Keywords high-altitude environment, brown adipose tissue, non-shivering thermogenesis, gut microbiota, physiological adaptation ,

Abstract Modern warfare and military operations are increasingly dependent on advanced high-tech equipment and emerging combat doctrines, resulting in a more complex and dynamic battlefield environment. In northern regions, severe cold during winter and challenging terrain generally lead to dysfunction of the multiple rescue system for combat casualties and significant difficulties in evacuation and medical transport of casualties. In recent years, the Democratic People’s Republic of Korea nuclear tests and the nuclear deterrence dynamics observed in the Russia-Ukraine conflict have heightened concerns over combat casualty management in cold regions under nuclear radiation conditions, making it a critical focus in military medical research. In this article, considering the core demands of our military combat casualty care and focusing on the construction of medical support capabilities, we primarily analyze the characteristics of changes in multiple systems of casualties in cold regions under nuclear radiation scenarios, profoundly explore the mechanism underlying trauma’s impact on the body, and then develop countermeasures from the various aspects, such as medical rescue levels and chains, rescue equipment, nutritional support, microbiome and other new techniques, providing references for reducing the casualty rate and improving success rate of treatment.