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Hypothermia by Tom Holtey
Kayaker's Guide to Understanding & Preventing Hypothermia
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chocorua lakeIt is heavily stressed that kayakers should wear their PFD at all times. Sadly, many lose their lives despite this when they succomb to cold water temperatures while awaiting rescue from a capsized kayak.

When the body loses heat faster than it can replace it the result is hypothermia. Your brain and vital organs need to be kept at the correct temperature for proper functioning, particularly the brain, your most vital organ. Regular body temperature is 98.6 F; hypothermia is medically defined when the body temp drops to below 95 F degrees. Severe hypothermia occurs when body temp drops below 90 F degrees. Photo by Andrew Thompson

When your body experiences heat loss at a rate that exceeds its ability to replace it, several automatic functions are triggered. This can happen rapidly after a capsize or soaking, or it can take place over a long period of time such as a cool, windy, rainy day when you are wearing inadequate clothing. Any time you are exposed to the weather and the elements you run a chance of hypothermia, hence the older name of the condition; exposure.


Signs & Syptoms

The first automatic responses to this type of cold exposure are common and many of us have felt them to some degree. Blood flow to the extremities is restricted, leaving the hands, feet, arms and legs cold, sometimes in pain. This happens to keep your core warm.

Hypo ManYour core is: head, neck and torso. Your body does this automatically to prevent blood from flowing (some still flows) into your extremities, cooling there, and then flowing back into your core, at a lower temperature, adversely affecting the function of your heart and brain. The other response is shivering. Shivering is also an automatic reaction to the cold. It is your body's way of creating more heat by exercising. When muscles contract, and burn fuel, in the form of calories, heat is produced. For example, you get warm when you work out at the gym. Shivering is an uncontrollable "work out" to make you warm and "feel the burn." ("Hypo Man" by I. M. Chilly)

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The first noticeable sign of hypothermia is shivering. You may feel your extremities cooling, but your comrades will only be able to see shivering. Judgment and coordination in the victim may begin to slip. As soon as you or someone in your group is shivering and feeling cold, take steps to prevent hypothermia by stopping and warming up. Put on a hat, an extra layer and change out of wet ones. Nip it in the bud now! Don't let yourself or anyone else "tuff it out."

Hypothermia will progress with out a warm up. Additional symptoms will indicate their worsening condition. They may seem a bit drunk with slurred or scrambled speech, stumbling and loss of dexterity evidenced by difficulty paddling. A paddler suffering from Hypothermia may make bad decisions or act confused. This is caused by the brain not operating at the correct temperature. These signs should indicate the need for IMMEDIATE action to warm that person.

Severe Hypothermia comes with the continued exposure to cold. The victim will exhibit disorientation, irritability, irrational behavior or apathy. Shivering will stop when the body temperature drops to about 90 degrees. Muscles will become stiff. They will likely not be able to do anything for themselves physically, or even be aware that the problem needs to be addressed. As symptoms progress the victim may look blue, gray, or even dead. Unconsciousness will eventually result. The final stage is cardiac (heart) and respiratory (lungs) failure.


Treatment

little pondAt first signs of shivering and feeling cold stop and get warm. This may be as simple as putting on a hat or extra layer if you act promptly prior to the onset of hypothermia. Check your paddling mates regularly if weather conditions are cool and water temperatures are low. If you or someone in your group is soaked and cold you need to go ashore and replace wet insulation layers with dry. Get out a hot thermos for those who are cold to drink something warm. High calorie hot chocolate or sweetened herbal tea is best. Caffeineated beverages and alcohol can worsen the situation. If possible have a non-affected party member set up a shelter, tarp or tent, to keep out of the rain and wind. Those who are affected may need help to change clothing, and refuel. Try to get insulation from the ground using a camp mattress or unfolded "crazy creek chair", spare clothing or any thing dry and handy. Stay off wet muddy beaches and rocky areas, move into vegetation and dry leaf litter on the ground.

