Don’t loose your cool! Cold Water Immerison

SECTION 1

Cold Water IncidentCase Study

 SECTION 2

Convict Lake

Tragedy

Relevance to you as:

1) A potential victim

2) A rescuer

3) An educator

4) A policy maker

0

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800

1000

1200

1400

1600

30-39 40-49 50-59 60-69 70-79 80-89 90+

accidents fatalities

U.S. Drowning Stats 2006

Water Temperature (ºF)

 

National

Lifesaving Society

Drowning Report

The Cold Facts

SECTION 3

QUESTION!

If you fall in ice water,

with winter clothes on,

how long do you think it

will take to become

hypothermic?

Estimated Time To Hypothermia

05

101520253035404550

0 to 5 6 to 10 11 to 15 16 to 20 21 to 30 >30

% o

f re

spondents

Minutes

This guy knows!

Here’s what’s new!

• The 1-10-1 Principle for survivors

• The Kick-and-Pull self rescue method

• The Gentle & Horizontal rescuer’s motto

Thermoregulation Basics

SECTION 4

General ThermoregulationLike a house climate control system

ThermostatHypothalamus

(37±0.5°C)

Lose Heat - Open Window - Vasodilation- Sweating

To warm up

Decrease Heat Loss - Close Window

- Vasoconstriction

Increase Heat Production - Furnace on

- Shivering

To cool down

Core Temperature

Sensors

Skin Temperature

Sensors

General Responses to Cold Exposure

• Vasoconstriction

- mainly in hands/feet

- primarily finger and toe tips

• Shivering

- Alternating contraction/relaxation

- Metabolic heat production

Shivering Thermogenesis

Inefficient muscle oscillations

Metabolic heat production

Which drink do you give the cold patient?

• Only for mild hypothermia.

• Conscious, alert, won’t choke.

Hot/Warm Water?

Cool Alcohol? Cold Soft Drink

BEST: Warm Chocolate

Mechanisms

of Heat Loss

RADIATION – infrared radiation of heat energy to nearest object

CONDUCTION – direct contact with solid or liquid

CONVECTION – boundary layer of air/water is moved away, requiring warming of new layer

EVAPORATION – change of liquid to gas requires energy, thus cooling surface

Infrared scans of skin surface temperature (light warm, dark cool)a) Normal conditions

b) Cold decreases surface blood flow (skin cooling and decreased heat loss)

c) Exercise increases surface blood flow (skin warming and increased heat loss)

4 Phases of Cold Water Immersion

SECTION 6

TerminologyImmersion vs. Submersion

Understand Cold Exposure

Immersion vs. Submersion

Immersion – Head Out

(main concern – hypothermia)

Understand Cold Exposure

Immersion vs. Submersion

Submersion – Head In

Main concern - drowning

✔ Skin gets cold

Cold Shock Response (1-2 min)

✔ Muscles and nerves get cold

Cold Incapacitation (10 min)

✔ The core gets cold

Hypothermia(30 min)

Here’s what’s new!

Cold Shock Response (1 min)

Cold Incapacitation (5-15 min)

Hypothermia (30 min)

Circum-rescue Collapse

4 Phases ofCold Water Immersion

Cold Water Swim

Megan Video

When and How You Can Die in Cold Water

Gasp Drown

1) Cold Shock Response

(0-2 minutes)

Keep head out of water

Enter slowly when possible

Thermal protection

Don’t panic, keep calm

If existing heart problems Cardiac Work Cardiac Arrest

Hyperventilation Faint

Drown

Cardiac Work Cardiac Arrest (If existing heart problems)

Winnipeg Free Press

When and How You Can Die in Cold Water

2) Cold Incapacitation

(2-15 minutes)

Local cooling of nerves and muscle fibers

- Swim failure,

- Can’t hold on,

- Can’t perform survival tasks

If you can’t get out in 5-15 minutes, you might not get out

on your own power!

If so, prepare to survive.

Widen window of opportunity for rescue.

