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I've read many of the posts that are related to this and believe it to be a be a snowflake of a question on the site.

If you have fallen into icy water and the temperature is very challenging, what are the immediate steps to take to assist the victim?

I've read this post and it's more driven by how to rescue someone who has fallen in icy waters. The obvious statements are made. Get the person warm, etc. This post seems to address the situation once the victim/patient is hypothermic.

My question is more driven by prevention.

The general framework is get the wet off, get them warm...but how?

  • A fire in short order seems like a good idea. If you have a group, a person can be assigned the task. RIGHT NOW.

  • As in other posts, discarding wet clothes immediately doesn't seem to be a bad idea at all.

When I have been in the situation of assisting I stripped the person, pulled my sleeping bag, opened my jacket, pulled up my clothes and went skin on skin with the victim and had someone assist with getting us both into a sleeping bag ASAP.

I've been chided for this, not for the skin on skin, just the whole process. Honestly, I had never considered an action plan before the moment it happened and I simply reacted.

I'd like to have a better action plan, especially if it were colder.

  • Is there something light that can be added to the plethora of gear we all might be lugging around out there?

  • Is there a better methodology than the example provided?

  • What is the most immediate/primary concern?

I've been told to focus on torso and head. Get ANYTHING on the head to retain heat. A baseball cap? Use dirt, if available, to rub into hair and quickly dry the head? Strip the victim naked and focus on torso due to capillaries constricting to force blood in the torso the torso should be the focus.

Any medical references and/or response frameworks are what I'm really looking for. The victim is wet, it's very cold. Now what?

As a side note, what if there's a base camp, everyone goes on a day hike with limited gear in smaller hydro packs and the incident occurs. That would be an interesting problem to solve.

Apologies in advance for the rant.

TIA

  • Confused: Do you mean how to treat mild hypothermia (preventing it turning into severe), or how to prevent mild hypothermia in the first case? Or, do you mean how to prevent a casualty from ALSO getting hypothermia? – Roddy Jan 5 '16 at 11:24
  • um, whats a 'snowflake of a question' mean? – Roddy Jan 5 '16 at 12:44
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    Get ANYTHING on the head to retain heat. This seems to be based on the urban folktale that people lose a disproportionate amount of heat through their head. Studies have shown that you lose heat through bare skin at basically the same rate (per unit area) all over your body. – Ben Crowell Jan 5 '16 at 14:49
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    I am honestly confused about your question: As far as I understand an actual happening prompted it. In this case a person fell into cold water, was successfully rescued and you tried to prevent further heat loss by getting into a sleeping bag with the victim. Then you were criticized for this procedure. Now you want to know how to better do that. First: Are this assumptions correct? If so, how was the criticism justified? As far as I see this was perfectly adequate and there is almost no more effective reasonable device than a sleeping bag for this... – imsodin Jan 5 '16 at 20:54
  • @imsodin I really don't know. I did what I did. I took control of the situation. I happened to be with a bunch of birders that wanted to go birdwatching in Colorado in the early spring. They wanted to see a Bald Eagle. The guy was pretty old. mid 60's at least. According to the post below, doing the sleeping bag thing can inhibit shivering which is a natural occurrence to warm the body. So, maybe screwed up, the guy was OK though. I was worried due to his age. – Citizen Jan 6 '16 at 2:17
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I try to address the situation you are asking about, even though I think you already did a good job so this may not be overly helpful/new. Additionally in one of your referenced answers that is actually about rescuing someone out of the water, there is already a great answer by D.Lambert on what to do after rescuing, so my answer will overlap greatly (I still do not think the question is a duplicate, more like this answers belonged here). As you are asking for references, I take this information from my favorite outdoor medical guide by the Swiss association for mountain medicine and the Swiss Alpine Club. So the situation as I understand it is, that we have a wet patient which was immersed shortly in icy water. I assume we now are out of danger of falling into water again.

This person will most likely not yet suffering from hypothermia or if so from first stage hypothermia, meaning he will shiver and be apart from psychological shock be of clear consciousness.
If you are very exposed to wind/rain/snow and have the possibility of getting to a somewhat shelter spot in the immediate vicinity - get there immediately. Is such a place further away try to provide some protection by other people, backpacks, ... while stripping the patient and getting him into dry clothes. Ideally these are spare clothes (in cold weather you should have at least some anyway) and what other can spare.

