Post T-Day Rescue

[Don]

Cold water Rescue at post-Turkey Day Misery Island paddle.

Four of us – Chad, Jonathan, Gayla and I left from the boat launch behind the Manchester Police station at about 10:30. We paddled to the east of House Island, then headed south around Bakers Island before heading back to Misery, where we met up with the group coming from Devereaux Beach just as before we converged on the beach – Cocktail Cove I believe it’s called.

Adam, Liz and Kim arrived a while later from Tuck's Point.

As Liz described, we had a flock of 23 mostly yellow-clad paddlers, with a few of us scattered around in green or blue just for contrast.

Shortly after the main part of the group left to return to Devereaux Beach, five of us – Chad, Jonathan, Liz, Gayla and I headed back to Manchester Harbor. The plan was to head east, circle around House Island and through the rocks at the tip of Gales Point, then into the harbor and back to the put-in behind the police station, dropping Liz off at Tuck’s Point along the way.

As we cleared Misery, I noticed a couple hundred yards to the south a group of three kayaks just clearing the southern side of the island, heading for basically the same point we were. Moments later, I looked again, and noticed one kayak was upside-down. I paused for a moment. At this time of year, only skilled, properly equipped and trained paddlers would be out, right? They would certainly have the swimmer back in his boat and be off again before I could get half way there, right? Well, better safe than sorry, so I hollered at the rest of our group to hold up, and started heading in their direction, fully expecting to turn back as soon as I saw they were under control.

As I got closer, I started to doubt what I had seen – no one seemed to be doing much – one kayak was backed off a ways and I couldn’t see the tipped boat. Maybe they were practicing some skills, or checking out a drysuit? Anyway, when I finally got close enough to see what was happening, I saw the empty boat, with a man hanging onto the rear deck, making shivering, moaning sounds punctuated with epithets. The other two were a husband and wife, who informed me that this was the first time the victim had been in a kayak, and that the two “experienced” paddlers in their group were on the other side of the island. The victim was paddling a wooden CLC boat (Chesapeake 17 or 18, I believe), built by one of the other paddlers. I don’t know what effort they had made to get him back into his kayak, but at this point they were apparently planning to tow the victim to Misery Island, just a few yards away. I was more interested in getting him back into his boat than trying to land on an extremely rocky shore. Seas were relatively calm, but even the light swells resulted in some pretty nasty surge against the rocks.

I pulled up alongside the victim’s boat such that his boat was between mine and his friend’s, and he was in the water between his boat and mine. I coaxed him, with considerably difficulty, to take hold of my boat and swing his legs up so we could try to get him up on the deck. From his responses up to this point I already figured he wasn’t dressed for the conditions, which was confirmed when he finally lifted his legs up to the point I could grab hold of his blue jeans. He had been in the water for about 5 minutes by now, and was already pretty well incapacitated. He was wearing a coat, with at least one sweatshirt underneath (probably cotton), and was wearing a PFD. He mentioned that when he hit the cold water his chest constricted and he swallowed some seawater. (see recent threads on Paddlewise listserve regarding cold water gasp reflex).

He was a rather large guy, probably around 250#, but with some pulling and what limited effort he could produce, we ended up with him on his back, across his boat and mine. At this point, we were stuck. He wasn’t able to do much more, I was using most of my effort to keep our boats together, and his friend couldn’t get in a position to help much.

Fortunately, the rest of my group arrived on scene at about this time, and we were able to push & prod and get him to squirm into the cockpit. Once in, we pumped out his boat and got him relatively comfortable. Without much discussion, and with no disagreement, we settled on a simple strategy: 1) put someone next to the victim to keep him upright and monitor his condition, 2) Tow him back to Manchester Harbor, where their vehicles were. None of us really considered taking him the short distance to Misery Island, as there were no facilities there to get him warm, and it was a relatively short distance into the harbor.

So, with Liz in her kayak holding onto the victim’s boat in a face to face position, Chad, Jonathan and I hooked up our tow lines single file and towed him in. This was hampered somewhat by the lack of deck lines or bow toggle – I ended up clipping onto one of the hatch straps.

Part way back, one of the “experienced” friends caught up to us. What was he wearing, you might ask? Yep, all the necessary gear for a late November paddle in 45 degree water -- jeans and a T-shirt.

