hypothermic paddler scenario

[rick stoehrer]

during the cam on sunday we had the ole "hypothermic paddler" scenario...an oldie but a goldie....here's how that went.

half an hour or so after an initial bout of rescues and being in the cold water (mid 40's or so), we had one paddler in crossing the harbor over to marblehead light do the following...he had been paddling with his paddle upside down for about half an hour. his stroke went from very nice to splashy wreckage, his shoulders were hunched, he was not participating in any of the conversation, when pressed he said he just didn't want to slow the group down...when he wandered away from the group and was corralled back in he said he didn't realize he was paddling away and that he was concentrating on getting out of the wind. after corralling him back to the group, 2 paddlers did stay beside him but other than saying "space shot" about paddling with the blade upside down, no aid was rendered. the paddler continued to flail and eventually capsized. the rescue was done well enough and a rafted tow started to the nearby beach. once on shore, folks concentrated on getting their boats squared away and then the cold paddler was allowed to stand up and start to walk away from his boat alone. he quickly fell face first into the water. once he was picked up and brought up the beach, a hat was found and a cag, etc.

with the scenario given, there were several points at which more successful treatment could have been given. as it was, we went from a cold paddler to a cold and wet paddler to a cold and wet paddler with possible head trauma from his fall before we managed to deal with the problems.

the first challenge is to diagnose

hypothermia first affects your judgment. then it starts with physical symptoms....loss of coordination and difficulty with simple tasks, listlessness, speech is impacted, incoherent, confused, fatigue, inability to control limbs, stumbling, uncontrollable shivering or trembling. their stomach can be cold to the touch, they are exhausted and they want to doze. in the beginning stages remember "the umbles" - stumbles, mumbles, grumbles.

we had a paddler that had a loss of coordination, was relatively listless and who's only response to questions was either "i want to get out of the wind" or "i don't want to slow the group down" regardless of the question asked.

once diagnosed, you need to treat

first things first, raft up and TELL them to put on a hat. you should have one in your day hatch. this is a very inexpensive, fast on water solution. if you have a CAG in your day hatch and can put on that on them in addition to a hat while you are on the water, even better. my CAG has a big pocket...in the big pocket? hats/gloves.

if they aren't so gone as to be unable to paddle, have them paddle. the action will warm them up faster. if they are still a mess, then do a rafted tow with one person supporting and another towing....while this is going on, you DIRECT one person to get to shore fast and break out their hypo kit. once the raft lands, this person on shore can now assist the cold paddler from getting out of the boat...BE PREPARED TO SUPPORT THEM....THEY'RE CLUMSY. lead them to your hypo area (which is ideally out of the wind).

if they are wet, get them undressed and into dry clothes and layer them back up...break out a shelter and everyone get in there...this should warm them up pretty fast. have a cuppa tea and a nosh and continue to have a conversation...look for specific answers to specific questions. if things get worse, you need to evac.

if they are dry in a dry suit then layer them up, keep the wind off of them and follow steps above.

have hats, gloves, dry clothes in a kit, a shelter or a means of shelter (tarp will do - you can taco wrap).

even if you're wrong and the person isn't hypothermic on that cold day...what's the worst that happens? someone gets warmer. but if you think to yourself, "hey, they might be hypothermic" and then DON'T ACT, what's the worst that can happen? they can die.

hypothermia is something and the early stages can be hard to detect if we aren't paying close attention - we've probably all been hypothermic and have probably all paddled with hypothermic paddlers and didn't realize it.

what did others do? anything learned, we can learn from?

[EEL]

Random thoughts from the peanut gallery:

Once upon a time there was a fall training program held on an exposed ridge in the Presidentials and the students were confronted with the "hypothermia affected hiker" scenario. The students recognized the problem and commenced to solve the "problem". Interestingly, the "victim" actually became hypothermic over the course of time the students went about protecting the "victim" from hypothermia. Sobering experience.

They failed to insulate the "victim" from the cold ground, they did not have a means of providing warm fluids, nor other means to warm the "victim" as opposed to adding insulation to the "victim". As a result, the "victim" became a victim. True story.

While the old BCU vacuum of tea routine has been the subject of some humor, there is much to recommend never leaving the beach without it. Morning ritual while touring; fill thermos with two tea bags and boiling water.

I have taken to having a foam pad fitted to the bottom of cockpit to make things warmer for cold water paddling, but it can also serve many functions including ground insulation. I recall some using a small pad rolled up as a backband to have pad for emergency use.

