New Generation Survival Ration: A Brief Report (1991)

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You can get water from some plants, and it can be used without further treatment. Coconuts contain refreshing water—the green, un- ripe coconuts about the size of a grapefruit are best. (See illustration on page 96.) Vines are often good sources. Choose a good-sized vine and cut off a 3- to 6-foot length. Make first cut at the top. Sharpen one end and hold a container or your mouth to the sharpened end. The water will be fresh and pure. Never drink from a vine that has milky sap. Bamboo stems sometimes have water in the hollow joints. Shake the stems of old, yellowish bamboo— if you hear a gurgling, cut a notch at the base of each joint and catch the water in a container. (See illustra- tion on page 91.) In the American tropics, the branches of large trees often support air plants (relatives of the pineapple) whose overlapping, thickly growing leaves may hold a considerable amount of rain water. Strain the water through cloth to eliminate most of the dirt and water insects. In climbing one of these trees, you may also find smal] frogs r snakes. Collect rain water by digging a hole and lining it with a tarpaulin or a piece of canvas. Catch water from dripping trees by wrapping a clean cloth around a sloping tree, and arrange one end of the cloth to drip j \to a container. An nal trails often lead to water. Follow them, but take care not to ge. lost. FOOD General Rules 1. Teke stock of vour availahle food and water. Estimate the number of days you expect to be on your own. (The pick-up time may vary from a few hours to several months, depending on the environment and available rescue facilities in the area. Divide availahle food ivito thirds: allow two-thirds for the first half of your estimated time betore resruc, and save the remaining one-third for the second half. 2. 1f you decide to divide your party, give each man traveling out for help about twice as much food as you give each man remaining with the airplane. In this way, the men resting at the airplane and those walking out will stay in about the same physical condition for about the same length of time, and the safety and rescue prospects of all will be increased. 3. If you have less than a quart of water dailv avoid drv. starchy, and highly flavored foods and meat. Keep in mind that eating increanea thirst. Best foods to eat are those with high carbohydrate content, such as hard candy and fruit bars. 4. Every bit of work requires additional food and water; remember that the leas you work, the less food and water you will need. 5. You on live many days without fond if vou have water. When water is no proviem, drink more than your nui. amount to keep fit. 6. Always be on the lookout for wild foods. Eat off the land whenever possible. Save your rations for emergencies. 43

7. Eat regularly, if r--.wle; don’t nibble! On limited rations, plan for one good meal daily; then sit down and make a feast of it. Two meals a day are preferable, especially if one of them is hot. If you are collecting wild foods, plan a hot meal. Cooking makes the food safer, more digestible, and more palatable. The time you spend cooking will give you a good rest period. 8. Native foods may be more appetizing if they are eaten by themselves. Mixing rations and native foods usually does not pay. ENERCY REQUIREMENTS. You get your requirements from foods which contain: CarsonypratTes. Mostly plant in origin—sugar, starches, cereals, and fruits. If your water supply is severely restricted, stick to these foods. Proteins. Mostly animal in origin—meat, fish, eggs, milk, and cheese. Proteins are valuable fuels but their real importance is in maintaining and repairing body tissues. When you eat more of them than you need for maintenance, the extra amount is burned as fuel or converted to storage fat and carbohydrate. Your daily need is 3 ounces under all conditions; hard work does not require more. If your water supply is limited, do not eat large amounts of protein. Fats. Partly plant—olive and cottonseed oil; partly animal—butter and lard. Except in very small amounts, fats are not essential for human nutrition. Although inefficient in comparison, fats provide more than twice as many calories per unit weight than do proteins or carbohydrates. Diets very high in fat cause digestive disturbances and often produce an acid condition (ketosis) that requires added water intake for elimination. Prepared Foods The food in your survival kit has been developed especially to provide you with proper sustenance in survival emergencies. When you eat it as directed on the package, it will keep you at maximum efficiency. You can eat it as it comes from the kit, without further orenarstion, alone, or with other toods. Save it for emergency use, if you can find enougn other food at hand. Wild Foods Learn to overcome your prejudices. Foods that may not look good to eat are often part of the natives’ regular diet. Wild foods are good foods, with high vitamin and mineral content. Fleshy-leafed plants make good salad greens; and fresh fruits provide fluid when water sup- plies are low. Eat enough to satisfy. With a few exceptions, all animals are edible when freshly killed. Don’t cat toads. Never risk your life with questionable sea food. Never cat fish with slimy gills, sunken eyes, flabby flesh or skin, or an un- pleasant odor. If the flesh remains dented when you press your thumb against it, the fish is probably stale. For poisonous and venomous fish, sec pages 79 and 80; for poisonous plants and mushrooms, see pages 55, 57, and 72. 44