His PFD was safely stowed in one of his hatches, so as not to overly encumber him or spoil the lines of his attractive homebuilt CLC Chesapeake 18 boat. This was no problem, of course, since if he were to end up in the water, he would surely be back in and on his way in a matter of seconds!

The victim was relatively stable during the ride back. Liz monitored him and kept him talking, and he was able to use a paddle to help keep the boat straight, and eventually even managed to finagle his feet back onto the rudder pedals to help maintain course. We stopped once to put a windbreaker around him, which seemed to help some.

Once on shore, it was quite a chore getting him on his feet, as his legs were pretty numb, and he had trouble standing on his own. He had some extra clothes in the rear hatch – a pair of socks, lightweight pants and a shirt – loosely thrown into an unsealed plastic bag, sloshing around with the water which had worked its way in. Liz pulled out her drybag with a full set of fleece clothing, which we got him into as his friend warmed up their vehicle. A thermos was pulled out with something warm for him to drink. After some discussion, we hesitantly decided that he was in good enough condition that immediate medical help wasn’t necessary. He seemed to be warming up and was becoming more mobile and coherent. We decided we had done what we could, so Liz headed back to her car at Tuck’s point and the rest of us went under the bridge to the other side of the harbor where we were parked.

As we paddled over, we passed the other “experienced” paddler in their group, who was paddling in with the woman who had been at the original scene. He, also, wasn’t wearing a PFD – it was on the back deck of his boat – however, he had switched boats with the woman, so his PFD was on the back of HER boat. So, the two experienced paddlers didn’t wear PFD’s, while the less experienced paddlers wore theirs. Apparently, once one is an experienced paddler, it’s not necessary to wear a PFD. I’m not sure what he or the woman were wearing for clothing – the woman’s husband was wearing a wetsuit, possibly the only one of the group wearing anything resembling proper gear for the conditions.

A few comments were made to some of their party regarding the need for proper clothing and PFD usage, but they didn’t seem to want to be lectured. I had figured that in the middle of a rescue was not the time to be getting in arguments, so I had kept my mouth shut and just paddled.

PPPO was across the street at the 7 Central restaurant, where we rejoiced in having cheated Darwin.

LESSONS LEARNED:

1) D-uhh . . . PFD & PROPER CLOTHING!!!!!

2) Need to practice rescues of incapacitated paddlers.

When I arrived at the scene and realized this wasn’t going to be an easy rescue, I should have immediately signaled to the rest of my group, who were waiting where I left them trying to figure out what was going on. I had the only pair of binoculars on my boat , so they couldn't see what was happening.

3) When I pulled up alongside the victim and his boat, I probably would have been much better off facing his stern (and him) rather than trying to work with him behind me on my back deck.

4) Deck Lines are a must for hanging onto or towing the boat.

5) Safety gear – tow lines, pump, dry clothing, etc. Never know when you might need them.

DISCUSSION

Any constructive criticism welcome, especially recommendations on deciding when it’s appropriate to call for help, and how to evaluate seriousness of hypothermia. I think we all left there wondering if we should have called for help while we were still out there (we had a couple VHF’s and at least one cell phone) and/or called an ambulance when we got to shore. At the very least, calling for help might have impressed upon this group just how serious the situation was – they never showed any real indication that they understood this.

Don

[eneumeier]

>Well, better safe than sorry, so I

>hollered at the rest of our group to hold up, and started

>heading in their direction, fully expecting to turn back as

>soon as I saw they were under control.

Don gets a lot of credit for heading over there to check it out, rather than assuming things were under control and leaving the scene. ASSUMPTIONS ARE A CURSE! Don't assume.

>The victim was paddling a wooden CLC boat

This being the first time kayaking, it was also his first wet exit. He struggled to get out, then remembered the spray skirt and had to calm him self down to release it before he could wet exit. He inhaled and swallowed lots of water.

>He was wearing a coat,

His outer layer was of cotton sweatshirt material. The pfd probably saved his life. He was wearing neoprene gloves. I had a neoprene cap tucked in my pfd and put it on his head as soon as we got him upright in his boat. Keep a spare neo cap handy!!

>This was hampered somewhat by the lack of deck lines or bow toggle – I ended up clipping onto one of the hatch straps.

The lack of deck lines also made it hard for me to hold the boat upright. I had to grasp the hatch straps too. If it had been rougher waters, they would have given way.

