Cold-Water Immersion

Overcome Panic, Maximize Chance of Survival

by Laurie Schreiber

Immersion suits provide floatation and warmth. One study asked 480 professionals – doctors, EMTs and search and rescue people – how long it would take to develop hypothermia in icy water. Fifty percent said 5 minutes; 20 percent said 10 minutes. But even in icy water, said Mirman, it takes at least 30 minutes to become hypothermic. Prior to hypothermia comes cold-water shock, in the first five minutes. © Photo by Sam Murfitt

ROCKPORT – To increase their chances of survival in the Atlantic Ocean, fishermen and others need to understand the nature and dangers of cold-water boating. Those unaware cannot formulate a plan to increase the likelihood of survival if a mishap plunges them into cold water.

That was the topic of a presentation on cold-water survival at the recent Maine Fishermen’s Forum. As it turns out, hypothermia is not the greatest risk, according to Dr. Ken Mirman, a retired cardiologist from Machiasport. The most common cause of death in the groundfishery, the most dangerous fishery in the U.S., and in the scallop fishery, also a dangerous fishery, is vessel disaster, said Mirman.

“But the most common cause of death in the lobster fishery is man-overboard,” he said.

From 2000-2009, nationwide, 504 fishermen died on the water. Of those, 155 (36 on the East Coast) fell overboard. None of the victims were wearing a personal flotation device (PFDs). Many were only minutes from rescue.

“Most fishermen do not wear PFDs while on deck,” said Mirman. “The waters of Maine are very cold and cold water is very dangerous.”What is meant by cold water? Mirman explained that normal body temperature is 98.6 degrees Fahrenheit. The United States Olympic swimming committee requires pool water to be 77-82 degrees, “which most people think is warm. Below 77 degree, water is cold enough to affect breathing.”

Very cold, and dangerous, is 68 degrees and below, because the body can’t maintain its temperature.

In the lower 60s and approaching 50 degrees, physiological changes produce life-threatening effects. These are significant numbers for the Gulf of Maine, he said. Here, the average seawater temperatures are: Portsmouth, N.H. 48, Portland 47, Bar Harbor 49, and Eastport 45.

Highest temperatures occur in August. For example, the water can reach 62 in Bar Harbor and 51 in Eastport. Temperatures decline as low as 33 degrees in February.

Mirman provided several examples of disaster: A volunteer firefighter capsized his kayak on a small wave on a river in Georgia. The air temperature was 65 degrees, the water was 45 degrees. He died by drowning.

Two women, age 18 and 20, were on a two-mile round-trip paddle between two islands in Casco Bay. The water temperature was 48 degrees. They died from hypothermia within hours.

Nine young and healthy elite marines were attending the Marine Corp Physical Fitness Academy. They were paddling a war canoe across the Potomac River. The water temperature was 36 degrees, “brutally cold” and also the average water temperature of Maine waters in the winter. None wore a PFD. The canoe capsized 100 yards from shore. None of the marines were able to swim to shore. “They all drowned. How is that possible, that young, healthy people can’t swim 100 yards in cold water?” Mirman said.

During the 1979 Fastnet race, a 600-mile sailboat race off the British Isles, 70-knot winds came up; the water temperature was 59 degrees. Nineteen yachts were abandoned; five sank. There was a massive search and rescue, but 15 people died. Of those, 10 died during rescue. Of those 10, seven died after they got into a life raft; two managed to climb the rope ladder up to the deck of a rescue boat, then died; and one was physically and mentally capable enough to get into a rescue harness and was winched up to a rescue helicopter. By the time he got to the helicopter, he was dead.

“How far were they from safety, like a boat, shore, dock?” Mirman said. According to a Canadian study, 66 percent of cold-water victims were less than 50 feet from safety; 43 percent were less than 6 feet from safety. “Intuitively, it doesn’t make any sense, if your life depended on it, that you couldn’t swim another 10 feet to safety. But this is factual,” Mirman said. “Cold water is very dangerous, and the seawaters of Maine are dangerously cold.”

Mirman explained that, if people make prior plans and understand what to expect, their chances of survival go up.

An important misconception concerns hypothermia. One study asked 480 professionals – doctors, EMTs and search and rescue people – how long it would take to develop hypothermia in icy water. Fifty percent said 5 minutes; 20 percent said 10 minutes. But even in icy water, said Mirman, it takes at least 30 minutes to become hypothermic.

