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As highlighted in this journal, there is increasing awareness that the delivery of military healthcare in extreme cold weather (ECW) requires adaptation in order to be effective.1 While being able to deliver care for cold weather injuries is vital, we must also recognise that the care required for other conditions must be modified. This ‘polar dichotomy’ of needing to care for cold weather injuries as well as injuries in cold weather is a key tenet to understanding where and why change is necessary for clinical effect.