Where to Look for Food You should be able to find something to eat wherever you are. One of the best hunting grounds for survival food is along the sea coast, between the high and low water mark. Other likely spots are the area between he beach and a coral reef; the marshes, mud flats, or man- grove swamps where a river flows into the ocean or into a larger river; river banks, inland water holes, shores of ponds and lakes; margins of forests, natural meadows, protected mountain slopes, abandoned cul- tivated fields. Poorest hunting grounds are high mountain tops, dry ridges, and dense, continuous forest stands. ANIMAL FOOD Animal food will give you the most food value per pound. Any- thing that creeps, crawls, swims, or flies is a possible source of food. People ent grasshoppers, hairless caterpillars, wood-boring bectle larvae and pupae, ant eggs, and termites. Such insects are high in fat. You have probably eaten insects as contaminants in flour, corn meal, rice, beans, fruits, and greens of your daily food, and in stores in general. HUNTING HINTS Most warm-blooded, hairy animals are wary and hard to catch. To hunt them requires skill] and patience. The best method for a beginner is “still hunting.” Find a place where animals pass—a trail, water- ing place, or feeding ground. Hide nearby, always downwind so the ar imal can't smell you, and wait for game to come within range. Re- main absolutely motionless. You can stalk an animal upwind by mov- ing very slowly and noiselessly, keeping under cover as much as possible. Move only when the animal is feeding or looking the other way. Freeze when he looks your way. The best time to hunt is in the very early morning or dusk. In your travels, keep alert for animal signs such as tracks, trampled under- brush, or droppings. On narrow trails be ready for game using same pathways. Game is most plentiful and easiest found near water, in forest clear- ings, or along the edge of thickets. Many animals live in holes in the ground or in hollow trees. Poke a flexible stick into the hole to deter- mine if it is inhabited. Use a stick to tease the animal into running out, but first close off other exits. Animals in hollow trees can be smoked out by a fire built at the base of the tree; be ready to club the animal as it comes out. Night hunting or fishing is always good, since most animals move at night. Use a flashlight or make a torch to shine in the animals’ eyes. They will be partly blinded by the light and you can get much closer than in the daytime. If you have no gun, try to kill the animals with a club or sharpened stick used as a spear. Eyes of spiders and in- sects are good reflectors, so don’t be surprised if you “shine up” eyes and can’t find the rest of the creature. Eyes of spiny lobsters on reefs 45

CAUTION Poisonous mushrooms are not safe to eat even after cooking. Cooking without Utensils Roastinc (in the coals of a fire). You can coat fish, potatoes, fresh water mussels, and many other. foods large in size with a layer of mud or clay and roast them directly in the flames or coals of a fire. Loss of food by burning is thus reduced. You need not scale fish prepared in this way; peel off the skin with the baked clay when cooked. STEAMING UNDER THE FIRE. Foods small in size, such as small bird eggs, fresh water snails, or any other shellfish, may be cooked in quan- tity in a pit bencath your fire. Fill a small, shallow pit with food, after lining it or wrapping the food in plant leaves, or cloth. Cover the pit with a \4- to 4-inch layer of sand or soil, and build your fire directly over it. After sufficient cooking, rake the fire away and recover the food. STEAMING WITH HEATED STONES (clambake style). Heat a number of stones in a fire, then allow the fire to burn down to coals. Place such foods as fresh water musscls (in their shells) directly on and between the stones, and cover the whole with plant leaves, grass, or seaweed, and also with a layer of sand or soil. When thoroughly steamed in their wn juices, clams, oysters, and mussels will show a gaping shell when uncovered; and you may eat the food without further preparation. STONE BOILING. Take a big howl with water and food. Add red-hot stones until the water boils. Cover for about an hour with big leaves, or until food is well done. BAMBOO JOINTS. Bamboo joints are good pots. Heat them until they shar. PRESERVING EXCESS FOOD. Use a knapsack or better yet, a hand pack, to carry extra food. Wrap soft berries or fruits in leaves or sphagnum noss to keep them intact. Tie mushrooms together with a light string, ‘0 keep them from crushing. Carry shellfish, crabs, and shrimp in wet waweed. Clean fish immediately; wash them well; carry them on a ine over a pole. Excess fish can be split (cut off the head and remove the backbone), -pread apart, and cut thin. Then dry over smoke fires, spread on hot ocks, or hang from branches in the sun. If sea water is available, plash it on to salt the outside. Do not keep any sea food unless it is vell dried and salted. Meat can be preserved as dried “beef” or jerk meat, either over a low fire or in the hot sun. Hang all drying meat high to keep it away rom animals. Cover to prevent blow-fly infestation. If mold forms on the utside, brush or wash off before cating. In damp weather, smoked or ir-dricd meat must be redried to prevent molding. To preserve cooked animal food, recook it once each day, especially 1 warm weather. DRYING PLANT FOOD. Plant food can be dried by wind, air, sun, or re with or without smoke. A combination of these can be used. The 64

