[Paddlewise] CPA Hypothermia Article

Swamped with work right now, but thought I'd dump this unedited version
of the article on to PW that I recently wrote for CPA -- now that it
came out (Copyrighted to myself). I'll be finishing off Part two this
weekend if anyone has any helpful suggestions for inclusion. I purposely
did not attempt to "paint" a complete picture, but rather outlined a
"join-the-dots" scetch that the reader can fill in through further
thought and discussion. Most of you don't get the CPA Newsletter, so I
figured there might be a few newer paddlers on this list that might
benefit. See Ya. Doug

----------------------------

Hypothermia: Cold Conclusions (Part One) - by Doug Lloyd

The fact that cold water kills, isn’t exactly bone-chilling news
anymore. Most of us are well educated about the dangers of cold water
immersion (and exposure). A growing majority of paddlers these days
posses some degree of sophistication in the area of wearing appropriate,
protective apparel. And even new paddlers seem to have enough savvy with
respect to circumventing conditions that might otherwise prove
troublesome. Of course, there will always be individuals who fall
through the cracks of recreational-based hypothermia education, just as
there will always be those who challenge conditions knowing full-well
the consequences -- or simply ignore the dangers. Yet overall,
accidental hypothermia (whether through immersion- or exposure-based
circumstance) still remains one of the primary causes of death amongst
the paddling public, which now includes a growing number of fatalities
amongst more experienced kayakers. Are you wondering why?

With the approach of winter, perhaps it is a good time to revisit the
issue of cold water/cold weather injury and prevention, and review some
of our thinking in light of on-going research and the increase in
incidents. Living and paddling around the cold-watered West Coast of BC,
I am also close to new rescue technology strategies, and I have also
been directly involved with a number of cold water paddling incidents,
which may help shed some light or otherwise prove interesting

Canadian Safe Boating Symposium
British Columbia played host to this year’s event back in March. One of
the keynote speakers was Dr Michael Tipton from the UK -- a thermal
biologist who has dedicated his life to the study of hypothermia and
survival medicine. The information presented would probably challenge
many non-professionals involved with water sports, who normally consider
themselves knowledgeable about the hazards of cold water activities. As
it was, the conference centered on the marine industry, and there were a
few noteworthy items.

Graphic footage was shown of a struggling swimmer, attempting to stay
alive in high winds, cold waves, and a very confused sea state with
cross-wave patterns. For this reason, deep water tradesmen (like oil rig
workers) are being issued with survival suits and/or combination
lifesaving apparel that incorporate a protective facial shield, helping
prevent the adverse effects of the "gasp reflex” and other undesirable
outcomes that breathing cold, aerated water cause. A quick call to
Mustang Survival (leading-edge manufactures of marine survival clothing,
etc), however, indicated there is no current plans to incorporate theses
new technologies into recreational PFD’s.

Dr Tipton went on to give accumulative evidence that many cold water
deaths occur within 10 to 15 feet of safety, conclusively signifying the
role of cold shock response (the gasp reflex), where sudden immersion in
cold water results in sufficient aspiration to cause drowning. Further
test results were presented from experiments that involved an individual
wearing a shorty wetsuit. Breath holding was less than 5 seconds in
50*  water. Apparently though, ventilatory volume can be cut in half and
resultant breath-hold ability improved through adaptation.

Application for Sea Kayakers
It certainly behooves paddlers to dress as much as possible for cold
immersion when and where indicated. As noted, many are meeting the
criteria. Mike Vandamm wrote an excellent article a while back for CPA
ascribing his measured thoughts to this subject. One area that may need
a little more protection is the neck and arms. We all know heat can
escape from your knoggin’ at a rate of 50%, but you might be surprised
by how much can escape from that area from between your chin/lower back
of head and the upper shoulders. I now use a real divers baklava with
neck flange (or have it available) for winter outings. I’ve also taken
to using a dual-density fleece sweater that utilizes a thicker vest area
with attached, thinner long sleeves. This allows for better core
insulating under a paddling jacket and Farmer John (with some arm
insulation), without overheating. With age comes a decrease in our
ability to adapt and deal with cold water, so I’m in the market for a
drysuit now – but it will never replace good seamanship.

