U.S. forces to train alongside allies in Norway, Sweden, Finland, and Canada.
“If you can’t hand a patient from SEALS to Special Forces to the Coast Guard to the Air Force without changing out tubing, you’re not going to succeed,” said Menéndez.
Feinberg noted that allies are eager to train together, to collaborate, and to become familiar with their backyard.
For the U.S. military, learning how to adapt to the Arctic is a mission readiness requirement — and staying fit to fight is imperative when cold weather can be the biggest threat. “The environment is trying to kill both of us: us and the enemy,” said Menéndez, “but if I can move faster … further than the enemy … I win.”
Story by Robert Hammer
Office of the Assistant Secretary of Defense for Health Affairs/Military Health System