>Part way back, one of the “experienced” friends caught up to

>us. What was he wearing, you might ask? Yep, all the

>necessary gear for a late November paddle in 45 degree water

> -- jeans and a T-shirt.

I won't go there. He was not impressed when I told him the Coast Guard issues big fines for not wearing a pfd at this time of year.

>The victim was relatively stable during the ride back. Liz

>monitored him and kept him talking, and he was able to use a

>paddle to help keep the boat straight, and eventually even

>managed to finagle his feet back onto the rudder pedals to

>help maintain course. We stopped once to put a windbreaker

>around him, which seemed to help some.

The wind on his wet sweatshirt was causing him to get colder. He was not able to paddle at all. I asked him to try to see if he could warm himself up. BTW, his friend's wife had taken the victim's paddle with her when she went "for help" so I let him use mine. I had my rain gear in my front hatch so his friend got out the rubberized rain jacket (super large size so it fits over pfds). With the hood up it at least blocked the wind. I questioned him about his chest, which he initially described as feeling tight. Then he said it felt like the congestion from a bad cold on the top of his lungs - not a surprise given the water he swallowed. I am going to learn a lot more about heart attack symptoms. At one point he started swooning and I was concerned we would not make it. His responses to my questions became monosyllabic. If we had any farther to go I would have asked for someone to raft up on the other side because I could not have held him upright if he really went over the other way. Once we were in the harbor channel and sheltered from the wind his color improved.

>

>Once on shore, it was quite a chore getting him on his feet,

>as his legs were pretty numb, and he had trouble standing on

>his own. He had some extra clothes in the rear hatch – a

>pair of socks, lightweight pants and a shirt – loosely

>thrown into an unsealed plastic bag, sloshing around with

>the water which had worked its way in. Liz pulled out her

>drybag with a full set of fleece clothing, which we got him

>into as his friend warmed up their vehicle. A thermos was

>pulled out with something warm for him to drink. After some

>discussion, we hesitantly decided that he was in good enough

>condition that immediate medical help wasn’t necessary. He

>seemed to be warming up and was becoming more mobile and

>coherent. We decided we had done what we could, so

Hard to know how far to push people. This guy really needed to see a doctor, which we told them. They were talking about driving straight back to Hudson where they were staying.

>Liz headed back to her car at Tuck’s point

NOT ALONE!! Adam and Kim were paddling into the harbor just then and I went with them.

>I had figured that in the

>middle of a rescue was not the time to be getting in

>arguments, so I had kept my mouth shut and just paddled.

Really the only option.

>

>LESSONS LEARNED:

>

>1) D-uhh . . . PFD & PROPER CLOTHING!!!!!

>2) Need to practice rescues of incapacitated paddlers.

>When I arrived at the scene and realized this wasn’t going

>to be an easy rescue, I should have immediately signaled to

>the rest of my group, who were waiting where I left them

>trying to figure out what was going on. I had the only pair

>of binoculars on my boat , so they couldn't see what was

>happening.

>3) When I pulled up alongside the victim and his boat, I

>probably would have been much better off facing his stern

>(and him) rather than trying to work with him behind me on

>my back deck.

>4) Deck Lines are a must for hanging onto or towing the

>boat.

>5) Safety gear – tow lines, pump, dry clothing, etc. Never

>know when you might need them.

Extra clothes are a must. You never know what you are going to find out there. I always carry my rain gear, even on sunny summer days, because it is so effective in blocking wind. Many times I have pulled on the pants over wet neoprene and been totally comfortable on a windy beach.

In retrospect, I think we should have radioed for help. Things could have gotten worse fast, if he was having a heart problem. There was no reason not to call on the CG. Plus, his "friends" could have been fined. :-)

Liz N.

Liz N.

[Guest guest]

Thanks for posting this in such great detail and being so open about using this as a tool for learning. It has been said the only mistake that is a total waste is the one you don't learn from. The most important comment I have is to recognize that you did something that ultimately prevented a needles death. That being said, I offer the rest of my comments for whatever edification you may take from them, and in no way as criticisms for what was done. I have labeled the pastes from the incident report with IR.

IR: The victim was relatively stable during the ride back. Liz monitored him...

