On January 29, 1989, a military aircraft crashed on approach to an airfield in Alaska. The subsequent extraction, evacuation, and casualty resuscitation occurred at temperatures lower than −50° F. Both the medical and military-literature are replete with instructions and advice regarding the handling of trauma victims in the field in the Arctic environment; however; case reviews of such incidents are rare. In this case, the circumstances of the incident, and the organizations on which it fell, argued for almost ideal handling of the care of the victims. Problems that have an impact on the availability of casualty management, generally, in the Arctic such as a widely scattered population and sparse medical facilities, poorly defined evacuation routes, and marginal communication patterns, were not encountered in this review because of the unusual circumstances of this incident. The difficulties of field care in this environment, even under “ideal” conditions, however, are real and evident in this case history. Transportion assets are critical. Rehearsal, critique, refinement, and re-rehearsal of a mass casualty plan can significantly increase victim survival. Proper protocols and confidence in them take on an importance far beyond their benefit in a more temperate environment. Procedures must be worked out in advance, known by all concerned, and practiced, because the “rescuer” is at the same risk of hypothermia as the “victim” and, in addition, is responsible for thinking for the incapacitated patient. Rote-learned drills will be acknowledged far longer in the cold than unspecific guidelines. Survival for trauma victims may depend on those rote actions.