I also take a big deep breath if the kayak starts to heel over suddenly
while navigating in cold rough waters. I prepare myself just in case the
kayak gets knocked over -- and keep my bracing skills and combat rolling
skills honed as much as possible. Winter rolling is a great adaptive
strategy. Without these skills, you are disadvantaging yourself during
deep-winter paddling in anything but controlled conditions. You are also
at an extreme disadvantage (all things being equal) without an adequate,
properly fitted and adjusted PFD -- one that keeps your head up out of
the water as much as possible. A buoyant PFD negates some of the
potential for sudden drowning syndrome (caused by the shock of cold
water and the gasp reflex). Also, cold water isn’t the place to be
retrieving your PFD, then trying to put it on and zip it up with
fumbling, cold fingers.

I once blew a roll after getting caught up in heavy air/sea/current
conditions. I reentered only to break my wooden paddle and subsequently
wet exit again in cold, rough water. I can attest to the difficulty and
frustration with such simple tasks as snapping a spare paddle together,
unclipping a Fastex buckle, and attempting to blow up an inflatable
device with cold fingers and lips -- all while aspirating sea-water. If
you ever do bail in cold water, do everything you can to stay with your
buoyant kayak. In my incident, I succumbed to the cold too quickly to
effect a required second re-entry and roll (forgot proper head
protection that day), but the buoyant kayak helped keep my torso out of
the water (I was tethered), extending my available time from loss of
function. I also carried a Sea Seat (small inflatable mini-life raft) in
a back pocket on my PFD as a back-up.

Paddling alone in cold water puts you possibly into the “known
consequence” category, but it is a personal decision based on judgement
and likely conditions to be encountered on route. Where experienced
paddlers are failing is with prior practice in COLD and ROUGH water --
with WIND. It is only then that the true extent of what you will face
becomes apparent. This applies to double kayak paddlers as well. They
are essentially a single vessel if there are no other kayaks around. The
tendency of double-kayak pairs is to dress a bit less for the water than
with the single, solo kayak. Yet, the kind of conditions likely to
capsize a wide double, are often the ones that make an unassisted rescue
very difficult without adequate thermal protection.

Here in the Northwest, it is often stated as fact that there is a
difference of only a few degrees between winter water temperatures, and
those of summer. This is meant to be a positive, reinforcing statement
to indicate that fair-season paddlers ought to be just as cautious as
cold-season paddlers are. Unfortunately, this can have a negative,
reverse impact. In fact, winter water temperatures can be considerably
colder than imagined. Add an arctic outbreak of colder air, or paddle
into the shadowy pocket of a cold inlet, and the water is anything BUT
summer-like. Dress for winter water when its winter (and don’t forget
that tidal mixing combined with an upwelling during summer can create
lower than expected water temperatures, too).

Surviving Hypothermia
Dr Tipton talked a bit about survival strategies, coping mechanisms, and
protocols. The unfortunate news was that too many hypothermia candidates
underestimate the disabling qualities of cold water (our bodies cool
OVER A HUNDRED times faster in water than in air of the same
temperature). It was also mentioned that patients are still not
receiving proper first aid and subsequent after-care -- though the good
news was that trained rescue specialists with advanced hypothermia
treatment skills and equipment are being employed at more and more
shore-based stations and aboard rescue vessels. The usual
recommendations for heat lessening positions were given, with the best
advice simply being to keep one’s arms close to one’s body while keeping
as still as possible. If you must swim, use your legs only, as this
causes less heat loss away from your core, than does using your arms.
During rescue, it is important to keep a victim as horizontal as
possible, and handle them gently, using slow re-warming methods.

The other difficulty an immersion victim faces, is the loss of dexterity
skills and cognitive abilities. This can happen fairly quickly in water
below 50*. This is bad news for kayakers. Attendant hyperventilation
decreases carbon dioxide in the blood, constricting cerebral blood
vessels, creating confusion and sluggish thinking. Blood shunts from
your extremities. Legs stiffen, and shivering caused acids to build up
in the muscles. Once muscle temperatures go below 80*, skin anesthetizes
and nerve impulses to the muscles reduce sufficiently enough to loose
functionality and grip strength (as with your hands). Paddlers must move
quickly to effect self rescue. Back-up methods, like a fixed-deck
Paddlefloat rescue that requires less strength should be considered.
Easy to use flares should be utilized. If subsequent self-rescue
attempts fail, as can happen during a rough sea state, deteriorating
mental abilities due to the cold, along with fatigue, takes a heavy toll
-- usually just at the point where a paddler may need their full
faculties to attempt something different. Add confusion to
disorientation and a decreasing sense of balance from the cold, and it
is not long before despair and apathy sets in. Conclusion one: nothing
beats hypothermia prevention and preparedness.

Part Two will examine a real life drama, and draw some conclusions about
exposure hypothermia.





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