Sunday, August 24, 2014

Hypothermia, an article by Sarah Jones

Hypothermia, a condition which every open water swimmer needs to understand, can quickly turn a great swim dangerous. There is always something new to learn, and so I encourage all swimmers, even the old-timers, to continue reading to add to your knowledge-base regarding this dangerous condition. Mild hypothermia begins when the body temperature is 95 degrees or below. This condition can reach severe hypothermia, when the body temperature is 86 degrees or lower. This article will focus on prevention, recognition, and treatment.

This is arguably the best place to start with your hypothermia education. Preventing hypothermia is not a single event or one-size fits all approach. Most important is acclimation, or helping your body over time get used to the colder temperatures in which you’d like to swim. This is a key element and cannot be ignored. As you expose your body to extremes in temperature (which cold water does much more efficiently than cold air), your body responds by producing brown fat which can help you regulate your temperature during cold swims. Developing more brown fat is a process and takes time. You need to consistently spend time in cold water to help this process. In her book Swimming to Antarctica, Lynn Cox shares how she not only trained in cold temperatures regularly, but also wore summer clothing during the winter, slept with her window open to the cold night air, and skipped socks. She reports feeling that all of these strategies helped her body develop a resistance to the cold. Our own SLOW swimmers, Gordon Gridley and Chad Starks, use the aid of ice baths to prepare their bodies to swim the English Channel and other cold water swims.
Some argue that acclimating is too tough and time consuming; it’s better to just put on 10 or 20 pounds and you’ll be fine. After all I've read, observed, and experienced, I would say that acclimating is not optional, but extra weight doesn't hurt either. The most successful cold water swimmers seem to have a sturdiness around their core that surely plays a role in keeping their organs warm enough while they swim. This extra weight must be balanced with the fact that however much weight you put on, you've got to move that much weight from point A to point B during a swim. You can’t ignore the fact that you may lose something in speed, athleticism, and general health if you gain weight. This may not ring true for everyone; weight isn't necessarily an accurate indicator of health. These are just things to keep in mind as you consider your own approach to preventing hypothermia.
Another important element to preventing hypothermia is to keep an accurate log of your cold water swims. Note the temperature, the time that you’re able to stay in the water, and your reaction afterwards. This information will be vital as you plan your future swims. You’ll know exactly how far you can push yourself and what your body can do. However, remember that many other factors can play a part in developing hypothermia; air temperature, the amount of sunshine, your health the day of the swim, and wind all need to be taken into account. It’s very important to swim with a buddy during your cold water training swims. Members of SLOW have assisted each other in recovering from hypothermia during cold water swims; it’s important to be smart and always have someone with you just to be safe.
The job of recognizing hypothermia is shared by both the swimmer and his or her kayaker. A swimmer generally doesn't stop to take his or her body temperature, so it’s very important to know the signs. These can come on quickly, as up to 90% of heat loss occurs through the skin, and the movement of the waves and water can increase heat loss up to 50%. During the first stages of mild hypothermia, a swimmer may be aware of some of the dangers. Shivering, feeling cold, and a drop in stroke rate are all danger signs. As mild hypothermia becomes moderate and then severe, blood vessels narrow, the liver and heart produce less heat as they attempt to shuttle more heat to the brain, and low temperatures cause confusion and fatigue.
At this point, due to extreme confusion, a swimmer is not capable of making intelligent and safe choices. Kayakers have the main responsibility to be decisive and act quickly to stop a swim. In the case of severe hypothermia, it is not exaggeration to say that a kayaker is dealing with a life or death situation. Eventually, as the body temperature drops, a swimmer would lose consciousness if he or she is not pulled out of the water. Kayakers need to understand the dangers and warning signs, know their swimmer so that they will be able to determine when hypothermia has set in, and have the guts to act quickly once they have made a decision to terminate a swim.
They also need to have a plan for what they will do if a swim needs to end. Some things to think about, for kayakers and swimmers both, include: Is my kayaker physically strong enough to pull me out of the water if I develop hypothermia and am too exhausted and mentally confused to help get in the kayak? How will my kayaker get the two of us back to shore in the event of an emergency? Does my kayaker have a way to call for help in the event of an emergency? Is my kayaker prepared with a life jacket if he or she needs to get in the water while I’m in the kayak? Is my kayaker decisive enough to terminate a swim, even if I’m arguing?
It’s important to think about these issues beforehand, because mental clarity really does go right out the window as hypothermia sets in. Unfortunately, I have first-hand experience with this, as I experienced severe hypothermia as I attempted a double-width crossing of Bear Lake this past summer. I didn't show the signs above, so it was a very good thing that my kayaker, Gordon Gridley, knew me well enough to know that I wasn't acting like myself. I’m usually very pleasant (this is what people tell me!), but I was stopping often, complaining, and glaring at Gordon. I ended up with a temperature of 78 degrees, clearly a very dangerous situation. Kayakers need to be attentive to these types of changes in a swimmer and follow their intuition to know when something isn't right.
The most obvious need when dealing with a person with hypothermia is getting him or her warm. The swimmer needs to be taken out of the water, brought indoors (or into a warm vehicle) if possible, and dried off. Wet swimming suits should be removed and he or she should be dressed and then wrapped in dry, warm blankets. Focus on warming up the person’s core, and then the warm blood will naturally circulate to the rest of the body. Cold hands and feet will take care of themselves.  If you focus on the extremities by immersing the hands and feet in warm water, you’ll increase the risk of shock.
Also, it may seem like a good idea to immerse the swimmer in hot or warm water if you have it available (such as a hot tub), but it’s not. This can actually cause heart arrhythmia due to the cold blood being heated so rapidly. If you have access to hot water bottles or chemical hot packs, place them under the swimmer’s armpits and between the thighs. Wrap the hot water bottles in a towel if they are hot to the touch.
Warm drinks are helpful, but avoid caffeine and alcohol, both of which can dehydrate the swimmer further. Wrap the swimmer’s neck with a warm blanket, and generally just be attentive as he or she warms up naturally. It’s important to take the swimmer’s temperature if you have access to a thermometer; that way you can tell when he or she is out of the danger zone. You’re watching for a temperature that is at least 95 degrees.
Experiencing hypothermia and then recovering is pretty exhausting. Your body has been through a lot of stress trying to keep warm and then warming up again. You’ll be very tired, right to the core, if you experience hypothermia. Allow yourself plenty of time to rest and recover, and eat lots of healthy food. You’ll also inevitably reflect on the blessing it is to be alive. Hug all of the people you love and vow to enjoy every single day as much as possible. Thank all of the people that were involved in making sure you were safe, from your kayaker to your swimming buddies.

As open water swimmers, we are so blessed to be able to experience all of the beauty of the water. Sunrises, fog, sunsets, rain, wind – all of these add to the joy of open water swimming. We forge close friendships as we support each other and swim together. Being aware of the dangers only makes us more prepared and better able to help ourselves and each other during tough situations. Let’s all take the time to make a personal plan to avoid hypothermia and also learn the signs in case we do encounter it.