main object is to get rid of the water. Plantains, bananas, breadfruit, tubers, leaves, berries, in fact most wild fruits, can be dried. Cut them into thin slices and place in the sun. A fire may be used if necessary. If you find a lot of edible mushrooms or fungi, dry them in the sun or with a fire. They will keep indefinitely if kept dry. ARCTIC AND SUBARCTIC Animals In the Arctic, the need for food will be your first consideration. In no part of the Arctic are native animals and plants a reliable source. Your chances for survival are best along the northeast coast of Asia, the northwest coast of Alaska, the Aleutians, and the northeast, southeast, and southwest coasts of Greenland, because sea food is more common there and gives you a dependable supply of food. Depending on the time of year and place, your chances for obtain- ing animal food will vary considerably. Arctic shores are normally scraped clean of all animals and plants by winter ice. Inland animals are migratory. Watch for tracks, trails, or dung. LARGE LAND GAME. Caribou and wild reindeer are migratory through- out northern Canada and Alaska. In northern Siberia they extend in- land almost to 50° N. All move close to the sea or into the high moun- tains in summer. In winter they feed on the tundra (open, treeless plains). Caribou and reindeer are frequently infested with botfly larvae, which bore in the hide. They rarely penetrate into muscles and are not dangerous to man. Mooee in northern America and Asia, and elk in Asia are primarily animals of northern mixed forests. In winter both animals congregate in herds. Musk ox may he found in northern Greenland and on the islands of . the Canadian archipelago. Mountain sheep and goats rarely descend into valleys except in severe winter; they are attracted to salt licks. Bears are surly and dangerous. Wolves are curious, running in pairs or groups. Fox are solitary and are seen most frequently when mice and lemming are abundant. SMALL LAND GAME. Tundra animals include rabbits, lemming, mice, ground squirrels, and fox. They may be trapped (see page 46) or shot, winter or summer, anywhere on the tundra. Most prefer some cover and can be found in shallow ravines, on north-facing slopes, or in groes of short willows. Ground squirrels and marmots hibernate in win er. In summer, ground squirrels are abundant along sandy banks of iarge streams. Marmots live in the mountains, among rocks, usually near the edge of a meadow, or in deep soil — much like woodchucks. To find the burrow in rocky areas, look for a large patch of orange- colored lichen on rocks. This plant grows best on animal or bird dung; and the marmot always seeks relief in the same spot, not far from his well-hidden entrance. 65

Constipation Lack of bowel movement is normal on rafts. Don’t be disturbed about it. Don’t take laxatives even if available. Exercise as much as possible. Difficulty in Urinating The dark color of urine and difficulty in passing it are normal — don’t get worried. Mental Disturbances Fear is normal among men in dangerous situations. Admit your feeling to yourself but carry on in spite of it. Remember that other men have had the same fear, yet have come through similar experiences. Fatigue and exhaustion resulting from severe hardships often lead to mental disturbances, which may take the form of extreme nervousness, exces- sive and violent activity, or depression. The best prevention is to get as much sleep and rest as possible. When not resting, keep busy with routine raft duties. Seeing mirages is not a sign of mental unbalance. Cheerfulness is a tonic and will spread to others. Cracked and Parched Lips and Skin Use chapstick or any oil or salve. Frostbite Frostbite may occur when wet skin is exposed to wind during winter in northern oceans. Your face, ears, hands, and feet are most susceptible. Try to keep them dry and covered. If your shoes are tight, take them off and wrap your feet in dry cloth. (See page 9 for treatment. ) Sunburn Keep your head and skin covered. Stay in the shade. Use cream or chapstick from kit. Remember that reflection from water causes sun- burn, too. Protect your neck with an improvised shield. WATER AND FOOD Water Water is your most important need, With it alone you can live for ten days or longer, depending on your will to live. SHORT WATER RATIONS. When your water supplv is limited and can- not be replaced by chemical oar mechanical means, but only hv chance rain, use if efficiently. Keep your body well shaded both from overnead sun and [rom reflection off the sea surface. Allow ventilation of air; dampen your clothes during the hottest part of the day. Do not exert yourself. Relax and sleep when possible. Fix vour daily water ration after considcring the amount of water you have, the output of sun stills and de-salting kit, the number and physical condition of your party. If vou have no water, don’t eat. If vour water ration is two quarts or more per day, you may eat any part of your ration or any additional 138

food that vou may catch. such as iirds, fish, shrimp, craba, etc. The motion of a life raft and the excitement mav cause nausea; and if you eat when nauseated, you may lose your food immediately. So rest and relax as much as you can, and take only water. To cut down loes of water by sweating in hot weather, soak your clothes in the sea and wring them out before putting them on again. Don’t overdo this during hot days when no canopy or sun shield is available. Be careful not to get the bottom of the raft wet. Watch the clouds and be ready for any chance shower; keep paulin handy for catching water. If your paulin is encrusted with dried salt, wash it in sea water. Normally, a small amount of sea water mixed with rain will hardly be noticeable and will not give you any bad physiological reaction. In rough seas you cannot get uncontaminated fresh water. At night, secure your paulin as for sun shade and turn up its edges to collect dew. Rain water does not always satisfy; it lacks minerals and is tasteless. Mix it with a little sea water, or dissolve hard candy or coffee or tea solubles in it to give it taste. When it rains, drink as much as you can hold. Sun ‘strLus. When sun stills are available, read instructions and set them up immediately. Use as many stills as possible, depending on the number of men in your raft and the amount of sunlight available. Secure sun stills to raft with care. DE-SALTING KITs. When de-sealting kits are available in addition to sun stills, use them only for immediate water needs or during long periods of overcast when sun stills cannot be used. In any event, retain de-salting kits and emergency water stores for such periods when vou cannot use sun stills or catch rain water. Don’t drink body fluids of fish, urine, or salt water. They are danger- ous. In Arctic winters, use old sea ice for water. This ice is bluish, has rounded ¢orners, and splinters easily. it is nearly free from salt. New ice is gray, milky, hard, and salty. Water from icebergs ie fresh, but icebergs are dangerous to approach and should be used as a source of water only in emergencies. See water section of “Survival on Land,” page 36 of this manual. Food FIsH AND FISHING. Most fish in the open sea are edible. Do not under any circumstances try to examine or eat jelly-fish. They are messy and can sting. If your fishing kit is lost, improvise hooks from insig- nia pins, pencil clips, shoe nails, pocket knives, fish spines, bird bones, and pieces of wood. Make hooks small and use as light a line as possible. You can get cord from shoe laces, parachute shroud lines, or thread from clothes. First catch small fish that usually will gather underneath the shadow of your raft or that you may shake out of clumps of sea- weed — such as crabs or shrimp. Use them for bait, with heavier hooks and lines, for dolphin or any other large fish. Fish will generally be at- tracted to the shadow of your raft. Make a spear by lashing a knife to 139