BA: Here you have committed one of the most common generalizations that occurs in emergency medicine. Breathing does not equate to stable. To determine that someone is stable requires a baseline observation and then subsequent observations to determine a pattern. You also need to be specific about what it is that you are monitoring, e.g. his vital signs were stable, his mental status was stable. You describe changes in his mental status that indicate he was not stable and was in fact becoming more hypothermic. The key things to monitor in a case like this are: Mental Status, Vital Signs (BP, pulse, respiration), and Core Temperature. It is not always practical to measure all of these, blood pressure and core temperature being the least likely to get monitored for lack of equipment, training, or conditions. I would be willing to bet that most people that will read this don't even have a hypothermia thermometer at home. (Go check the one in the medicine cabinet and see how low it goes.) So let's look at the ones you can monitor: pulse - easy(?) to check at the wrist, maybe not in a choppy sea. Respiration - hard enough to check on land when not moving, now add clothing and a moving boat. What is the message here? If you have been trained in doing this it is easy and will be useful as part of the bigger clinical picture. If not, don't worry about it. A generalized observation will still be helpful. Are they breathing very slowly or very fast? Do they look like they are working hard to breath?

So what can you monitor and use to base your decisions on? Mental status. Is the victim oriented to Person, Place, Time? If they are not alert, what does it take to arouse them? I once had a hypothermic patient who had run most of the Boston Marathon and thought he had come in second and was now in NY city, while he had only made it as far as Heartbreak Hill.

Another important sign to look for is shivering. Sounds simple huh? At some point, as your temperature drops, you will stop shivering. I would guess from the descriptions given, that he stopped shivering after a while. By the way, it is not a good thing when that happens.

IR: ...and eventually even managed to finagle his feet back onto the rudder pedals to help maintain course... At one point he started swooning... His responses to my questions became monosyllabic... I could not have held him upright if he really went over the other way... He was not able to paddle at all.

BA: Here we see some classic signs of hypothermia. An altered mental status and loss of coordination. First to go is the fine motor skills, i.e. can't tie knots, clip a caribiner with any ease. Lesson: don't plan to tie a tow rope with hypothermia. You can hold a paddle, but not with a good grip. This guy eventually had problems with balance and coarse motor skills, to the point of not being able to paddle.

IR: We stopped once to put a windbreaker around him, which seemed to help some.

BA: As soon as you got him in the boat you should have put any extra layers on him that you had. He was loosing heat from conduction through the wet clothes and convection from the wind blowing on the wet clothes. These are two very effective ways to lower body temp.

IR: I questioned him about his chest, which he initially described as feeling tight. Then he said it felt like the congestion from a bad cold on the top of his lungs - not a surprise given the water he swallowed. I am going to learn a lot more about heart attack symptoms.

BA: I won't get deep into the of issues near drowning here, let me just say it is very hard to get any significant amount of water in your lungs. I wasn't there and so it is impossible to know for sure what his problem was. Keep in mind that, BY FAR, the most common sign of a heart attack is DENIAL. The usual scapegoat symptom is "It's just indigestion, I've had it before" I would have assumed this was just a variation on that theme. I once had a patient who's wife called an ambulance because her husband was in horrible pain. He quickly blamed it on a bran muffin, and his heart stopped a few minutes later. Next is pain: generally in the chest, may radiate to either arm; Usually described as crushing, squeezing, tightness, "like a belt being tightened around my chest". I would have assumed the worse at this point. All else aside, this alone was enough to trigger a call for Coast Guard assistance.

IR Once on shore... A thermos was pulled out with something warm for him to drink

BA: He should have gotten this at the start. If it was hard to get access to the thermos while on the water, then it was in the wrong place.

IR: Hard to know how far to push people. This guy really needed to see a doctor, which we told them. They were talking about driving straight back to Hudson where they were staying.

BA: If anyone out there knows him, they may report back he went home and is fine. What does that prove? Nothing. Many people eventually get to a doctor for one reason or another and are put on a cardiac monitor and are asked, "When was your first heart attack?" only to reply: "What heart attack?" I certainly hope he is fine and that it was only some respiratory difficulty. If he is over the age of 35, I would strongly encourage him to have a check-up if he didn't go to the hospital that day. Heart and blood vessel disease kills more people in the U.S. than all other causes combined. Why take any more chances.

IR: In retrospect, I think we should have radioed for help. Things could have gotten worse fast, if he was having a heart problem.