I believe one reason why it is a good idea to have enough kit to get by for one night on any paddle of more than trivial nature is that means having enough stuff to deal with hypothermia on some forlorn beach or ledge.

Ed Lawson

[rick stoehrer]

peanut gallery thoughts appreciated...

just a note...when i say TELL them to put on a hat? yeah, hand them a hat and TELL them to put it on.

[Phil Allen]

I'd just add that early stage "umbles" can also be a sign of someone with low blood sugar, so giving them some sweetened tea or other high calorie treat along with the hat can't hurt.

Phil

[Lallen]

I'd just add that early stage "umbles" can also be a sign of someone with low blood sugar, so giving them some sweetened tea or other high calorie treat along with the hat can't hurt.

Phil

He MAY be speaking from personal experience since he has a spouse who really crashes when her blood sugar levels drop either on the water or skiing in the woods in Winter. Can be hard to tell the difference when cold conditions are present which is the problem...

[rick stoehrer]

He MAY be speaking from personal experience since he has a spouse who really crashes when her blood sugar levels drop either on the water or skiing in the woods in Winter. Can be hard to tell the difference when cold conditions are present which is the problem...

cuppa tea and a nosh would address...if only coincidentally. if someone were diabetic or had a problem in the past where they got "umbly" when their blood sugar got low, the beach briefing might be an excellent place to address that.

i used to drink a lot of hot tang winter camping...there was something about ALL that sugar delivered hot when you're cold and beat - it really hit the spot.

[scamlin]

cuppa tea and a nosh would address...if only coincidentally. if someone were diabetic or had a problem in the past where they got "umbly" when their blood sugar got low, the beach briefing might be an excellent place to address that.

i used to drink a lot of hot tang winter camping...there was something about ALL that sugar delivered hot when you're cold and beat - it really hit the spot.

Amen on the low blood surgar--and as Rick says diabetics will really get the umbles when they crash.

Also, want to second Ed's advice on insulation from the ground: when we do the Wilderness First Aid scenarios in early spring outdoors, we are reminded that when you lay on the cold much less wet ground, in minutes your body temp will plummet. 1" of foam makes a huge difference. Hot sugary drinks work, just watch the crash about 30 minutes later (insulin spikes, metabolizes the sugar, etc.).

Scott

[rick stoehrer]

Amen on the low blood surgar--and as Rick says diabetics will really get the umbles when they crash.

Also, want to second Ed's advice on insulation from the ground: when we do the Wilderness First Aid scenarios in early spring outdoors, we are reminded that when you lay on the cold much less wet ground, in minutes your body temp will plummet. 1" of foam makes a huge difference. Hot sugary drinks work, just watch the crash about 30 minutes later (insulin spikes, metabolizes the sugar, etc.).

Scott

i've been with folks on the water when it happens and it isn't terribly subtle. the scariest encounter i've had is with my dad (on the needle diabetic) once...we had ordered lunch at the pub, it got busy and before my eyes sitting there i could see the change...he got kind of a glassy stare/look, he was disoriented and had no idea coming in, was vague on where he was and didn't remember that we had ordered. i left him with my mom, went over to the station and got juice and then went out back and got some bread....they weren't happy but i wasn't going to wait or ask again. he was fine a few minutes later but that was freakish and scary. i didn't care for it at all.

[GJ Carey]

Great thread, and timely reminders.

One thing I will add is not to neglect the person(s) who may be supporting the hypothermic paddler during the rafted tow. They are probabaly a bit cold as well (everyone is likely wet) and have gone from moving (paddling) to not moving. Make sure they have a hat and cag on and have been provided some fuel just like the hypothermic person. Another thing to think about is not to put the smallest, thinest person as the supporter if you can help it. Some of us with a little more "insulation" might be the better choice.

It would suck to inadvertently go from one hypothermic person to two or more.

Glad everyone had fun on Sunday.

Galen

[Michael_Crouse]

Kind of a rhetorical question but......

Why do we ask "Are you cold?" when we see someone shivering and we know what their answer should be?

As soon as you hear the "I'm fine" response what can you do?

Denial should be considered one of the stages of hypothermia

This is like the "can I help you?" - "just looking" exchange that happens in stores everyday

[EEL]

Why do we ask "Are you cold?"

Great point. Its like asking if someone is OK or if they are comfy when things kick up.