an oar; use it for large fish which cannot be caught with a hook. Use dip net to scoop up fish, crabs, and shrimp. If the net is lost, make one from mosquito head-net, parachute cloth, or clothing fastened to a kection of oar. In using either the dip net or an improvised net, hold it under water and scoop upward. Shine flashlight on water at night or use a mirror to reflect moon- light onto the water. The light will attract fish. At night some fish, especially flying fish, may land in your raft. Do not be alarmed by any fish that sails in, but be sure to secure it for food. Rig your rubber sheeting in such a way that it will reflect moonlight. Natives use this trick to get leaping or flying fish. When fishing, @:.2°. make lines fast to the raft or person. Fish or bright objects dangling in water alongside of raft may attract large dangerous fish. Be careful. Large fish should be handled without cap- sizing or damaging raft. Land fish with net or harpoon. Avoid spiny fish and those with teeth. Kill fish with a blow on the head before you bring them into the raft. Don’t molest large fish or sharks by shooting or spearing. Clean and cut all fish immediately and eat them before they spoil. To preserve any fish left over, cut them into thin strips and dry thor- oughly in the sun. Don’t eat eggs or liver. Don’t eat fish with unpleasant odor, pale, slimy gills, sunken eyes, flabby skin, or flesh that stays dented when pressed. All guts of fish and birds can be used for bait. Sea turtles are good for bait, too. Kill them by shooting them in the head; or snag them with a hook and then kill with blows on the head. Avoid their beaks and claws. The liver and fat are edible. The muscle is tough but can be chewed for a while, then thrown away. Biros. All birds are potential food. They can be caught on baited hooks, triangular pieces of shiny metal, or by a baited toggle of metal or wood. (See illustration of toggle on page 153 of this manual.) Many birds will be attracted to the raft as a possible perching place. Sit still in the raft and they may settle on the raft or even on your head or shoulder. Grab them as soon as they have folded their wings. But don’t grab until you are sure you can reach the bird. SHarks. Avoid attracting or annoying sharks. Most of them are scavengers, continuously on the move for food. If they don’t get it from you, they will lose interest and swim on. Their fiesh is extremely strong and smells of ammonia. Chances of being attacked by sharks are very small. Even in warm oceans where attacks are possible, you can reduce the risk by knowing what to do and how to do it. When not in the raft, keep a sharp lookout for sharks. Use shark repellent, if available and if sharks are in the vicinity. Keep your clothing and shoes on. If your group is threatened or attacked by a shark, bunch together and form a tight circle. Face outward so that you can see an approaching shark. If the sea is rough, tie yourselves together. Ward off actual attack by kicking or stiff-arming shark. If you are apparently undetected, stay as quiet as you can. Float to save energy. If you must swim, use strong, regular strokes; don’t 140

make frantic, irregular movements. When swimming alone, stay away from schools f fish. If a single large shark threatens at close range: Use strong, regular swimming movements; try feinting toward the shark — he may be scared away. Don't swim away directly in the shark’s path; face him and swim quickly to one side to avoid him. As a last resort, kick or stiff-arm a shark to push him away. Make loud sounds by siapping the surface of the water with cupped hands. Use regular strokes. Use knife at close quarters in a showdown. Stab the shark in gills or eye. If a shark threatens to attack or to damage the raft, discourage him by jabbing snout or gills with oar (be careful not to break the oar and don’t take roundhouse swings that may upse* you). Fire a pistol above a shark — it may frighten him away. Look for sharks around and under your raft before you go into the water. Sharks are known to be curious and will often investigate any large floating object. After investigation, the shark will usually swim away. At other times it may approach or circle the object in the water and bump or nudge it. Sharks are attracted by blood and vomit, body waste, and garbage. Therefore, these should be discarded in small amounts as far away from the raft as possible. Don’t clean fish into water when sharks are sighted. Any contact with the rasp-like skin of a shark wil] cause brush wounds. The severity of these wounds will depend on the size of the shark and its speed at impact. Hit the shark with your bare hand only as a last resort. Try shouting or screaming under water, as this has been found effective by many skin divers. If injured, it is important to remain in the raft. When in the raft, do not dangle your arms or legs over the side. Remove jewelry or other bright objects which might attract a shark. Dark-colored clothing and equipment are preferable to light-colored ones. Don’t fish from the raft when sharks are nearby. Abandon hooked fish if a shark approaches. If bitten, the first and most important measure is to quickly control hemorrhage and shock. Get into a raft or ashore as soon as possible, stop bleeding, and treat for shock. If in the water in a group, you should circle the victim and apply a tourniquet improvised from an article of clothing or a large gauze pressure bandage if available. Should any member of your party die, his body should be thrown over- board, preferably at night, and the survivors moved as far from it as possible.

