Here is a copy of my recent article that Ralph mentions as worthwhile sending to the list. I sent Part One last month. I wasn't sure about sending it to PW due to privacy issues, but it is written without reference to names and places which was at the request of the other paddlers. Secrecy does not exist in today's communicative world, but privacy should still be an option. All I ask is that you do not reproduce it on any site accessible by the internet. If a small club is intersted in it for a hard copy edition, you can contact me privately. Please comply with this request. You don't want my 90 lb Nordkapp smashed over your head ;-) To Duane and others, remember, "Its not nice to fool with mother nature." :-) PS This month's CPA Newsletter has excellent articles by Vince Dalrymple on paddling in following seas, and David Whyte on his Tasmanian journey, respectively. Some very mature writing, submitted to a mature little newsletter in an area of North America that has some very - you guessed it - very mature paddlers. BC'in Ya for awhile, In friendship to the list and all, Doug Lloyd Long post warning ------------------------- > Hypothermia: Cold > Conclusions (Part Two) > > by Doug Lloyd ©2000 > > With reference to Part One, the dangers of rapid-onset immersion hypothermia typified in water temperatures below 50ºF were discussed. While the attendant issues of sudden “cold shock” and “the gasp reflex” must be considered, these mechanisms are less of a problem for most fit, reasonably appareled kayakers -- unless water temperatures are very low. And by implication, the first article deliberately profiled the difficulties faced by the solo cold water paddler, where rapidly accelerating time-course deterioration can occur. > Part two examines the slower-onset effects of exposure hypothermia, which can arise after a self- or assisted-rescue, or exposure to generally cold conditions -- both on and off the water. Net results from all types of hypothermia are the same: a drop in core-body temperature and biochemical imbalance once passive external rewarming fails to generate sufficient heat. To reiterate, full immersion hypothermia does have a higher mortality rate, even amongst sea kayakers (on both sides of the 49th Parallel); though statistically, most paddlers do live to tell their tale. > > Exposure Hypothermia > While immersion hypothermia still warrants full attention, out-of-water, incipient cold-induced injury and post-immersion-event hypothermia have the potential for adverse outcomes too. Depending upon the depth of cooling and duration, pertinent and predisposing physiological factors (age, weight, etc), and the reduced metabolic regulation that accompanies fatigue or insufficient nutrition/hydration -- a paddler can get into trouble in any season or almost any latitude. > The line between hypothermia that develops while attempting to get back into the kayak after immersion and that of cold stress once back aboard -- can be difficult to define. Subsequent to reboarding, you are often very wet, nervous, and exposed to wind and spray. Pockets of water may not have drained properly from certain shell paddling apparel. The space that normally fills the air-voids in high-tech insulating garments are often saturated with water, providing little insulating value -- despite your high faith in them. And water may still be present in your cockpit. In cold water, you are still better off out of the water -- though you may feel colder due to evaporative heat loss. > > Resuming Paddling > For both the solo paddler and the rescue-assisted paddler, one of the options for mild hypothermia is to increase heat production through muscle exertion and exercise. That means resuming paddling when off shore (perhaps after eating a quick calorie-booster or adding more insulation -- and a paddling jacket if one was not worn). Paddling immediately again may be too much to ask from certain paddlers. Where help is at hand from other mariners, a decision must be made after capsize, whether or not the paddler is capable of resuming paddling. It is important to bear in mind, that the decision to resume paddling activity can often be hampered by worsening conditions, a paddler only moderately dressed for immersion, and an over-tasked leader. There is a lot of variability with individual physiologic responses to the water and ambient air temperatures present. Compensatory mechanisms cannot last forever. Always head for shore where it is prudent to do so, and allow an hour for rew! ! ! ! ! ! arming and > reassessment. Exclude any potential that might exacerbate cold stress: get out of the wind, dress into dry clothing, and drink hot beverages. I’m also of the opinion that in real emergencies, a “space blanket” is less effective than a heavy gauge poly-bivi bag, though you should have a number of tools in your toolbox of rescue protocols and procedures. > > Prompt Recognition > Literature reminds us that hypothermia has an insidious, difficult to detect onset. Windy, wet, cold conditions usually factor prominently. These are precisely the environmental factors that can be found in sea kayaking. Indeed, the cold-exposure skills necessary to recognize and deal accordingly with actual, in-the-field diagnosis are often not evident or ignored. The lone paddler, shivering at increasing intervals, often simply initiates more vigorous paddling (which eventually yields diminishing returns as noted). > In a group situation, suffering paddlers of various experience levels are often loath to say anything, not wanting to impede the progress of the group. Further, experienced paddlers with good situational awareness will most likely be looking out for the novice (for signs of erratic behavior, clumsiness, course veering, etc.) but typically no one is observing the advanced paddler or leader. Moreover, your peer-group paddling partner(s) may not have enough awareness to recognize a fellow paddler in decline, expecting the paddler to say something if there is a problem. In reality, the hypothermia candidate often cannot self-diagnose. The conditions that favor hypothermia are often the ones that affect cerebral energy decline, which negates proper detection with