1
|
Davis CA, Schmidt AC, Sempsrott JR, Hawkins SC, Arastu AS, Giesbrecht GG, Cushing TA. Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update. Wilderness Environ Med 2024; 35:94S-111S. [PMID: 38379489 DOI: 10.1177/10806032241227460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management of drowning in out-of-hospital and emergency care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the second update to the original practice guidelines published in 2016 and updated in 2019.
Collapse
Affiliation(s)
- Christopher A Davis
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Andrew C Schmidt
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | | | - Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ali S Arastu
- Division of Pediatric Critical Care, Stanford University School of Medicine, Palo Alto, CA
| | - Gordon G Giesbrecht
- Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation, University of Manitoba, Winnipeg, Manitoba, Canada
| | | |
Collapse
|
2
|
van Duijn T, Cocker K, Seifert L, Button C. Assessment of water safety competencies: Benefits and caveats of testing in open water. Front Psychol 2022; 13:982480. [PMID: 36248477 PMCID: PMC9554088 DOI: 10.3389/fpsyg.2022.982480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Drowning has been the cause of over 2.5 million preventable deaths in the past decade. Despite the fact that the majority of drownings occur in open water, assessment of water safety competency typically occurs in swimming pools. The assessment of water safety competency in open water environments brings with it a few difficulties, but also promises tremendous benefits. The aim of this position paper is to discuss the benefits and caveats of conducting assessments in open water environments as opposed to closed and controlled environments, and to provide recommendations for evidence-based practice. The first theoretical section discusses the effects of the environment and key variables (such as temperature and water movement) on various factors of assessment. These discussions are linked to the two perspectives of representative learning design (based on ecological dynamics) and information processing theory. The second section presents two pilot studies of relevance and provides practical implications for assessment of water safety competency. It seems that a combination of pool-based practice and open water education may be ideal in assessing aquatic skills competency. Assessment in open water presents clear benefits regarding validity, but often poses seemingly unsurmountable barriers, which providers may have reservations about in the absence of clear evidence. Hence this article provides a robust discussion about competency assessment and signals the practical importance of faithfully reproducing the environment in which skilled behavior is most relevant.
Collapse
Affiliation(s)
- Tina van Duijn
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
- *Correspondence: Tina van Duijn,
| | - Kane Cocker
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Ludovic Seifert
- CETAPS EA3832, Faculty of Sport Sciences, University of Rouen Normandy, Mont-Saint-Aignan, France
- Institut Universitaire de France (IUF), Paris, France
| | - Chris Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| |
Collapse
|
3
|
Marine Survival in the Mediterranean: A Pilot Study on the Cognitive and Cardiorespiratory Response to Sudden Cool Water Immersion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031601. [PMID: 35162622 PMCID: PMC8834950 DOI: 10.3390/ijerph19031601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 02/05/2023]
Abstract
Background and Aim: The Mediterranean is one of the major gateways of human migratory fluxes from Northern Africa, the Middle East, and Central Asia to Europe. Sea accidents have become an urgent humanitarian crisis due to the high number of migrants on the move, but data on the physiological effects to sudden cool water immersion are not as extensive as cold-water studies. We wanted to evaluate to what extent cool water immersion (~18 °C) may detrimentally affect cognitive ability and cardiorespiratory strain compared to the more prevalent cold-water (<10–15 °C) studies. Methods: In this case, 10 active, healthy men participated in this study which consisted of completing one familiarization trial, and then a control (CON) or experimental (EXP) trial in a randomized, repeated-measures, cross-over fashion, separated by at least 7-days. Cognitive function was assessed via the Symbol Digit Modalities Test (SDMT), a code substitution test, performed at baseline, then repeated in either a thermoneutral (~25 °C room air) dry environment, or when immersed to the neck in 18 °C water. Testing consisted of six “Step” time-blocks 45-s each, with a 5-s pause between each Step. Cardiorespiratory measures, continuously recorded, included heart rate (beats per minute), minute ventilation (V˙E, L∙min−1), oxygen consumption (V˙O2, L∙min−1), and respiratory frequency (fR, count∙min−1). Results: Initial responses to cool water (<2 min) found that participants performed ~11% worse on the code substitution test (p = 0.025), consumed 149% greater amounts of oxygen (CI: 5.1 to 9.1 L∙min−1, p < 0.0001) and experienced higher cardiovascular strain (HR CI: 13 to 38 beats per minute, p = 0.001) than during the control trial. Physiological strain was in-line to those observed in much colder water temperature. Conclusion: Sudden, cool water immersion also negatively affects cognitive function and cardiorespiratory strain, especially during the first two minutes of exposure. The magnitude increase in heart rate is strongly associated with poorer cognitive function, even in (relatively) warmer water consistent with temperatures found in the Mediterranean Sea environment.