Thrashing around will:

- increase heat loss

- cause exhaustion (Drowning)

When and How You Can Die in Cold Water

The body is thermally protected by

• Vasoconstriction (decreased head loss)

• Shivering (increased heat production)

Mild Hypothermia (35°C) > 30 minutes

Cooling to UNCONSCIOUSNESS (~30°C) >60-90

minutes

If head is submerged (under water)

• Drowning (within 30-90 minutes)

If head above water… (i.e., with flotation)

• Cooling to CARDIAC ARREST (28-25°C) > 90-180 minutes

3) Onset of Hypothermia

When and How You Can Die in Cold Water

4) Circum-rescue collapse

Just before, during or after rescue

Collapse – ranging from fainting to death

May be caused by:

• Mental relaxation, and

• Decreased output of stress hormones

(epinephrine/adrenaline)

• Drop in blood pressure (faint)

• Extra cardiac work (cardiac arrest)

1-10-1 Principle

SECTION 7

1 - 10 – 1 PrincipleRefers to first three phases

of cold water immersion

• 1 minute to get your breathing under

control

• 10 minutes of meaningful movement

• 1 hour before you become unconscious

due to hypothermia

DO NOT PANIC, because you have:

Drowning Prevention

1-10-1 Principle

• DO NOT PANIC

• If possible, enter the water slowly and try to keep

your head from being submerged

• Focus on surviving the first minute by getting

control of your breathing

Regarding the Cold Shock Responses…

Consider the following:

1-10-1 Principle

• You have 10 minutes of meaningful movement

for self rescue

• Once you start becoming weaker, prepare to

wait for rescue

Regarding Cold Incapacitation…

Consider the following:

Delaying the Onset of Hypothermia

• Must wear a PFD (life jacket)

• HELP position

• Groups of individuals (HUDDLE)

• Exit water as soon as possible

• If exit not possible, get as far out of the water as possible

Regarding Hypothermia…

Consider the following:

1-10-1 Principle

HELP (Heat Escape Lessening Position)a) Consider areas of high heat loss

b) Position to minimize heat loss

LIFE SAVING MESSAGE1 - 10 - 1 Principle

• 1 minute to get your breathing under control

• 10 minutes of meaningful movement

• 1 hour before you become unconscious due

to hypothermia

DO NOT PANIC, because you have:

Cold Water Immersion

• Don’t panic

• Don’t drown

• 1-10-1 Principle

• HeartLong time until cold

enough to stop

(heart must cool ~10°C)

So What?

Hypothermia TherapyGiesbrecht

Cold Water Drowning

SECTION 8

DROWNING IN A SWIMMING POOLIrreversible brain damage after ~ 4 minutes

DROWNING IN COLD WATER (<10°C)

Successful recovery after up to ~ 66 minutes

Cold Water Drowning (Submersion)

Brain cooling protects the brain from anoxia

Giesbrecht Hypothermia Therapy

Mechanisms of cold protection

for the anoxic brain (no oxygen)

Decreased oxygen requirements

• As tissue cools 10°C, O2 requirement decreases to ½ to 1/3

• Even cooling the brain 3°C protects the brain from anoxia

Other mechanisms:

• Brain cooling decreases production of harmful

neurotransmitters

• Brain cooling decreases harmful changes in vascular

permeability in the brain

Protection occurs:

• During anoxia (drowning)

• After rescue (reperfusion)