During periods of in activity you may need to exercise a bit to keep your body heat up. Jogging, jumping jacks and such should warm you up, but don't over do it and start to sweat; the moisture will cool you too much.

If one member in a group is suffering it may indicate that others are on the verge. Every one should, at this point, replace wet garments and layer up, at least while resting. The group members should drink something warm and have a snack; high calorie foods with sugar, carbohydrate, oils and fats are best.

This type of break is good to assess you choice of clothing and your back up garments, the weather and maybe even your paddling plan for the day. If all party members are completely re-warmed, dry, full of food and drink, fit and rational, then you can resume your journey or head back home. When in doubt of your ability to continue safely, staying warm and dry, cancel your plans and return to the put in. It may even be necessary to stay put until conditions improve.

For really cold paddlers and chilly conditions put several people in a tarp shelter or tent, or even huddled under the same space blanket, this will warm body and spirit. Heat packs can be used to help warm a cold paddler. Make sure that they are wrapped in a cloth to avoid direct contact with the skin and prevent the possibility of burns. Test them on your own skin. They should be placed at the soles of feet, palms of hands, neck, chest, armpits and groin, where blood flows close to the surface.

spring thawIf a hypothermia victim has advanced beyond the first indications, and is exhibiting loss of speech and dexterity, or consciousness, then greater steps need to be taken. Landing and shelter is imperative. Changing the victim into warm, dry clothing is necessary, but other steps need to be taken as well. Keep head and neck warm and dry; most body heat is lost from there. A fire may need to be built. (Careful not to burn yourself or the victim.) Rapid re-warming, such as a hot bath is not advised. Insulation from the ground is very important, use any dry materials at hand. You will likely need to wrap the victim and a warm volunteer in a blanket, sleeping bag or space blanket with direct skin contact if sufficient insulation is available. One or two warm, dry volunteers can re-warm a victim in this manner. Shelter then in such a way that the air they are breathing is warmer than the air out side. Warm beverages can to be administered only to a conscious, coherent victim in small amounts slowly and carefully so as not to cause cold blood from the extremities to rush to the core. If the victim is unconscious, or disorientated, beverages cannot be given until consciousness and rationality are regained to avoid choking. In severe cases treat the victim very carefully, like glass. Keep them still and avoid moving them. Sudden or jerky movement can affect heart rhythm adversely. Photo by Andrew Thompson

If things have progressed this far you will need help in treating and evacuating the victim. It can take as much as 24 hours or more to fully recover from Hypothermia. Your party is unlikely to be prepared for treatment and evacuation on many levels. HELP MUST BE OBTAINED. If there is no way of calling for help with VHF radio or cell phone, then messenger(s) must be sent. If possible send two together to head for the nearest source of aid, three if the party is large enough. Ideally two or three people will stay behind to administer to the victim(s). Other emergency signaling devices and methods should be used as well, and will be essential if messengers can not be sent.

If your victim appears dead, or signs of breathing and heartbeat are absent do not give up, they may not be gone. Treatment and, if necessary, rescue breathing should continue until the victim is warm, and only then can you assume they are dead. Do not use standard CPR. CPR must be very gentle and slow. (1 breath, long & slow, every 10 sec. & 1 compression very 2 sec.) Chest compressions can affect heart rhythm with fatal results; only perform chest compressions if you are absolutely sure they are in cardiac arrest. Bear in mind pulse may be very weak and slow. Rescue breathing only, would be a more cautious approach and can even be administered carefully to a barely breathing victim matching their breath rate.


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Preparation & Prevention

Well that all sounded terrible, are you scared yet? You can take steps to prevent and prepare for this scenario. In doing so you will reduce your chance of experiencing hypothermia greatly.

The easiest step in preparation is proper rest, food and water intake. Plan your trip carefully so you do not have to stay up all night packing, fixing equipment and driving. Get a good nights sleep before any day trip or expedition.

