Don t loose your cool! Cold Water Immerison SECTION 1
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1 Don t loose your cool! Cold Water Immerison SECTION 1
2 Cold Water Incident Case Study SECTION 2
3 Convict Lake Tragedy
4 Relevance to you as: 1) A potential victim 2) A rescuer 3) An educator 4) A policy maker
5
6 U.S. Drowning Stats Water Temperature ( º F) accidents fatalities
7 National Lifesaving Society Drowning Report
8 The Cold Facts SECTION 3
9 QUESTION! If you fall in ice water, with winter clothes on, how long do you think it will take to become hypothermic?
10 % of respondents Estimated Time To Hypothermia to 5 6 to to to to 30 >30 Minutes
11
12 This guy knows!
13 Here s what s new! The Principle for survivors The Kick-and-Pull self rescue method The Gentle & Horizontal rescuer s motto
14 Thermoregulation Basics SECTION 4
15 General Thermoregulation Like a house climate control system To cool down Skin Temperature Sensors Core Temperature Sensors Thermostat Hypothalamus (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
16 General Responses to Cold Exposure Vasoconstriction - mainly in hands/feet - primarily finger and toe tips Shivering - Alternating contraction/relaxation - Metabolic heat production
17 Shivering Thermogenesis Inefficient muscle oscillations Metabolic heat production
18 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
19 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
20 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)
21 4 Phases of Cold Water Immersion SECTION 6
22 Terminology Immersion vs. Submersion
23 Understand Cold Exposure Immersion vs. Submersion Immersion Head Out (main concern hypothermia)
24 Understand Cold Exposure Immersion vs. Submersion Submersion Head In Main concern - drowning
25 Here s what s new! 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)
26 4 Phases of Cold Water Immersion Cold Shock Response (1 min) Cold Incapacitation (5-15 min) Hypothermia (30 min) Circum-rescue Collapse
27 Cold Water Swim Megan Video
28 When and How You Can Die in Cold Water 1) Cold Shock Response (0-2 minutes) Gasp Drown Hyperventilation Faint Drown Keep head out of water Enter slowly when possible Thermal protection Don t panic, keep calm Cardiac Work Cardiac Arrest If existing heart problems
29 Winnipeg Free Press Cardiac Work Cardiac Arrest (If existing heart problems)
30 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)
31 When and How You Can Die in Cold Water 3) Onset of Hypothermia 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 minutes) If head above water (i.e., with flotation) Cooling to CARDIAC ARREST (28-25 C) > minutes
32 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)
33 Principle SECTION 7
34 Principle Refers to first three phases of cold water immersion
35 Drowning Prevention DO NOT PANIC, because you have: 1 minute to get your breathing under control 10 minutes of meaningful movement 1 hour before you become unconscious due to hypothermia
36 Principle Regarding the Cold Shock Responses Consider the following: 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
37 Principle Regarding Cold Incapacitation Consider the following: You have 10 minutes of meaningful movement for self rescue Once you start becoming weaker, prepare to wait for rescue
38 Principle Regarding Hypothermia 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
39 HELP (Heat Escape Lessening Position) a) Consider areas of high heat loss b) Position to minimize heat loss
40 LIFE SAVING MESSAGE Principle DO NOT PANIC, because you have: 1 minute to get your breathing under control 10 minutes of meaningful movement 1 hour before you become unconscious due to hypothermia
41 So What? Cold Water Immersion Don t panic Don t drown Principle Heart Long time until cold enough to stop (heart must cool ~10 C) Giesbrecht Hypothermia Therapy
42 Cold Water Drowning SECTION 8
43 Cold Water Drowning (Submersion) Brain cooling protects the brain from anoxia DROWNING IN A SWIMMING POOL Irreversible brain damage after ~ 4 minutes DROWNING IN COLD WATER (<10 C) Successful recovery after up to ~ 66 minutes Giesbrecht Hypothermia Therapy
44 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)
45 IMMERSION Head out Hypothermia HEART Prevent Drowning Don t Panic Don t Drown Heart stops -Long Time Summary SUBMERSIO Head Nin CW Drowning BRAIN Focus on Treatment Don t Give Up Don t warm Oxygenation Cold Brain - May survive
46 Cold Water Survival SECTION 9
47
48 Factors Affecting Core Cooling Water temperature / sea state Air temperature / wind chill Wind Chill Chart* Temperature Celsius Fahrenheit Wind Speed Equivalent Temperatures 5 kph mph kph mph kph mph kph mph kph mph kph mph kph mph kph mph kph mph kph mph kph mph kph mph kph mph kph mph kph mph kph mph * 10 windchill units warmer with full sunshine Frostbite Guide 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 High Risk (>95%) within 2 minutes exposure
49 Factors Affecting Core Cooling In water: thermal protection In air: clothing insulation/permeability
50 Lost hiking / skiing Stranded Vehicle/Snowmobile Extreme sport/recreation - Climbing /skiing Other Avalanche Injury Cold Air Risk Of Exposure
51 Life jacket Behaviour Activity HELP / Group HUDDLE Cold Water Survival
52 Cold Water Survival Signals
53 Cold Water Survival Signals
54 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
55 Stay or Swim SECTION 10
56 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?
57 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
58 In C water With a PFD Swimming distances for: Novices was ~ 800 m RECENT STUDIES Experts was ~ 1500 m Average swim time was ~45 min The evidence suggests swimming is possible... But still very risky
59 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!
60 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!
61 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
62 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
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