No there are two scenarios: The patient might feel up to moving by himself. In this stage this is optimal, as a lot of heat can be produced by activity. Just start easy and immediately abort if the patient feels dizzy. Otherwise you try to isolate the patient as good as possible. If you have some kind of heating device (like those little chemical bags) put them onto the first layer on the torso, never directly onto the skin. If you have a sleeping bag, get the person in it, then use rescue blankets, bivy bags, etc. as an outer protection. Of course if two people fit into the sleeping bag, all the better, that's just another heating device inside. However as mentioned in the comments, this may be of limited help. It is likely the person can do more good on the outside (transport, shelter, fire, ...) than he helps inside the bag (thanks Roddy). Unless psychological issues are included, then the cuddling can be highly effective :)

A person in this stage should be given hot liquids to drink, preferably sugary, and motivated to move, even in the sleeping bag. After these initial steps you want to get to a sheltered area. Without such a place you need to improvise: Create some shelter against wind (e.g. snow cave, beside a rock, under tree using branches) and start a fire. This is a whole topic on its own. Thus further cooling should be preventable and if there are not further injuries the patient should recover and immediate evacuation to a hospital is not necessary.

However if you cannot accurately protect the patient it can get life threatening fast. Its out of scope, but just as a warning: When the patient consciousness gets clouded and/or stops shivering this may already be stage two hypothermia. You cannot do much more than prevent further heat loss, but now the patient should not be actively moved and not given anything to drink, unless he is on clear conscious (danger of aspiration). In this case organize evacuation asap and be on alert to perform CPR and remember: A patient with hypothermia is never dead unless he is warm and dead.

Addressing your specific questions:

  • Useful gear:

Sleeping bag, bivy bag, chemical heating thingy, rescue blanket and thermos flask (with hot liquid) (I know, kinda obvious and not very light-weight).

  • Correctness of stated example:

Well as far as it was described, sounds good to me.

  • Most immediate/primary concern:

Prevent further heat loss (again, obvious) - the rest follows.

  • Day hike with limited gear:

Improvise the heck out of the situation. In this situation the chance is big, that you cannot provide ample protection from the cold, but on a day hike external help should be fairly quickly available - do not lose time, organize help immediately if in doubt about whether you can handle it on your own.

Reference: A.G. Brunello, M. Walliser, U. Hefti, Gebirgs- und Outdoormedizin (SAC Verlag, Bern, 2011), p.232.

  • I hope I did not completely miss what you actually wanted to know @PaulD – imsodin Jan 5 '16 at 21:58
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    Good answer :) Interesting stuff re shared sleeping bags here. rendezvous.nols.edu/content/view/1677/964 - basically can inhibit the casualty's shivering response which is one way the body warms itself. – Roddy Jan 5 '16 at 22:15
  • +1, especially for "...never dead unless he is warm and dead." Remember this if you accompany a severely hypothermic person to the hospital! A recent study, published in JAMA Neurology last week as reported by "The Washington Post" 01/05/16, page E3, on Brain Death is ...disquieting. The WP: "[hypothermic] patients may...satisfy many of the criteria for brain death, but they often recover when warmed. Regardless, only 36% of hospitals surveyed required physicians to ensure that a patient's core body temperature reached near-normal levels before declaring the person brain dead." – ab2 Jan 5 '16 at 22:51
  • @Roddy See! That's good stuff. Totally counter-intuitive. – Citizen Jan 6 '16 at 2:14
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    I'd really add rescue blankets to the list of items. Very useful, super light and compact (you can carry this in your pocket easily) and you get them a dime a dozen... – fgysin Jan 7 '16 at 8:04
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Hypothermia is likely the least of your problems after an involuntary dip into icy water. Drowning and cardiac arrest are the killers here.

Read these, and maybe watch the videos. It's all good stuff, and difficult to summarise.

http://beyondcoldwaterbootcamp.com/4-phases-of-cold-water-immersion

http://beyondcoldwaterbootcamp.com/en/rescue-a-treatment

Basically, adults need over 30 mins in icy water before you get even mildly hypothermic. From beyondcoldwaterbootcamp:

While it varies with water temperature and body mass, it can take 30 minutes or more for most adults to become even mildly hypothermic in ice water.

http://sportsscientists.com/2008/01/exercise-in-the-cold-part-ii/

Perhaps the first, and maybe the most surprising fact about cold water physiology, is that your body has too much heat to become hypothermic within about 30 minutes, no matter how cold the water is!

... and from @imsodin's link:

Even in ice water hypothermia does not set in until after 20 to 30 minutes, depending on the amount and type of clothing.

If you're out of the water and wet, you will lose heat by evaporation (as well conduction and convection), so dry clothing and dry body are important.

