When I come across someone’s story about how an emergency was handled I always try to keep the story in perspective since I know that even when we drill for an emergency, it will seldom follow the course we expect. Many decisions are made in the heat of the moment and only a well drilled team will overcome the tendency to shoot from the hip.
Reading these accounts is always enlightening but most times it’s downright scary. And even though the facts about hypothermia are well documented and the shortcomings regarding field treatment recognized, there is still a lot of mis-information regarding how to treat someone who has fallen into cold water.
The recently released newsletter from the N.M.A. contains a letter from a mariner describing a late night-cold water M.O.B. situation on a Western Rivers towboat and the efforts expended to recover a very large, cold, and wet individual. There are many facets to the story but the ones of immediate interest to me included how the habit of many deckhands wearing a P.F.D. too loosely can have a dangerous consequence. Additionally, the lack of rescue training could have killed this man after he was safely back aboard his boat.We all regard a man-overboard situation as a priority emergency.
Time is always “of the essence”, cold water makes it even more so. The small window of opportunity available to find, recover, and maybe revive a victim is quite small and training needs to reflect a higher level of awareness as to what can and cannot be utilized during a rescue. The last thing we need is to manage the first three steps successfully and fail in the end because we didn’t follow the course of action that may have saved the victim’s life.
The N.M.A Newsletter’s story relates how a large individual (5’9″ at 260 lb.s) is recovered from 39*F water. The efforts expended by 2 large men to pull this soaking wet victim from the water was nearly a failed effort due to the loosely fitted P.F.D. and girth of the man. He was too cold to assist in his rescue, and more to the point, too heavy to be pulled from the water, he was waterlogged and the one thing that may have aided his rescue was in danger of slipping off. Until more help arrived, this man was not getting out of the water.
As the story continues, the help arrives and he is pulled aboard only to be put into another life threatening situation by his rescuers. He was stripped of his clothing and put in a shower to be rewarmed. The absolute wrong thing to do! His next trip may very well have been to the morgue, the swift rewarming in the shower may well have caused a dump of the colder blood in his arms and legs and caused cardiac failure in moments. This is not what should be done to assist a hypothermia victim. The victim’s body mass may have protected his core temperature for a longer time, but his extremities were cooling quickly.
The link provided here has a few of the methods used by professionals when treating a hypothermia victim and none of the methods listed allow for a quick rewarming in any situation. The most effective means includes warmed and moist oxygen and wrapping the victim in layers of blankets. The method of sharing body heat from a rescuer is NOT considered the proper method to rewarm a cold water victim..
Basic First Aid training seldom goes far enough when it comes to hypothermia. Beyond describing its effect and how to recognize it, there are too many remedies passed along like “old wive’s tales” that are potentially deadly in a real world situation. Here’s a fact, if the cold blood in the limbs is dumped into the core by a rapid rewarming, a heart-attack is nearly guaranteed, regardless of the victims age.
The most important phase of treatment is the prevention of post-rescue collapse during the first 30 minutes following rescue, and during transportation to a medical facility.
Some recommended methods of treatment are difficult to apply in the workplace. The lack of enough crew to actually pull the victim from the water. Handling the victim to keep them oriented horizontally will be problematic since most victims will not necessarily be all that co-operative. They may try to help, but in doing so will force cooled blood into their core and risk further complications. Moving limbs will pump cold blood, this is a bad thing until the victim is properly rewarmed. Warm sweet drinks (hot chocolate is a good one, not coffee) will help but the real answer lies in getting professional help as quickly as possible and minimizing the further cooling of the victim. Wrap them in blankets, but don’t try to get them warmed up all at once.
It can’t be emphasized enough how we need to understand cold water immersion and prudent prevention and rescue methods. The link to Cold Water Boot Camp was very useful for illustrating the effects of cold water, but it fell short when it comes to after the rescue. If you’re going to wear a Personal Floatation Device, why wouldn’t you wear it correctly? It takes 30 seconds to properly fit the device, and it will be of use when someone tries to pull you from the water. Bear in mind that although Spring is here in the Northeast, the surface water temps won’t rise above “bone chilling cold” until August.
Mario Vittone, a name known to most of us these days has put himself into the water, suffered the effects of hypothermia and recovery in highly controlled experiments for our benefit. The lessons learned have been freely shared and we can be grateful he suffered in our place for the cause of educating rescuers to the reality of the effects of cold water.