Prior to hypothermia comes cold-water shock, in the first five minutes. This affects mainly the skin.

Incapacitation occurs in the next 5-30 minutes. This affects muscles and the ability to swim. More than 50 percent die in the first two stages, not during the hypothermic stage, he said. Of those, at least 10-20 percent die during rescue.

“So the majority don’t die from hypothermia,” he said. “The greatest risk is drowning.”This is important to understand, as it affects the victim’s expectations, he said.

“Most commercial fishermen believe not only that you become hypothermic in 10 minutes, but that you die within 10 minutes,” he said. One fisherman who drags for scallops in Cosbscook Bay in the winter told Mirman that he takes precautions.

“But he said, ‘It doesn’t make any difference. After all, hypothermia will kill you in five or 10 minutes,’” Mirman said. “It’s not true. The main problem is, it’s fatalistic, because if you really believe it doesn’t make any difference what you do when you go into cold water, then it prevents you from doing what you need to do prior to the time you have a cold-water mishap, and during a cold-water mishap. And you’re going to panic, and it’s been shown that if you panic, that will increase the life-threatening changes.”

The first life-threatening effect occurs immediately, when the victim involuntarily gasps upon hitting the water.

“If you gasp when your head is underwater, you could easily drown then,” he said. “It’s not common, but it’s common enough.”

Hyperventilation, pain and spasm of the muscles, panic, difficulty coordinating breathing with wave splash, difficulty in thinking clearly, and swim failure follow.

A PFD helps alleviate panic and helps breathing by keeping the head above water.

Mirman had recommendations on how to prepare for and what to do in a cold-water emergency.

Most important is always to wear a PFD. One study had fishermen test six PFDs for comfort and their ability to work in them. Four were approved: the Mustang inflatable, the Stearns inflatable, the Regatta oilskin with flotation, and the Stearns foam work vest.

“The best type of PFD is the one fishermen wear,” Mirman said. “And that’s going to depend on two things – the particular fishery, because different fisheries have different tasks and equipment. And even within that fishery, there are individual fishermen’s preferences. But we can conclude that if commercial fishermen wore PFDs, many lives would be saved.”

Mirman recommended that fishermen take a marine survival course every five years, to train with immersion suits, life raft use, and water survival techniques. There are crucial details to consider, he said. One is how to get back onboard a boat, particularly if the victim is alone. Lobsterboats have high freeboards, and a person overboard cannot get back on.

“So think about putting a rope ladder on the side,” he said. “That kind of thing can mean the difference between life and death.”

He recommended that crews have man-overboard drills, and drills to don immersion suits within a minute. Fishermen should make an emergency checklist of procedures to follow during an emergency, when things can become too stressful to think clearly.

They should make their distress call early, to let other fishermen and the Coast Guard know they have a problem. “Sometimes, things evolve so quickly you don’t have time to make an adequate mayday call,” he said.

Mirman also had recommendations for victims to follow when they’re in the water.

“One of the all-important decisions is, do you stay with your boat or do you try to swim to safety? The question you have to answer is, What’s the likelihood of rescue? Was your mishap witnessed? Are you able to get out of the water? How far are you from safety? And, very critically, are you wearing a PFD? Because if you’re not, and you attempt to swim to shore, and you don’t make it, then you drown. The final thing is the sea state. If you’re wearing a PFD, what direction is the wind and current going to take you? If it’s going to take you to the shore, it makes sense to swim. If it’s going to take you to open ocean, it probably doesn’t.”

In 50-degree water, a person wearing an insulated PFD can last about seven hours. Those wearing immersion suits can last for days, he said.When it becomes impossible to swim, the victim needs to conserve heat in order to live longer and increase the opportunity for rescue. “Assume a fetal posture,” he said. “You’re covering the high heat loss areas of the body.” If there’s more than one person, they can huddle around the most vulnerable person.

Mirman recommended fishermen remember a “one ten one” mantra.

“You have one minute to get your breathing under control. You have ten minutes of purposeful movement. Whatever you have to do to get out of the water, onto flotation, or to swim, you have about 10 minutes to do it. And you have about one hour before you become unconscious due to hypothermia.”

In the first seconds, though, the victim must find a way to stop the automatic reactions that will kick in.

“It’s extremely difficult not to panic,” he said. “And then follow the one-ten-one mantra. Our ancestors accepted death at sea as an occupational hazard; it is not an inevitable fate. Wearing a PFD on deck will save lives.”