Never going to get an accurate self assessment and just makes it harder to take appropriate action. One suggestion is to initiate a routine conversation. If they can carry on normal conversation and look at you while doing so, then odds are they are comfy in stuff and/or OK.

Ed Lawson

[johnlevy]

My question to the group is this. When I have gotten cold on a Ski or Hike or paddle I always handle it like an emergency! I'm cold I tell everyone around, I put on all extra clothes I have and head for warmth. When will that panic or elevated concern be replaced with the classic hypothermic symptoms. why didn't the victim in this case not say I need help. Yes it is a simplistic question, but are there any thoughts.

[rick stoehrer]

My question to the group is this. When I have gotten cold on a Ski or Hike or paddle I always handle it like an emergency! I'm cold I tell everyone around, I put on all extra clothes I have and head for warmth. When will that panic or elevated concern be replaced with the classic hypothermic symptoms. why didn't the victim in this case not say I need help. Yes it is a simplistic question, but are there any thoughts.

you want us to explain why people do some of the things they do?

got me...but they don't always say help.

someone may feel self conscious about slowing the group down by taking the time faffing about for a hat or a cag and may not stay ahead of getting cold. imagine your not as confident as you are...you're in a group, you've gone in the drink and feel self conscious about having to be rescued and now you think "sheesh, i'm going to waste more of these guys time rummaging around for a hat" or some such nonsense....nah. or it may even be that your judgment is already impaired by the cold.

who knows why people do what they do...suffice to say none of us always do the best/right thing.

[pikabike]

How well did any other paddler know this person?

The reason I ask is that such knowledge might allow you to tell very early on if something is amiss. The only time I had to deal with a hypothermic paddler was in a relatively safe situation: re-entry practice but on a cold November day. The guy in question is normally alert, listens well, and practices diligently. On this day he chose to wear not his drysuit but a Farmer John over a Hydroskin shirt "to see how badly the cold would affect me without the drysuit." Turns out, very badly very quickly. It only took less than 30 seconds in the water before he began holding himself tightly as if to fight off shivering. He failed to re-enter the boat and reverted to bad techniques such as trying to pull himself straight up onto the deck, resulting in flipping over the boat again. He repeatedly seemed to be functioning at the "in one ear and out the other" level and was staring off into the distance. Next, the shivering became obvious. At that point, we did an assisted re-entry instead just to get him out of the water ASAP. He warmed up quickly but there was no more practice that day...

The problem is, when practicing re-entries with someone else of almost opposite, errr, diligence, on a beautiful summer day in warm calm water, that person made the same mistakes and also functioned at the "in one ear and out the other" level--because that's how he ALWAYS is. But in his case, I don't know if I'd be able to tell if he got hypothermic until things turned really bad. I doubt he'd admit needing help of any kind until it's pretty dire. Funny how egos still work a long time when cold.

[jdkilroy]

Not to perseverate but I would add one additional thought:

This was drummed into our head by Gordon Brown during a leadership training: "... If one person in your group becomes hypothermic you need to treat the whole group." (spoken with a Scottish brogue) Assuming there wasn't a specific event that caused only one of your group to become cold, there are likely to be others headed for a similar state.

Jon

[Paul Sylvester]

I have always wondered when I would find some cold and wet rec boaters around the next bend in Portsmouth and carry my kit mostly with them in mind. We have a duty to look out for others and if something does not seem right further checking seems the right thing to do.

I know sunday was scenarios and we don't all play along well at it....but I should have had people on me while under way.Throw your hands on my deck and get in my face, Cag,tow and people on my flanks to watch. I was at the point where I could have kept paddling with a tow to speed up getting to shore. Once ashore the usual warm up..

It was a fun day and I always enjoy teaching and watching newer paddlers learning. Hope to make some other club trips this year as it has been quite some time.

thanks,

Paul Sylvester

[Rob Hazard]

I keep wondering whether the others in your group held back from approaching the "hypothermic" Paul because of a combination of Rick's being his usual entertaining self and Paul's being "one of the Leaders" and, thus, above being approached as a victim. It might be that under less of a classroom atmosphere they would react as we would like them to. I would hope so!

Last year during one of these exercises I found myself feeling woozy, so I announced that I was seasick and turned it into an exercise. The group rafted me up and towed me to a pocket beach on Marblehead Neck. Afterwards one of them confided to me that she didn't know if I was really sick or just faking it. I don't know what would have happened if I had silently toughed it out.