Gordon Giesbrecht "Cold Water Dangers and Benefits" NDPA Symposium 2012

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Gordon Giesbrecht "Cold Water Dangers and Benefits" NDPA Symposium 2012

  1. 1. You’re as cold as ice:the dangers “and benefits?” of drowning in cold water Gordon Giesbrecht University of Manitoba
  2. 2. Relevance to you as: 1) a potential victim 2) a rescuer 3) an educator 12-03-26 4) a policy maker Gordon Giesbrecht
  3. 3. U.S. Drowning Stats 2006 1600 1400 1200 1000 800 600 400 200 0Temp oF 30-39 40-49 50-59 60-69 70-79 80-89 90+ accidents fatalities
  4. 4. Understand Cold Exposure: Immersion vs Submersion Immersion - Head Out! Giesbrecht Hypothermia Therapy 4
  5. 5. Estimated time to hypothermia %504540353025 Correct20 Answer1510 5 * 0 0 to 5 6 to 10 11 to 15 16 to 20 21 to 30 30
  6. 6. 4 Phases of Cold Water Immersion  Cold Shock (~ 1 min)  Cold Incapacitation (5-15 min)  Hypothermia ( 30 min)  Circum Rescue Collapse
  7. 7. When and How You Can Die in Cold Water1) Cold Shock Response (0-2 minutes) ⇓ Keep head out of water Gasp  Drown Enter slowly? Thermal protection ⇓ Hyperventilation  Faint Don t panic, keep calm  Drown ⇓ Cardiac Work  Cardiac Arrest If existing heart problems
  8. 8.  Cardiac Work à Cardiac Arrest (If existing heart problems)
  9. 9. When and How You Can Die in Cold Water2) Cold Incapacitation (2-15 minutes) Local cooling of nerves and muscle fibers Swim failure, Can t hold on, Can t perform survival tasksIf 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)
  10. 10. When and How You Can Die in Cold Water 3) Onset of Hypothermia  Human body is a large mass  Thermally protected by VC and SHP  Mild Hypothermia (35°C) 30 minutes  Cooling to UNCONSCIOUSNESS (~30°C)  If head goes under   Drowning (within 30-120 minutes)  If head above water… (i.e., with floatation)   Cooling to CARDIAC ARREST (28-25°C)   Death (90-180 minutes)
  11. 11. When and How You Can Die in Cold Water4) Circum-rescue collapseJust before, during or after rescueCollapse – ranging from faint to deathMay be caused by:- Mental relaxation, and- Decreased output of stress hormones (epinephrine/adrenaline) - Drop in blood pressure (faint) - Extra cardiac work (cardiac arrest)
  12. 12. 1 – 10 – 1 PrincipleRefers to first three phases of cold water immersion
  13. 13. DROWNING PREVENTION 1 - 10 - 1 PrincipleDO 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
  14. 14. 1 - 10 - 1 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
  15. 15. 1 - 10 - 1 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
  16. 16. 1 – 10 – 1 Principle Regarding Hypothermia Consider the following:Delaying the Onset of Hypothermia  HELP position  Groups of individuals (HUDDLE)  Exit water as soon as possible  If exit is not possible, get as far out of the water as possible
  17. 17. So What?Cold Water Immersion  Don’t panic  Don’t drown  1-10-1 Principle  Heart   Long time until cold enough to stop Giesbrecht Hypothermia Therapy 17
  18. 18. 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   Successful recovery after up to 66 minutes Giesbrecht Hypothermia Therapy 18
  19. 19. Mechanisms of cold protection for the anoxic brain   Decreased CMRO2 (Q10)   Human tissue = 2   Brain = 3 (37-27°C), 4.8 (27-17°C)   Moderate cooling of rat brain to 35-33°C   Considerable ischemic protection   Not based on CMRO2   Other Mechanisms   During ischemia   ReperfusionGiesbrecht Hypothermia Therapy 19
  20. 20. So What?Cold Water Immersion  Don’t panic  Don’t drown  1-10-1 Principle  Heart   Long time until cold enough to stop Giesbrecht Hypothermia Therapy 20
  21. 21. So What? Cold Water Drowning   Don’t give up   Don’t warm   Ventilation/CPR   Cold brain   Can survive longer period of anoxiaGiesbrecht Hypothermia Therapy 21
  22. 22. Do children have an advantage?   Adult will cool slower   Adult will cool slower   Advantage - adultGiesbrecht Hypothermia Therapy Advantage – child?   25
  23. 23. What is hypothermia good for?  Cold water near drowning  Cardiopulmonary resuscitation  Traumatic Brain Injury  StrokeGiesbrecht Hypothermia Therapy 26
  24. 24. Summary  Head out   Head in  Hypothermia   CW Drowning  Heart   Brain  Prevent   Focus on Drowning Treatment  Don’t panic   Don’t give up  Don’t drown   Don’t warm  1-10-1   Oxygenation  Heart stops   Cold Brain   Long Giesbrecht time Hypothermia Therapy   May survive 27
  25. 25. On line sources:www.umanitoba.ca/kinrec/giesbrechtwww.beyondcoldwaterbootcamp.com

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