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    I have no first hand knowledge on the topic, but just to take this maybe with a grain of salt: I found a source who says that you lose consciousness in 15min in near freezing water and lose dexterity due to centralization after 2-3 minutes. shipwrite.bc.ca/Chilling_truth.htm – imsodin Jan 5 '16 at 12:26
  • @imsodin : Loss of dexterity is cold incapacitation ,not hypothermia. Quote from your link: "it is impossible for a victim to become hypothermic in less than 20 to 30 minutes immersion in cold water." – Roddy Jan 5 '16 at 12:29
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    I only looked at the table and first paragraphs, in which they talk only about heat loss - hence my doubt. Reading on changes the picture a lot, did not know that - thanks for correcting! As you seem to have quite some knowledge at the topic I suggest you write a short summary about this mechanics. I guess some of the confusion you address in your comment to the question could be resolved by this. – imsodin Jan 5 '16 at 12:44
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    adults need over 30 mins in icy water that sounds overly optimistic. – njzk2 Jan 5 '16 at 15:30
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    @njzk2 I was surprised too. But I've added a few references. I don't know enough about this stuff to risk making it up. – Roddy Jan 5 '16 at 19:56
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My copy of Buck Tilton's Wilderness First Responder notes that for cold water immersion, aside from providing standard treatment for hypothermia, the patient should be "handled gently, lifted from the water, and kept in a horizontal position". Dry them off, and insulate them from further cold before you think about building a fire. (The reason behind keeping the patient flat is to avoid stressing their heart.)

If you fall in yourself, use the first minute to get control of your breathing, then assume you only have about 10 minutes of useful muscle activity. Use that time to pull yourself out or swim to safety.

In terms of re-warming, the vast majority of the work will be done by the patient's own body: your role is to support that by minimizing their external heat loss and topping up their fuel supply (calories) if they are conscious. Adding external heat sources may help a small amount.


Now, there is some contradiction between the need to get someone into dry clothes and the need to keep them insulated from the environment; obviously if they are in the open with howling winds and rain it's probably a bad idea to pull off their clothes. So, let's look at some other protocols that may be better suited for the solo traveler or those who were only briefly immersed (e.g. fell in and climbed straight out).

For this I'll reference a "re-warming drill", which you can read an example of at https://www.sitkagear.com/insight/a-navy-seal-rewarming-drill. This method relies on both body heat (as previously mentioned) and also proper gear selection: wicking fabrics and synthetic insulation. If you don't have the proper clothing, it's not likely to work very well. The type of clothing system mentioned in this article may be referred to by many different acronyms; searching for ECWCS or PCU should give good results.

In the first form of the drill, the troops pair off and immediately add synthetic insulation layers. One person sets up the tent, the other sets up a stove and gets snow melting or water heating. With that done, both burrow into their (synthetic) sleeping bags. As soon as they can, they then get some hot drinks and calories into them and lie back down.

The second form of the drill addresses the case of what to do without tent, sleeping bag, or stove. In that case, the troops simply put on their synthetic insulation layers and their packs, and then marched for a few hours at a slow, easy pace (enough to generate heat, but not to sweat).


Having described a pair of options, you can also look at the Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia section on field re-warming. It suggests that patients not be immediately allowed to stand or walk, and that delaying exercise for about 30 minutes will help reduce the risk of afterdrop.

On a personal note, I haven't yet decided to jump in an icy lake, but I can attest to the drying abilities of modern synthetics. This past summer, after getting my hiking pants largely soaked in a thunderstorm, I added GoreTex pants over them and after a moderate amount of walking had completely dried them out.

  • Thanks for the response. I really like the Gore Tex segue. +1 – Citizen Jan 6 '16 at 2:21
  • Great information. Do you know the reasoning for not getting out of the wet clothes ones a tent is built up? Water has a huge heat capacity, so while as described it is possible to heat and eventually evaporate it by body heat, that initially means being a lot colder. If it is just about drying the clothes, couldn't that be delayed until after one is warmed up (and the soaking wet stuff can be wrung out)? – imsodin Jan 7 '16 at 8:56
  • @imsodin I've been thinking about whether I should edit that portion. The clothing layers the troops are wearing would be grid fleece baselayers (like Patagonia's R1) and a softshell, neither of which would retain much water. Most other clothing will retain water and should come off. I think I'll retain the dynamic part, as that's applicable to the "on a day hike, got soaked, have no sleeping bag" case. – requiem Jan 7 '16 at 16:32
  • Well when I wash my softshell (very lightweight one, so no additional isolation or anything) I can wring out still quite a bit of water - of course much less than "classical" clothing, but still a significant amount. Currently you do not address whether to take them off in the answer itself, right? – imsodin Jan 7 '16 at 16:59
  • Correct. It seems some sort of decision tree may be needed. By chance, I found an interesting clothing-related observation in the story here: missoulian.com/lifestyles/recreation/… – requiem Jan 7 '16 at 17:45

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