CONTENTS OF APPENDIX III Selected Reference Papers Used by the CMNR Calloway, D. H. 1960. Nutritional aspects of the all-purpose survival ration: A critical appraisal. U.S. Armed Forces Med. J. 11 (4):403-417. Davenport, R.E., J.K. Spaide, and R.E. Hodges. 1971. An evaluation of various survival rations. Amer. J. Clin. Nut. 24:513-523. Sargent, F. and R.E. Johnson. 1957. The physiological basis for various constituents in survival rations. Part IV. An integrative study of the All-purpose Survival Ration for temperate, cold, and hot weather. Wright Air Development Technical Report 53-484, Part 4. 18 pp.

Nutritional Aspects of the All-Purpose Survival Ration A Critical Appraisal DORIS HOWES CALLOWAY, PH.D. ARMED FORCES interest in short-term emergency feeding has centered about the problems faced in a survival situation by military person- nel—the men who abandon ship and are castaway on salt water; men who ditch aircraft over any terrain from desert to Arctic; and small partics cut off from normal resupply channels in combat. Similar problems would be present in a civilian crisis resulting from war or a major disaster. Because the space available for emergency supplies 1s severely limited, consideration of the relative importance of survival compo- nents is critical. In most cases, protection from the environment is most important. For the man ditched In the icy waters of the North Atlantic, escape time mav be measured in minutes. In other areas of more gencrous geography, protection from sun, storms, sharks. and scorpions must be provided. Thus, a portion of the available space must be eiven to shelter, sleeping gear, repellents. and a few tools. Provision of reseue-aiding equipment such us flares and mark- ers Is an obvious necessity. Most of the remaining space must be given to water or means of obtaining it. Last of all comes food. There is tude evidence that more than a token food supply is essential to man's survival for brief periods. Among survival experiences reported by the U.S. Air Force? was one in which a group of 3 men survived the rigors of arctic weather without fuel or shelter for 10 davs, on an average daily intake of From the Quartermaster Food and Container In-titute for the Armed Forces, Chicavy, A Presented in the Svmposium on Problems in Nutritien of Military Significance. Medical Education for National Defense Program, at U.S. Arms Medical Research and Nutrition Laboratory, Fitzsimons Army Hospital, Denver, Colo., 30 ApriJ-1 May 1959. APRIL 1960 103

U.S. ARMED FORCES MEDICAL JOURNAL less than 100 calories of malted milk tablets. The men were in grave condition when rescued, suffering from exposure and frostbile, but they survived. In another instance, 4 men lived under similar chmatic conditions, but with the shelter of their aircraft and its fuel, for almost 2 months, during the last 17 days of which they had no food; these men died. Obviously, sustaining life under these conditions was not without a price. Whether a slightly increased food supply would have ap- preciably altered the course of events is worthy of debate. As a result of experience gained in a survival field test in which the men first fasted for 2 davs, the Roval Canadian Air Force? concluded: “The abrupt improvement in morale with the commencement. of limited feeding shows the psychological value of including food in a survival pack.’”’ Certain physiologic evidence also suggests a positive need for food. REQUIREMENT FOR FOOD Much data have been accumulated on responses of animals and man to acute starvation, and to various lesser levels of caloric insufficiency. We shall concern ourselves only with more recent studies in which some attempt was made to evaluate man’s ability to perform phvysi- cally, since this ability is determinant in survival. Table 1. Performance capacity of 12 men during a 4\2-day fast with hard work*® Performance Control sere | S Ss | = RSe* SUSTAINED WORK ; Work pulse, beats per min 129=9 143 144 151 i24 Recovery pulse, beats per min 101414 : 120 , 321 125 7 Blood sugur (work), mg per 100 m) 80+3 $3 59 | 62 ; - EXHAUSTING WORK ; | Score 72.14206 ! 47.8 | - |! ms ! 933 Time of run, sec M061 ; 163 : - |! WH > 239 Bodyweight, kg 70.544.7 6S.5 | 67.0 | 65.9 70. 6 *Adapted from Henschel, Taylor and Keys.? **S refers to day of starvation, R to recovery. A series of tests on total starvation, In which no water limitation was imposed, were conducted under laboratory conditions at the Univer- sity of Munnesota.°-§ The trained. physically fit voung subjects were required to do about 2,500 calories of work daily, for 3 to 5 davs. Some criteria used to evaluate fitness are presented in table 1, 404 VOLUME 11, NO. 4