BA: Things were getting worse. And yes, they could have gotten a lot worse, even faster. Period. No heart complications necessary to make that happen. Once your core temperature drops past a certain point, things get bad vary fast. Part of the treatment for severe hypothermia is handling them carefully, rough handling can cause cardiac problems. Rewarming is another issue. After a certain point, improper rewarming technique can kill a person. The most important treatment for hypothermia is prevention. Too late in this case, do whatever you can to keep it from getting worse. Although I don't know just how cold he got, I can tell you for sure his temperature went below 90deg. F. He was getting close the the point where sitting him in a hot car could have killed him. Add the possible cardiac issue and, well, you get the picture. As much as the emergency services may complain about false alarms, no rescuer wants to be called when it is too late to save a life.

This man was very, very lucky to have some intelligent and prepared rescuers nearby. He came very close to being another statistic. Great job! You all deserve a pat on the back.

[Ken C]

It certainly sounds to me like you people saved this clown's life! Much longer in that water and he would have quickly lost total use of his hands, arms and legs and been unable to hold on to a boat let alone help in a rescue. I think you guys did a fantastic job!! We commend you here... as it sounds like that group doesn't realize how close they came to disaster!! Did you even get a "thanks" from them?

Observations.

I hate to make any comments or second guess anyone on a rescue that prevented a potential death. However we are all here to learn from events that take place and be even better prepared next time.

During our "Scenarios" leadership training we had a potential hypothermic paddler on one of the legs I was leading. When dealing with potential hypothermia the goal is go get the victim out of the water and wind, and out of any wet clothing as quickly as possible. Then into warm clothing and a hypo warap if necessary and warm liquids. At that point the victim can be evaluated as to wether they are improving or if medical help is necessary. The ONLY alternative I would have considered is if a landing on misery would have been closer to get the victim warmed into dry clothing, and evaluated.

Rescue of a totally incapacitated victim was part of a recent leader trip and is something we all agreed we need to work on and practice.

Again, a GREAT JOB Don and group!!

Ken Condon

Romany 16

Yellow over white

[eneumeier]

You raised a number of good points. We were able to check some of the things you mentioned, even on the water.

He was oriented x 3, Person, Place, Time, throughout the whole thing. Although he could not paddle he was able to use the paddle as a stern rudder and kept track of when he needed to steer, with no prodding from me. He figured out that it would be better if he could use the rudder - less drag. His mental faculties were still functioning. His breathing, which was shallow, did not change enough to notice. He was not gasping for breath while being towed. He did not really "swoon" - rather he looked at one point as though he might. Sorry if my original description exaggerated that bit.

I was concerned about "after drop" and watched him carefully on shore. I checked his core temp (my hand to his back - primitive but something) and was actually surprised at how warm he was under his pfd, given that he had not been paddling. He was able to pull the dry shirt on over his head unassisted. After being helped from his boat and up the bank, he very quickly was able to stand and walk unassisted. Given all of that, putting him in the heated vehicle seemed safe. I conversed with him several times after he was in the vehicle and he was totally coherant. He asked me to thank everyone involved. He started shivering after being in the truck for only a couple of minutes. (He had not been shivering before - definitely a bad sign and why I was watching him so closely on land.)

Taking him around to the Misery beach to dry off and try to warm up, and radioing for assistance from there would have been the more conservative and, in retrospect, the wiser course. Manchester Harbor seemed so close . . . .

I must say that it was a pleasure to be on the water with such a capable group!

Liz N.

[Guest guest]

How about submitting this or some re-write to the Globe for a bit wider coverage? We in NSPN know the other kayakers were acting irresponsibly: It would be even better to let other paddlers know as well. Who knows? It might encourage more interest from novices or those lacking in training.

Juan Ochoa

Harvard, MA

Juan Ochoa

[Guest guest]

HATS OFF TO YOU ALL, GREAT TEAM WORK!

[Don]

Thanks Liz for filling in the details from your perspective, and thanks to everyone else who responded here or on one of the spinoff threads.

Yes, I know I learned a lot from this event, and agree that it was a touchy enough situation that the prudent course of action would probably have been to call for help. A heart attack or other aggravating problem, or misinterpretation of his level of hypothermia could have rapidly changed the situation for the worse.

Don

[Guest guest]

Nice job all!

A successful rescue is a great rescue.

As you all know - Practice and be prepared for the mistakes of others as well as your own. Practice, practice, practice!!!!!!!

B