cold water
Hypothermia and Cold Water Kayaking
Signs
Treatment
Survival







Kayak Skills - Hypothermia: Signs, Treatment and Survival
Hypothermia: Signs, Treatment and Survival by Robert Finlay of Kayak Lake Mead

An abnormally low core temperature is the condition of hypothermia. In this condition normal muscular and
mental abilities are impaired. If the condition continues to deteriorate it will lead to death. This article is about
hypothermia, its signs and treatment and about your survival as a cold water kayaker.

Succumbing to hypothermia is a process of heat loss (getting cold) versus heat retention and heat production.

Everyone is different and will succumb to hypothermia differently. Some people will show signs sooner in the
process and some later. Given the same conditions, some people will get hypothermia while others will not.
Some people will not indicate, except by the most obscure clues, that they are suffering from hypothermia.

These differences can be attributed several factors...
1) to genetics (Arctic peoples have greater immunity to the cold than Amazon jungle denizens),
2) to percentage of body fat (more fat equals more insulation), 
3) to acclimatization (if you have trained in the cold your body will have adapted to the cold), and
4) to mental attitude (this a particular danger to adventure racers).

Adventure racer sidebar: The total team attitude and desire to prevail in the race is absolutely the way to be.
But, you must watch yourself and your team mates. When the competitive attitude is "totally on" it is very easy to overlook the dangerous hypothermia indicators. The problem is exacerbated because it is quite likely everyone on the team may be suffering from hypothermia OR suffering in other ways causing team mates to overlook the problems of others. This could lead to a DQ or DNF - unless you detect the signs and apply treatment.

Additional adventure racer sidebar: Also, a condition occurs in adventure racing that I call silent hypothermia. This is a condition whereas after days of continued exposure to cold temperatures, wetness, and wind AND with minimal heat retention (constant wet clothes) AND with minimal heat production (lack of food) an adventure racer finally succumbs to hypothermia. AND this is without any OVERT signs or symptoms showing until it is too late. In other words, your team mate is down without ever giving the slightest clue of shivering, mumbling, or stumbling. 

Hypothermia occurs in general stages (remember everyone is different). Early detection is important because 1) hypothermia is dangerous and 2) the earlier it is detected the easier it is to treat.

Reality check: Self-awareness is VERY important. If you are a kayaker, adventure racer or just an overall
rugged outdoor adventurer, you are not a very competent kayaker or adventurer UNLESS you can recognize the signs of hypothermia in yourself AND let others know OR if you are by yourself... You can self-treat /
self-recover from hypothermia. 


Stages and Signs and Results of Hypothermia:
This is about detecting hypothermia. It is not a math formula. It is the evaluation human beings and each one is different. It is also about being aware of and honest with yourself.

Mild Hypothermia - core temperature 98.6 - 96 degrees F:
1) Cold sensation begins - getting goose bumps feel cold, hands, nose, or feet are numb.
2) Shivering - not under voluntary control.
3) Can't do complex motor functions - can walk and talk but putting on a rappel harness is difficult and paddling
strokes are sloppy.

These above three signs are enough for corrective action - retain or produce more heat.

Moderate Hypothermia - core temperature 95 - 93 degrees F:
1) Dazed consciousness - may at first appear alert, but mild confusion will become apparent.
2) Uncoordinated movements - the stumbles, walking isn't easy.
3) Slurred speech - the mumbles, or isn't talking at all because of the effort to speak correctly.
4) Loss of fine motor coordination - particularly in the hands, can't zip up parka.
4) Mild depression - may appear withdrawn, gets the "I don't care attitude".
5) Irrational behavior - may appear alert and "with it" but starts behavior that is not goal oriented.
6) Violent shivering - shivering has increased in duration. 

If you have missed the signs before, NOW with any of the above signs, it is time to take ACTION.

Severe Hypothermia - core temperature 92 - 86 degrees and below:
Now the situation is immediately life threatening.
1) Shivering occurs in waves, violent then pause, pauses get longer until shivering finally ceases
2) Person falls to the ground, can't walk, curls up into a fetal position to conserve heat
3) Skin is pale
4) Pupils dilate
5) Pulse rate decreases
6) At 90 degrees the body tries to move into hibernation, shutting down all peripheral blood flow and reducing
breathing rate and heart rate. May be unconscious.
7) At 86 degrees the body is in a state of "metabolic icebox." The person looks dead but is still alive.