Pack a lot of easy to eat snacks that can stand up to a wet environment and be eaten in the cockpit with wet hands. Bring extra to share, and as emergency rations for extended stays. I like single serving, plastic packed snack bars, string cheese and such. They fit into PFD pockets and deck bags with out additional waterproofing. Granola and sports bars (Not the kind you drink beer and watch TV at.) have sugars and carbohydrates that metabolize fast and give quick burning fuel. Granola bars also contain oils that burn a bit slower. String Cheese, and other similar foods containing fat and protein burn much slower. Their fuel benefit is not immediate but long lasting. Your strategy should be to have the fast burning fuels regularly, maybe every hour or so, and take the slow burning fuels periodically to maintain a reserve of high calorie fuel.

Adequate hydration is very important to performance in all activities. The water you drink will maintain the proper level of blood flow and circulation. Dehydration can help accelerate Hypothermia. Have a drink before the start of your trip, and bring along a couple bottles to sip on along the way. It is best to sip a bit frequently, rather than guzzle a whole bunch at once. I have found that a drinking hose, hydration system, like a camelbak, helps me to keep up a regular intake. Many kayaks have a spot in the cockpit to hold a water bottle. If it is right there in front of you than you will be more likely to take a drink. We frequently use spring water bottles (often refilled) for convenience and economy. Don't forget the cocoa! A hot beverage in a durable quality thermos will not only hydrate you but keep you warm, and may be a lifesaver.

little pondA proper clothing plan will help you stay warm and dry. Select garments from your clothing arsenal that you feel are best suited to the weather conditions of that day. Pay special attention to the water temperature as opposed to the air temperature. Think in terms of layers that can be added or removed while seated in the cockpit of your kayak, a hat is the most effective layer with this in mind. If you are wearing a dry suit you will NOT be able to add or remove layers, except a hat. Never open your dry suit while on the water, it will flood if you fall in and prevent you from re-mounting your kayak, as well as compromising your insulation layer. If you over-heat in a dry suit, slash your self, you will cool down.

When using layers plan to take off a layer before you over heat and get sweaty. As soon as you stop exercising put on a layer before you cool down. A hat can be very handy for this purpose, as well as a poly vest or splash top.

Be prepared, or over prepared, in your clothing selection and layering plan. Be ready for unexpected weather, waves and capsize. If you know you will be paddling through surf, or see rain clouds on the horizon have your splash gear on. If you know that you will be in rough open water conditions you should be wearing the garments, from the very start of your trip, which will protect you if you end up in the water.

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Pack a complete outfit of back up clothing into a dry bag and store in a hatch Have extra layers like splash wear, fleece vest, and hat in a handy, ready access location like a large backrest pocket or deck bag. If you have fair weather at the start of the trip these extra layers will be ready for you when the weather turns foul.

Pack your self a Hypothermia kit. In a waterproof bag place as many of the following items as you feel necessary. Bring a space blanket, or two. They are so easy to pack and can fit in a pocket. They will reflect your body heat back to you. I like to bring the heavy-duty kind as well, sometimes called an "All

Weather Blanket." Not only are they a good space blanket but they can be strung up as a windbreak or emergency shelter, using the corner grommets and some string. Speaking of bulky, a fleece blanket will be of great need to any accident victim, nice for picnics too. A camp towel is a bit easier to pack and if large enough it is almost a blanket. The camp towel will allow you to dry off during a change and reduce evaporative heat loss as well as keeping your back up clothing dry. Fire starting material is nice to have. Waterproof / windproof matches or a lighter are the basic tools, but you can supplement them with tinder, such as candle stubs, commercial fire starters, and other saved dry materials like paper, birch bark. (I have even heard that dryer lint and steel wool can be used in this manner.) Some paddlers will bring along a camp stove or sterno can, with pot and cup, complete with cocoa, tea or instant soup. Pack your fuel separately to avoid leaking problems.

Use your common sense, be well prepared and educate your self with first aid knowledge to be safe and secure in your paddling adventures.


RESOURCES:

See also our articles:

Clothing recommendations:

For More information on Hypothermia:
http://www.hypothermia.org

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