Summary

• Head out

• Hypothermia

• HEART

• Prevent

Drowning

• Don’t Panic

• Don’t Drown

• 1-10-1

• Heart stops-Long Time

• Head in

• CW Drowning

• BRAIN

• Focus on

Treatment

• Don’t Give Up

• Don’t warm

• Oxygenation

• Cold Brain

- May survive

IMMERSION SUBMERSIO

N

Cold Water Survival

SECTION 9

Factors Affecting Core Cooling• Water temperature / sea state

• Air temperature / wind chill

Wind Chill Chart* Temperature

Celsius 0 -5 -10 -15 -20 -25 -30 -35 -40 -45 -50

Fahrenheit 32 23 14 5 -4 -13 -22 -31 -40 -49 -58

5 kph -2 -7 -13 -19 -24 -30 -36 -41 -47 -53 -58

3.1 mph 28 19 9 -2 -11 -22 -33 -42 -53 -63 -72

10 kph -3 -9 -15 -21 -27 -33 -39 -45 -51 -57 -63

6.1 mph 27 16 5 -6 -17 -27 -38 -49 -60 -71 -81

15 kph -4 -11 -17 -23 -29 -35 -41 -48 -54 -60 -66

9.2 mph 25 12 1 -9 -20 -31 -42 -54 -65 -76 -87

20 kph -5 -12 -18 -24 -30 -37 -43 -49 -56 -62 -68

12.2 mph 23 10 0 -11 -22 -35 -45 -56 -69 -80 -90

25 kph -6 -12 -19 -25 -32 -38 -44 -51 -57 -64 -70

15.3 mph 21 10 -2 -13 -26 -36 -47 -60 -71 -83 -94

30 kph -6 -13 -20 -26 -33 -39 -46 -52 -59 -65 -72

18.3 mph 21 9 -4 -15 -27 -38 -51 -62 -74 -85 -98

35 kph -7 -14 -20 -27 -33 -40 -47 -53 -60 -66 -73

21.4 mph 19 7 -4 -17 -27 -40 -53 -63 -76 -87 -99

40 kph -7 -14 -21 -27 -34 -41 -48 -54 -61 -68 -74

24.4 mph 19 7 -6 -17 -29 -42 -54 -65 -78 -90 -101

45 kph -8 -15 -21 -28 -35 -42 -48 -55 -62 -69 -75

27.5 mph 18 5 -6 -18 -31 -44 -54 -67 -80 -92 -103

50 kph -8 -15 -22 -29 -35 -42 -49 -56 -63 -60 -76

30.5 mph 18 5 -8 -20 -31 -44 -56 -69 -81 -76 -105

55 kph -8 -15 -22 -29 -36 -43 -50 -57 -63 -70 -77

33.6 mph 18 5 -8 -20 -33 -45 -58 -71 -81 -94 -107

60 kph -9 -16 -23 -30 -36 -43 -50 -57 -64 -71 -78

36.6 mph 16 3 -9 -22 -33 -45 -58 -71 -83 -96 -108

65 kph -9 -16 -23 -30 -37 -44 -51 -58 -65 -72 -79

39.7 mph 16 3 -9 -22 -35 -47 -60 -72 -85 -98 -110

70 kph -9 -16 -23 -30 -37 -44 -51 -58 -65 -72 -80

42.7 mph 16 3 -9 -22 -35 -47 -60 -72 -85 -98 -112

75 kph -10 -17 -24 -31 -38 -45 -52 -59 -66 -73 -80

45.8 mph 14 1 -11 -24 -36 -49 -62 -74 -87 -99 -112

80 kph -10 -17 -24 -31 -38 -45 -52 -60 -67 -74 -81

48.8 mph 14 1 -11 -24 -36 -49 -62 -76 -89 -101 -114

* 10 windchill units warmer with full sunshine

Frostbite Guide

High Risk (>95%) within 2 minutes exposure

Low risk (< 5%)

Increasing risk (5-95%) within 30 minutes exposure

High risk (>95%) within 10 minutes exposure

High risk (>95%) within 5 minutes exposure

Wind Speed Equivalent Temperatures

Factors Affecting Core Cooling• • In water: thermal protection

• In air: clothing insulation/permeability

• Lost – hiking / skiing

• Stranded –

Vehicle/Snowmobile

• Extreme sport/recreation -

Climbing /skiing

• Other – Avalanche

• Injury

Cold Air Risk Of Exposure

Cold Water SurvivalLife jacket

Behaviour• Activity

• HELP / Group HUDDLE

Signals

Cold Water Survival

Signals

Cold Water Survival

Cold Water Survival

Life jacket

Behaviour• Activity

• HELP / Group HUDDLE

Signals

Thermal Protection• Clothing

• PFD

• Wet suits

• Extended wear “paddling” dry suits

• Low activity/short duration wear dry suits• Survival suits / Rescue personnel

Stay or Swim

SECTION 10

What to do?

• Your boat has capsized in the

middle of the lake

• The water is cold

• There is little chance of rescue

• Should you

“Stay with the boat no matter what?”

To swim… or not to swim?

Can you make it?

If you swim and are wrong…

• Without a PFD, the price is death

• With a PFD, the price is

incapacitation but at least you’re

still floating

• In 10-14°C water

• With a PFD

• Swimming distances for:

• Novices was ~ 800 m

• Experts was ~ 1500 m

• Average swim time was ~45 min

• The evidence suggests swimming is possible . . .

But still very risky

RECENT STUDIES

Decision Making

In 2006 the Canadian Red Cross

Society stated:

“If rescue is unlikely, it may be

preferable to swim to safety”

Note: this is true only if you have a

PFD on!

After you fall into cold water

• Don’t panic

• Get your breathing under control (~1 min)

• IF YOU HAVE NO PFD . . .

STAY WITH THE BOAT!

After you fall into cold water

IF YOU DO HAVE A PFD:

• Get breathing under control

• Ask “Is rescue likely”within an hour or so

• If yes – stay with the boat, preserve energy and heat

• If not - you may consider swimming

• Once you make your decision, stick to it

After you fall into cold water• Determine the closest/easiest destination

• Do you think you can make it?

or

• Can you get there within 45 minutes?

• If so, you can proceed

• Swim with a head out breast stroke at even

and sustained pace (consider back stroke)

• No guarantee! But you have a PFD