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GRAFENWÖHR, Germany — Grisly images of blackened toes, fingers and even buttocks are being used to warn soldiers and civilians about the risk of cold weather injuries in a place nicknamed the Bavarian Siberia.

Capt. Matthew Perry, chief environmental health officer at Medical Activity Würzburg showed photographs of frostbitten body parts to about 100 people assembled for a winter safety briefing at the Grafenwöhr Field House on Friday.

Germany — along with Fort Drum, N.Y., Fort Lewis, Wash., and Fort Bragg, N.C. — is second only to Alaska when it comes to cold weather injuries among U.S. soldiers. Alaska has more than 150 such injuries annually while Germany and the other bases have more than 100, Perry said.

“I’m guessing a lot of these cases (in Germany) happen right here in Grafenwöhr,” he said, adding that average temperatures in the region drop below freezing in November and don’t warm up again until April.

Perry outlined the four main types of cold weather injuries — chilblains, frostbite, trench foot and hypothermia.

Chilblains are patches of skin irritated by exposure to cold wind, he said. “Its not life-threatening but it indicates you are on the way to something serious,” he said.

Trench foot, which can crop up on hands and noses as well as feet, happens when cold and water are combined, Perry said.

“Water will take heat away 25 times faster than wind,” he said, adding that a trench foot will be red, swollen and numb. “Then it feels really painful and the tissue starts to break down and separate. Seek medical attention when this happens,” he said.

Frostbite is the most common cause of hospitalization for cold weather injury, he said. It starts with a feeling of numbness and then a wooden feeling.

“That is really bad and a sign of serious frostbite. You can literally freeze your butt off,” Perry said, gesturing to a large photograph of a man’s badly frostbitten buttocks.

One soldier attending the briefing, Sgt. 1st Class Stephen Roberts, 40, of Friendship, Maine, said he had had chilblains on his nose, face and ears many times skiing in Maine. He’d also seen several cases of frostbite while training with the Army, he said.

The worst he saw was at Fort Drum, on the fingers of a soldier who was not wearing gloves during a field exercise. “His fingers turned black,” said Roberts, who serves with the 69th Signal Battalion at Grafenwöhr.

Hypothermia, the most severe cold weather injury, happens when core body temperature falls below 95 degrees Fahrenheit, Perry said. “When that happens your internal organs start to get messed up. When you stop shivering it’s a sign your brain is not functioning properly,” he said.

“When your core temperature drops below 92 degrees you might act erratically and experience hallucinations. Below 68 degrees your brain shuts down.”

However, people have been resuscitated after their core temperature dropped as low as 60 degrees, he said. “When you find somebody who you think has frozen to death, react like it is a living person,” he said.

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