ALL-PURPOSE SURVIVAL RATION together with results of the tests. The investigators noted no signi- ficant changes during the first day of fasting. On the morning of the second dav, acrobic work pulse rates were increased 10 to 15 beats per minute and the blood sugar in work decreased 25 mg per 100 ml. Essentially, no further change in this regard was noted. The ability to perform exhaustive anacrobic work was definitely impaired on the second day and continued to diminish through the fourth day. During performance of work, nausea and vomiting were frequently encountered. As measured by dynamometers, strength was not. im- paired, but maximal speed of motion (tapping test), and eve-to-hand coordination were reduced parallel to the decrease in blood sugar. The authors suggested that acidosis and dehydration were the factors primarily responsible for the observed decrements in per- formance. This view is supported by the findings of Young and Spector,’ who observed that in dogs, a species in whom marked ketosis does not accompany fasting, aerobic work performance was not impaired by 2 weeks of starvation. Data obtained in man by Sargent. and co-workers,’ both in the laboratory and in the field, produced similar conclusions. In practical terms, we find that men with no food can perform ade- quately for 1 day. Thev can continue to perform sustained phivsical work at greater physiologic cost for several davs, but are less able to complete activilies requiring spurts of high energy. Decrements in reaction me and coordination suggest that the ability to perform such important tasks as hitting a target would be impaired. Logic, therefore, requires that some food should be provided. The question becomes how much of what? Before we can approach this problem intelligently. the relative need for water has to be considered, since space provided for one is at the expense of space for the other. REQUIREMENT FOR WATER A brief review of the components of water exchange. presented in figure 1 as modified from Gamble,® shows the dehydration of starva- tion. Removal of bodv-fluid solutes was accomplished at a loss of 550 ml of body water. <A daily intake of about 800 ml] was necessary to prevent the further loss of body water depicted in the second pair of bars, which show the added condition of thirst. Of the avenues of water loss. onlv the smaller component, urine volume, can be modified by dietary adjustments. The rate at which an incapacitating loss of bodv wate: is reached is dependent chiefly on the volume of the evaporative loss. The amount of this -xtrarcnal output depends, in turn, upon the ambient APRIL 1900 405

U.S. ARMED FORCES MEDICAL JOURNAL temperature and the amount of work performed. With 8 hours of hard work in a hot environment, sweat loss may be 12 to 16 liters per day. Sweating is also increased during hard work in the Arctic, be- cause of the insulating properties of the protective clothing. 1sO0r— W.IN.| UW 1700r— 1060} 825 1GOOR— | --ne- eee ee- 1597 1SOOh— oon 1515 1400}— » 300 632 | 597 x Q 1200—- & ly Qa 1wOR © WIN. WATER INTAKE (min=minimol) * 100F— aren WOX. WATER OF OXIDATION R os BW. BOOY WATER x 900;- i UW URINE WATER (min: minimal) Q IW INSENS:BLE WATER 600r— Y w AAAE © vinne he 214 ar xX 600 ees 2 | S00f- i od 4007— “y iw 000 sO | 200}— 1\0Or— tet A TE ill: FASTING FASTING -THRSTING Figure 1. Components of water exchange and dehydration of starvation. Redrawn from Gamble.® Major reduction in both routes of evaporative loss is observed. however, when water is restmeted. Figure 2 shows the minimal levels achieved when water intake was reduced to 1.800 or 900 ml 100 VOLUME 1], NO. 4

ALL-PURPOSE SURVIVAL RATION per day.”? By this conservation, over 1 liter of water per day was spared, but the reduced sweating rate resulted in a rise in body temperature during work, with increased pulse and respiration rates. Evidence indicates that the loss of § to 10 percent body weight as water is incompatible with sustained performance. It is apparent that the primary requirement of the survival ration is that it must not interfere with conservation of body water. COMPOSITION OF THE RATION We are indebted to Gamble’s group for data basic to the construction of a survival ration. These workers demonstrated conclusively that 1700-— 1600 1800 1400 1dOo CONTROL 100 1000 CAL. WATER AOL S354 (000 CAL So. S23 heed WATER 900 1000 CAL 800 900 m!. WATER 700 690-— E S T I M A T E D W A T E R L O S S GM S. P E R D A Y Figure 2. eaneren eenene seeenee ensoce sevecee aeeeee eee eccnve aocees eeeees eennee eervcee eseore issecses eesess "Voy Veeoese@ tit. | Prats” 6 HOURS SLEEP 14 HOURS REST Estimated minimal fluid loss when food was restricted and water intake was reduced to 1,800 or 900 ml perday. Adapted from Grande, ct al.’ APRIL 1960 107