The signs above indicate conditions that will soon lead to death if not quickly treated. At this point your paddle
friend or adventure team mate has just become a patient. Seek medical help.

Critical Hypothermia - 85 degrees and under:
1) Unconscious - may appear dead.
2) Little or no apparent breathing or pulse.
3) Skin is cold - may be bluish and gray.
4) Muscular rigidity - very rigid

Assume the patient is still revivable, don't give up. Medical help is imperative. Look, listen, and feel for breathing and pulse every 2 minutes. 


Treatment of Hypothermia:
The basic principle of rewarming a hypothermia victim (the victim could very well be yourself) is to conserve
the heat they have (heat retention) and warm the victim (heat production), getting them back to normal.

In general...
1) Get the victim dry and out of the wind.
2) Gently remove all wet clothes (get dry).
3) Insulate the body, including head and neck (heat retention).
4) Apply mild heat to body core and rewarm gradually (heat production).
5) Handle gently.

Afterdrop: Is a situation in which the core temperature actually decreases during rewarming. This is caused by peripheral vessels in the arms and legs dilating if they are rewarmed. This dilation sends this very cold, stagnate blood from the periphery to the core further decreasing core temperature which can lead to death. Afterdrop can best be avoided by not rewarming the periphery. Rewarm the core only! Do not expose a severe hypothermia victim to extremes of heat.

Sudden drops in blood pressure from sudden or quick movements can also lead to afterdrop. Leave the victim horizontal because vertical position changes can also lead to afterdrop.

Mild to Moderate Hypothermia Treatment:
1) Reduce heat loss - getting the victim dry, out of the cold, and out of the wind (shelter).

2) Increase heat retention - additional layers of dry clothing OR sleeping bag

3) Increase heat production by physical activity and / or food and water intake:

3) Increase heat production by warm (not hot) liquids. Give warm sweet (carbs) drinks. DO NOT give alcohol
(opens the capillaries and will increase peripheral heat loss), caffeine (causes water loss), or tobacco (closes
capillaries and will increase risk of frostbite).

4) Increase heat production with external sources. These can include fire, chemical heat pads, or from body to
body contact with a warm person. The best method for body to body contact warming is in a sleeping bag with
both victim and warmth giver dry and both in light clothing.

Sidebar to adventure racers: If you have a team mate (or you yourself) that is hypothermic, giving the care
and allowing the victim to properly warm up and rest for a couple hours is your ONLY course of action. You
know yourself, that if you are in a race that is cold and wet, many teams will not finish. But, if your team
hypothermia protocol is in play... Your team will finish. I was in the Adrenaline Rush '03 and witnessed the lead team, with more than 2 hours lead drop out from hypothermia; bad hypothermia protocol. 

Severe Hypothermia Treatment:
Same general principles apply but extra effort must be given to heat retention. And special care must be given to food and liquids.

1) Shelter: Warm - Dry - Out of the Wind:
To reduce heat loss and increase heat retention get the victim in a Hypothermia Wrap:
The idea is to provide a shell of total insulation for the patient. No matter how cold, patients can still internally
rewarm themselves much more efficiently than any external rewarming.

Make sure the patient is dry, and has a polypropylene layer to minimize sweating on the skin.

Get the victim in a sleeping bag and further insulate the sleeping bag. Pay particular attention to getting insulation between the victim and the ground. Include an aluminum "space" blanket to help prevent radiant heat loss.

2) Add Fuel & Fluids:
Warm Sugar Water - for people in severe hypothermia, the stomach has shut down and will not digest solid
food but can absorb water and sugars. Give a dilute mixture of warm water with sugar every 15 minutes (sugar
source should be simple carbs).

Urination - people will have to urinate from cold diuresis. Vasoconstriction creates greater volume pressure in
the blood stream. The kidneys pull off excess fluid to reduce the pressure. A full bladder results in body heat
being used to keep urine warm rather than vital organs. Once the person has urinated, it precious body heat will be used to maintain the temperature of vital organs. So in the end urinating will help conserve heat. You will need to help the person urinate. Open up the Hypothermia Wrap enough to do this and then cover them back up.

3) Add Heat:
Heat can be applied to transfer heat to major arteries - at the neck, at the armpits, at the groin, and at the palms of the hands. Use chemical heat pads, warm water bottles, warm rocks, towels, or compresses

Rescue breathing can increase oxygen and provide internal heat.

4) Get medical attention.



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