its attendant irrationality. > > Experience With Exposure > While the actual pathophysiology of cold exposure (and immersion-related exposure) is beyond the scope of this article and my medical knowledge, it is not beyond my direct experience. I was part of a pre-season trip involving three experienced sea kayakers making their way down a mixed open and sheltered coastline. While the trip was well planned, its execution was not necessarily well done. Certainly, the harsh conditions were not entirely anticipated. Nighttime temperatures went below freezing. Daytime temperatures varied, but the cold humidity combined with SE gales, snow, hail and sleet made hypothermia a constant threat. On wet, snow-bound days, survival-mode skills were important, as were the folding survival saws for fire building. Normal conversation and navigational comparison exercises were replaced. Instead, we attempted to keep warm and dry -- and repair boat damage from heavy seas. > Despite state-of-the-art synthetic undergarments, insulating properties of the name-brand products often impair by mid-day, due to rapid condensation and lowering body shell temperatures. Respiratory heat loss, high wind-chill, copious internal and external moisture sources, and heat loss through normal radiation, conduction and convection -- all took their toll despite proper outer-garments that matted against the skin. Headwear choices were difficult, due to heavy rain, high wind, and wave action. One member of the team, Fred (not his real name) was eldest by 10 years. He had packed a shoulder-length, summer bag that wasn’t up to the demands. Each day his “set-point” at where he became increasingly dysfunctional occurred earlier in day. Particularly at the end of a grueling day with 30+ knot head seas, Fred needed physical lifting out of his kayak upon reaching shore. > > Cold Lessons > A break in the weather on day eight of the trip lulled us into the proposition of making a crossing in very open water subjected to unmarked tidal action, rather than continue to a more southerly, narrower crossing. This was meant to remove us from the exposed coast. After an hour into the first 7-mile leg of the crossing, Fred’s rudder cable broke. I deployed my 50-foot towline, and the three of us somehow decided to attempt to get to the first-leg, mid-point island-chain to > put in for repairs (returning with a following sea was thought to be a dangerous proposition). > The SE gale got much worse, causing 6- to 8-foot seas to break mercilessly on top of the constant westerly swell already coming in at 6 feet. Combined seas were reaching the feasibility for paddling safely. Gusts climbed to 40-knots a few times. A record-snowmelt (estuarine outflow) had combined with unknown persistent ebb tides and the aforementioned gale. We were helplessly flushed out into open water for a total of 6 to 7 more hours. Fatigue and cold eventually overcame Fred (fortunately in a wider, stable kayak, preventing capsize). His lips were swollen from the constant barrage of spray and waves, while the other paddler, John (not his real name) fought to keep his kayak from tumbling backwards in the cold, breaking seas. > Both paddlers were succumbing to the conditions at a variety of levels. Dehydration, an important but often overlooked aspect in combating hypothermia, was one of the factors that overcame our collective sheer determination to reach the island. Though we didn’t feel hungry (actually a sign of dehydration), we were nutritionally disadvantaged having only had a light breakfast. Rafting difficulties in the heavy air/sea conditions made water-sharing an arduous task. My fast, but narrow kayak, didn’t help the situation. > As the sole person towing, tiring back-spasms and my higher dehydration levels were overcoming the fitness evident during the just-ended record-winter storm-paddling season back in my hometown. Fred had sat the winter season out, and had all but given up paddling near mid-point in the crossing due to the cold, his decreased “set point” and lack of developed stamina. His hands and digits burned with pain due to their high surface-to-volume ratio loss-of-heat and his death-grip on the paddle shaft. His light polypro fingerless gloves were entirely insufficient for the conditions (both Fred and I took a week to regain full use of our hands). Wave-spray continuously washed over his body increasing convective heat losses. He was drained emotionally too. Cold can do terrible things to your mind and body. > > Cold Circumstances/Cold Comfort > Toward the end, John’s kayak split a side seam in the rough seas (it had a few years on it), and his cockpit filled with cold, 45°F seawater right up to the knee-tube. He didn’t inform us right away, however, about his split seam. Cold conditions can do terrible things to communication. John was already getting very cold and exhausted before that point, despite wearing polypro underwear, a fleece paddling jacket, and a 3-mil Farmer-John wetsuit under a full top-of-the-line drysuit. Critical cold stress would eventually worsen while he attempted to bail out the cold water in the difficult seas. A group is only as strong as its weakest link, and at that point, two big chains were letting go. We had already spent countless hours trying to close on the last two miles to the island. These considerations, along with the collective fatigue as a group, played heavily into our decision for a conservative bailout prior to the coming of nighttime -- though I was still relying heavily o! ! ! ! ! ! n > determination and adrenaline -- and praying for a tide change and redemption. Neither would ever come. > Fred had repeatedly insisted he was fine other than extreme fatigue and fear of capsize every time the towline jerked after coinciding waves. The true extent of his hypothermia-distress finally became evident to John during the initial flare launch. John had to yell directions at Fred, so Fred could try to load and fire the normally easy-to-launch pistol flares (I was towing both as a temporary raft, unaware of Fred’s condition, while John stabilized Fred’s boat). John instantly recognized Fred’s unmistakable symptoms: shivering, fumbling fingers, clumsiness -- all indicating a loss of fine motor control. Fred did not understand simple and direct verbal commands, returning communication with irritable, slurred speech giving clues to his clouded consciousness and loss of cerebral capacity. Fred was able to finally fire a few flares, but the mild recoil associated with these guns was sufficient to almost cause a couple of capsizes. It was fortunate no one was shot in t! ! ! ! ! ! he head > with a flare. > The first set of flares failed to attract the attention of a passing vessel. Left to the mercy of the cold sea, we continued Plan A trying to make the island before darkness, despair, and possible death engulfed us. Sometime later, another vessel was spotted, and more flares and complex radio communication sessions ensued. The Coast Guard already had a military aircraft aloft, unknown to us at first. The pilot requested a series of coordinating flares to be fired in order to pinpoint our location and give vectors to the two fishing vessels in the area who were unable to find us, despite the intense display of pyrotechnics meant for them. I was towing the raft again. Fred, normally a strong, powerful man, was unable to hold on to John’s boat during this reversal of duties from the first flare session. Cold conditions can do terrible things to your strength. I continued towing, unaware that John had drifted away. Only prior training, incredible skill and professional p! ! ! ! ! ! rotocol on > the part of John allowed the positive rescue outcome in such cold, trying circumstances. > > Post-Rescue Hypothermia Care > Rescuing three cold, stiff paddlers was not an easy task, but once aboard, Fred was immediately assessed by the Captain, and ordered into a heated cabin. He was given dry clothing, a sleeping bag, and warm tea. Fred complied, as the Captain would take no guff. This was the correct aid for his apparent stage of hypothermia (but would have been wrong for deep hypothermia). A fast response Zodiac dropped off a SAR Tech, who indicated to me quietly the preponderance of a more profound hypothermia; then promptly administered oxygen and moist air to Fred via an inhalation-rewarming device. It required 40-minutes to bring our friend back to normothermic values. > The specialized device, called the RES-Q-AIR, was designed at the University of Victoria, during hypothermia research that is now recognized worldwide. The device has proven superior as a non-invasive method for heat donation (via the airway) for critical core-tissue temperature stabilization for all stages of hypothermia in a wilderness environment. It is the only pre-hospital, portable field-treatment method for slow, safe, active internal rewarming -- where prevention of post-rescue collapse after acute cooling is a danger. It is a small, heavy device about the size of a climber’s small backpack. Older models were called “Heat-Treat” and ran on propane, but this latest unit came with its own battery pack and supplemental oxygen supply. > I’m positive Fred would have lapsed into sharp decline had we not been rescued. As it was, definitive medical care had been summoned, and active external rewarming, other than that provided by the second-mate, was not necessary with the availability of the device and rescue personal. (It should be noted that an individual in deep levels of hypothermia encounters associated dangers with external rewarming techniques. The stimulation of peripheral circulation can reduce blood volume at the core, bringing about rewarming shock. Metabolic waste products can return via venous blood surging back to the heart from cold muscles, causing fatal heart arrhythmias, and warm drinks can rob core heat -- all avoided with the RES-Q-AIR which provides a conservative rewarming rate that promotes cardiovascular stability). Miracles come in strange packages. > > Cold Truth/Cold Convulsions > The device employed also assisted Fred by passing the moist, 105°F steam through his lung tissue and directly into the blood stream, assisting rehydration and brain metabolism (the brain is warmed from the increasing warm blood flow). This also had the effect of permitting rapid psychological improvement, as expressed by the big smile on Fred’s face, his true tears of joy, and the positive communication. Fred finally realized that he had indeed been chilled almost to the core and had been “out of it”. > An aggressive fluid intake and caloric replacement regime were given to John and I once transferred to the Coast Guard vessel for the 3-hour return to home port. Adrenaline continued to serve me well (in between bouts of pending seasickness) until all the kayaks were unloaded at the lockup. Once ashore, I tried to regain my “land legs”, but my knees buckled beneath the cold evening air, and from the twelve hours in a damp wetsuit and the sudden psychological release of all that adrenaline and anxiety. In the blink of an eye, I went into violent, unimaginable shivering convulsions. At my request, I was immediately assisted to the CG’s private hot showers, having self-treated this condition twice before in my twenty years of paddling (trickle-warm water, directed at the torso only, increasing flow rate and hot water gradually, remaining for 20 minutes; then dry clothing and exercise). Caution is advised, however, when self-treating the sudden-onset of cold-shock. One m! ! ! ! ! ! ust be > deeply aware of what stage of decline one is in. It is not normally recommended. nd as I found out, overcoming the psychological impact of hypothermia can take considerable long time. > Conclusion Two: Proper protective apparel and avoiding immersion do not prevent the potential for hypothermia. > > Due to the privacy issues with the incident above, this article is for CPA > members' reading only, unless permission is obtained from the author. You can > reach Doug at: dlloyd_at_telus.net. > *************************************************************************** PaddleWise Paddling Mailing List - Any opinions or suggestions expressed here are solely those of the writer(s). You must assume the entire responsibility for reliance upon them. All postings copyright the author. 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