U.S. ARMED FORCES MEDICAL JOURNAL 100 grams of carbohydrate reduced the deficit of body water by low- ering the amount of body solutes claiming excretion and by prevent- ing ketosis, thus permitting a reduction in urine volume.’ Henschel, Tavlor and Keys,’ found that the loss of speed and coordination in their fasted subjects could also be reversed by administration of 100 grams of sugar. There can be no question that 100 grams of carbohydrate constitutes the minimal essential ration under any sect of conditions. Such a ration has, in fact, been tested in the ficld many times with success. U.S. Navy trials '' were carried out in 195] at Balboa, Canal Zone (mod- erate heat 74° to 89°F) and at Argentia, Newfoundland (moderate cold, 37° to 50°F), where the men were given about 300 calories (60 grams carbohydrate) daily, with a total of 4 pints of water allowed for the 5-day period. Maximum body weight loss was roughly §& percent, and none of the 10 subjects was incapacitated. Acctonuria was present in 9 subjects at Argentia but was less pronounced at Balboa. The Royal Canadian Air Force evaluated a similar ration in 1952 ? and again in 1958,'? concluding on both occassions that this ration was adequate for survival periods of 7 to 10 days during the Canadian summer (temperature 52° to 76°F, water as needed). The U.S. Air Force found, during a 10-day trial in the Alaskan winter, that the physical fitness index of test subjects fed such a ration was unimpaired. The chief complaints were that this ration jmposed a very large caloric deficit, and failed completely to prevent ketosis. In view of this evidence, the continued search for an improved ration of universal applicability may scem unwarranted. This posi- tion has been held by the Navy, with acknowledgment of the fact that survival does not necessarily mean survival in perfectly fit con- dition. However, the Air Force wishes to maintain castaways more nearly in nitrogen balance, caloric balance, and water balance, so that survivors can undertake more active efforts of escape and eva- sion. The Navy envisions a 5-day period of search and rescue, while the Air Force anticipates 4 davs of active or 10 davs of static sur- vival.* In order to meet these different requirements, the prac- ticality of incorporating other nutrients into the ration was examined. First, replacement of salt was considered as an aid in reducing water loss and as the change least costly of space. Gamble’s ® find- ings in this regard are shown in figure 3. More body sodium and extracellular water was conserved in the fasting subject by 100 grams of glucose than by 4.5 grams of sodium chloride. When sodium chloride was given with glucose, all extracellular water loss was prevented. However, the loss of potassium. and consequently of intracellular fluid, was increased, leading the author to conclude 40H VOLUME 1], NO. 4

ALL-PURPOSE SURVIVAL RATION that this was “an unsound physiological bargain.” Issue has been taken with this view by Taylor,'® who reported no aberration when sodium chloride was given to men on limited intakes of carbohydrate and no added benefit from replacement of sodium chloride by potas- sium chloride (3.75 grams) plus magnesium oxide (360 mg). Sargent and co-workers * have also indicated that an all-carbohydrate ration contains too little osmotically active material and accentuates dehydration. WATER INTAKE= !200 cc. -~500 5O0r- = 100 GM. GLUCOSE +4.5GM. NoCl 0 ~< O 50 \ | ‘ = = ~500 o | Q , X 100 S S i Sj = 1000 NX : 150 . ~J a — a& wd x NS w 8 = v5 —!500 & CM, NoC* iy 250 = ly Qing 42000 300r- | l ! 1 OAY | 2 3 4 5 6 Figure 3. Cumulative losses of sodium and extracellular water. Redrawn fron Gamble. Another obvious modification is a simple increase in energy supply. The Minnesota group ™ made precisely this comparison. Young men received a carbohydrate ration with 4.5 vrams of salt and a vitamin supplement for either 12 days at 580 calories per dav or 24 davs at 1.010 calories per day. Assigned treadmill work output was 1,200 APRIL 1960 109

U.S. ARMED FORCES MEDICAL JOURNAL calorics per day. The capacity to perform work was well maintained in both groups, but pulmonary ventilation during work, oxygen debt, and pulse rate responses to a fixed task indicated some deterioration at the lower caloric level. No evidence of poor physiologic response to the stress of work was noted at the higher intake level. The investigators concluded that “when sufficient calories and sodium chloride in the presence of an adequate vitamin intake are provided to prevent ketosis, dehydration and hypoglycemia under conditions of moderate energy output, performance capacity is well maintained up to a weight loss of 10 percent of the original body weight.”’ Addition of protein and fat to the ration is a matter to be approached with some. caution, since the most widely divergent views among investigators and agencies revolve about this problem. The classical studies of Gamble *® showed that at a very low calorie level, a protein intake did not appreciably preserve body protein and that removal of the urea formed increased the renal water requirement. Later, Schwimmer and McGavack reported that nitrogen balance was definitely improved by incorporation of 45 grams of high-quality protein in a 30. percent-fat, 900-calorie ration. This finding was re-examined by the orginal investigators and by the Quartermaster Environmental Protection Research Division early in the 1950’s. Both agreed that there was no significant difference in nitrogen loss between a protein-containing and a protein-free 900-calorie ration with either 800 or 1,800 ml of water per day.'* 7 2" Ketosis occurred only in the protein-fed group and when water was limited, bodv- water losses were greater in this group than in the protein-free group. It was recommended that protein be omitted from rations of 900 calories or less.?° #! At this time the Air Force also undertook an evaluation of nutrient mixtures for survival rations. These studies by Sargent and co- workers ® encompassed 4 nutnent mixtures, ranging from an all- carbohydrate, salt-free ration to a high-protein, high-fat pemmican (ype; 4 calorie levels (0 to 3,000); 3 climates: 2 physical work levels: and 2 water levels. Their ‘normal’ nutnent mixture, with 15 per- cent of the calories derived from protein, 52 percent from carbo- hydrate, and 33 percent from fat, most adequately fulfilled the battery of equally weighted criteria selected from among the many responses evaluated. Others have taken issue, not with the data obtained, but with the evaluation of these data.'® It has been pointed out that for survival potential, a negative nitrogen balance cannot be considered equal to a negative water balance. The poorer performance of the all-carbohydrate ration in this test than in others may have been attnmbutable to the deficiency in salt noted earlier. 410 VOLUME 1), NO. 4

