How to deal with
Hypothermia and Cold Shock
How to deal with
Hypothermia and Cold Shock
We will cover:
Statistics
The Five Phases of Cold Water Immersion
0
1 – 10 – 1
80.5 and 84.6
Baby It’s Cold Outside
Lies
Version 3.0/10/09/2016
© Jason Cummings 2016
Statistics
Over the past 10 years NSW has recorded 27 boating fatalities in which cold water was
a likely factor.
Over 70% happened in June and July
1 fatality in October
Cold water incidents have been recorded throughout the year.
96% of the 27 were not wearing a lifejacket.
Neil Patchett 2016: Transport NSW
© Jason Cummings 2016
0 - Before Immersion
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0 – Improve your Chances
Clip on
Wear a Lifejacket
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1 – Cold Shock
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Cold Shock
(First Minute (1) at 15 degrees)
You Gasp

Drown
Hyperventilate

Faint
 Cardiac Work

Cardiac Arrest

© Jason Cummings 2016
Drown

Drown
1 – Improve your Chances
Know what’s going to happen
Wear appropriate clothes
Don’t panic
Fight to keep head above water
Fight hard to control breathing
Wear a Lifejacket
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10 – Incapacitation
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2) Cold Incapacitation
(10 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 within 10 minutes, you might
not get out under your own power!
• Thrashing around will
Increase heat loss
Cause incapacitation quicker
© Jason Cummings 2016
10 – Improve your Chances
Know this will happen
Conserve Energy
Get rescued Quickly
Watch systems
PLB’s, Proximity Alarms
Carry a light and whistle
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1 – Hypothermia
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What is Hypothermia?
• Hypothermia is a medical emergency that occurs when your
body loses heat faster than it can produce heat, causing a
dangerously low body temperature. Normal body
temperature is around 37 C. Hypothermia occurs as your
body temperature passes below 35 C.
• When your body temperature drops, your heart, nervous
system and other organs can't work normally. Left
untreated, hypothermia can eventually lead to complete
failure of your heart and respiratory system and to death.
© Jason Cummings 2016
Onset of Hypothermia
(1 hour)
Loose heat by Conduction, Convection, Evaporation, Radiation
Your body will conserve heat by vasoconstriction which shuts down extremities
Your body will create heat by shivering
Mild Hypothermia at 35°C UNCONSCIOUSNESS ~30°C.
If your head goes under, drowning (within 30-120 minutes)
If head above water cooling to CARDIAC ARREST, Death (90-180 minutes)
© Jason Cummings 2016
© Jason Cummings 2016
Rewarm
- Arrest fall in core temperature
- Environment
- Remove wet clothing
- Insulate against further loss (Vapor barrier)
- Maintain cardiovascular stability
- Be gentle
- Don’t start treatment only to stop and restart
- Secure patient
- Establish steady safe warming
- Heat core first
- Rehydrate if appropriate
© Jason Cummings 2016
CPR
Chest compressions will fibrillate a cold functioning heart
• This is not a temporal emergency
• It took time to become hypothermic
• Delaying CPR a few minutes will not compromise patient
• Rushing to start CPR may be fatal if victim is not already in full arrest.
• An extended attempt to determine if a pulse exists should be made (At least 60 seconds by the clock
(look listen and feel))
• Ventilation (3 min) to increase oxygenation of heart
• Check for pulse again (60 sec)
• Final judgment on cardiac activity
• If necessary then 30 compressions @ 100 bpm, 3 breaths
Note: CPR only successful 8% of time by conventional bystander, in hospital only 19% (REF at End)
© Jason Cummings 2016
1 – Improve your Chances
Know this can happen
Appropriate clothing
Have a retrieval system
Introduce external heat source
Get rescued Gently
© Jason Cummings 2016
80.5 and 84.6
Source: WHO
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Circumrescue collapse
Research suggests that it may be caused by mental relaxation and
decreased output of stress hormones (epinephrine/adrenaline). This in turn
relaxes the venus system that therefore increases relative blood volume.
Some research suggests that it has nothing to do with circulation problems
that may be experienced from lifting a casualty out of the water vertically
but…
There is some suggestions that a higher volume of cold blood from
extremities returning to the bodies core may be forcing the body to cool
even more once rescued.
Increased blood volume, increased cardiac work, more cooling - A triple
whammy!
© Jason Cummings 2016
80.5 and 84.6 – Improve your Chances
Know this can happen
Do not give up/relax
Get rescued gently (and horizontally?)
Take any incident seriously
© Jason Cummings 2016
0
1 - 10 - 1
80.5 and 84.6
© Jason Cummings 2016
Baby It’s Cold Outside
© Jason Cummings 2016
© Jason Cummings 2016
Lies
If someone cools quickly they should be heated quickly
Showers are a good way to warm a patient
Hot drinks warm a person quicker
I could swim that!
Circum rescue collapse happens because you lift a casualty vertically.
Cold water freezes quicker than hot water!
© Jason Cummings 2016
How to deal with
Hypothermia and Cold Shock
We have covered:
Statistics
The Five Phases of Cold Water Immersion
0
1 – 10 – 1
100
Baby It’s Cold Outside
Lies
© Jason Cummings 2016
Websites and Links
http://www.beyondcoldwaterbootcamp.com/
http://bicorescue.com/
Australian 10 degree test:
https://www.youtube.com/watch?v=2bTLIhjf1wk
RNLI Video:
https://www.youtube.com/watch?v=22StzfxvAn4
© Jason Cummings 2016
References
http://www.beyondcoldwaterbootcamp.com/educators/113-circum-rescue-collapse 4th May 2016
Gordon G. Giesbrecht, PhD; John S. Hayward, PhD (2006). Problems and Complications with ColdWater Rescue. Wilderness and Environmental Medicine, 17, 26 30
http://www.mysailing.com.au/news/report-on-textbook-rescue-of-six-crew-after-yacht-sinks
CPR 8% figure: Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, Vadeboncoeur TF, Clark
LL, Gallagher JV, Stapczynski JS, LoVecchio F, Mullins TJ, Humble WO, Ewy GA (2010). "Chest
Compression–Only CPR by Lay Rescuers and Survival from Out-of-Hospital Cardiac
Arrest". JAMA. 304 (13): 1447–1454.
CPR 19% figure: Brady WJ, Gurka KK, Mehring B, Peberdy MA, O'Connor RE (2011). "In-hospital cardiac arrest:
Impact of monitoring and witnessed event on patient survival and neurologic status at hospital
discharge". Resuscitation. 82 (7): 845–852
© Jason Cummings 2016
© Jason Cummings 2016