ALL-PURPOSE SURVIVAL RATION The pemmican or meat-bar ration, too high in osmotically active material, was also deemed inadvisable. In direct opposition to these findings are those of Drury, Vaughan and Hannon * af the U.S. Air Force Arctic Acromedical Labora- tory. Their test was conducted under severely cold (+ 14° to —55° F) field conditions, with a 1,000-caloric ration derived exclusively from pemmican making up the dict of a group of 5 young men. A 40-gram sugar allowance replaced 1 ounce of the pemmican issuc in a second group. Neither the level of fluid intake nor the output was reported. Fasting blood-sugar level was somewhat higher and ketone production somewhat lower in the group given the sugar supplement, but the groups did not vary in any other measured characteristic. Over-all performance of both groups was rated adequate for most Arctic survival situations. All physiologic changes leveled off or re- versed direction toward a more normal level after the third dav of the 9-day test, which was interpreted as evidence of adaptation to the high-fat, high-protein, low-caloric dict. In actual experience, most rescues were accomplished within the period required for adjust- ment to the pemmican diet, so that it would seem desirable to obviate the necessity for this adaptation by supplying a more usual dict. However, the concept of adaptation to calorically restricted dicts is an intriguing one. Several workers * 7 * have reported that sub- jects previously exposed to limited food intakes showed reduced nitrogen exeretion, less severe ketosis, and more adequate blood-sugar levels on subsequent repeated treatment. If such biologic memory is maintained for a sufficient period of time, it might be advantageous to pre-expose men to stress which they may iater encounter. Further evidence on this point 1s needed. An attempt was made earlier to resolve the question of nitrogen balance during caloric insufficiency by review and analysis of the data then available.® The experiments cited above did not vield infor- mation differing in any important regard from that published prior to 1954. Since this analysis suggested the formulation of the All- Purpose Survival Ration currently being offered to the various services, the pertinent conclusions are quoted below: For voung, essentially normal, active nen, when no nitrogen is fed, the protein deficit (negutive nitrogen balance) can be maximally reduced by supplying about 700 nunprotein calories. No significant protein-sparing is achieved by intakes as high as 2,800 calories in the ab-ence of vrutein. . . . An intake of aporoximately 900 calories was the lowest level at which the addition of protein to the diet produced noticeably Jess negative nitrogen balance than the same number of protein-free calories. At vhis calorie level the same reduction in negativity of nitrogen balance oeeurred with 3 grams APRIL 1960 HHI

U.S. ARMED FORCES MEDICAL JOURNAL as with 6 grams of nitrogen fed. . . . It is apparent that [excess] protein fed under these circumstances is largely burned as an energy source, producing a concomitant rise in urinary nitrogen exeretion (and obligatory urine volume]. These relationships are illustrated in figure 4. A food unit, in which 7 to § percent of the calories are derived from protein, could be consumed in any multiple number with maximum benefit. from the protein at each energy level and without damage to the water economy. The flexibility of a unit svstem permits adjustment of the level of issue with regard to the number of people to be fed from available supplies and the energy expenditure required of the SUrVIVOrs. | -12b WJ ( 75 9-10 = IS 18-20 [I] 30 36-40 Figure 4. Calculated alteration in ob!‘igatory urine volume compared with nitrogen deficit at varying intakesof protcin and calorics. Fram Calloway and Spector. § A 915m mT S 700 + A < ff : Ss 600 F- TT] mT i § 500} | | | Hl | s 400 + | § 500 - | / | = S [H a ' | = 200 + 1 [u S oot 1] BEL) OME UTE i LJ $ 0 -east~ S00 CALORIES — 1000 CALORIES- 1500 CALORIES 2000 CARIES g -ob on on mr Ef ye" TIgc $ “45 SU LEGEND S -6 - | | | | Protein Q 6 L L % of Cal gm /500Cal. . ~io bk [ ] o 0 Ss = = Provided that sufficient carbohydrate is supplied to prevent ketosis and promote protein utilization, the amount of fat in the ration may be adjusted to achieve maximum caloric density consistent with palatability. Although it was reported that a dict containing 30 per- 412 VOLUME 1), NO. 4