Collapse
|
4
|
van Duijn T, Button C, Masters RSW. A Multidisciplinary Comparison of Different Techniques Among Skilled Water Treaders. Front Physiol 2021; 12:719788. [PMID: 34489736 PMCID: PMC8417780 DOI: 10.3389/fphys.2021.719788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
In an immersion incident, a person may be required to tread water for extended periods of time in order to survive. Treading water, or maintaining a stable head position above the water surface, can be achieved in several different ways. Determining which treading water techniques are economic (energetically and cognitively) is an important first step in approaching evidence-based water safety instruction. The present study investigated the cognitive and metabolic demands associated with four main techniques for treading water in experienced water treaders. Skilled water treaders (n=21) performed four common treading techniques for 3min each: "running" in the water, "flutter kick" with hands sculling, "upright breaststroke," and "egg-beater." Self-reported rate of perceived exertion (RPE) and task load index (TLX) score, as well as objective measures of probe reaction time (PRT; i.e., response to auditory cues while treading), oxygen consumption and heart rate were assessed. The "egg-beater" technique and the "upright breaststroke" technique were linked to significantly lower cognitive and energetic demands compared to the other techniques (VO2: p<0.001 - "Running" M=29.02, SD=7.40/"Flutter kick" M=29.37, SD=8.56, "Breaststroke" M=23.47, SD=7.28, and "Eggbeater" M=23.18, SD=6.31). This study lays the groundwork for future research that may establish the ideal movement behavior in drowning situations and investigate movement instruction to less experienced treaders.
Collapse
Affiliation(s)
- Tina van Duijn
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Chris Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Rich S W Masters
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| |
Collapse
|
5
|
Schmidt AC, Sempsrott JR, Hawkins SC, Arastu AS, Cushing TA, Auerbach PS. Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2019 Update. Wilderness Environ Med 2019; 30:S70-S86. [PMID: 31668915 DOI: 10.1016/j.wem.2019.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/05/2019] [Accepted: 06/14/2019] [Indexed: 01/16/2023]
Abstract
The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management and treatment of drowning in out-of-hospital and emergency medical care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the first update to the original practice guidelines published in 2016.
Collapse
Affiliation(s)
- Andrew C Schmidt
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
| | - Justin R Sempsrott
- Department of Emergency Medicine, TeamHealth, West Valley Medical Center, Caldwell, Idaho
| | - Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University, Winston Salem, NC
| | - Ali S Arastu
- Division of Pediatric Critical Care, Stanford University School of Medicine, Palo Alto, CA
| | - Tracy A Cushing
- Department of Emergency Medicine, University of Colorado Hospital, Aurora, CO
| | - Paul S Auerbach
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA
| |
Collapse
|
6
|
Sorensen JA, Weil R, Echard J, Hirabayashi L, Scribani M, Jenkins P. Lifejackets and Lobstermen: Giving Safety Equipment a Competitive Advantage. J Agromedicine 2019; 24:381-390. [PMID: 31256715 DOI: 10.1080/1059924x.2019.1635935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Falls overboard are the most frequent cause of death in the Northeast lobster fishing industry. National Institute for Occupational Safety and Health (NIOSH) surveillance indicates every victim of a fall overboard who has been found was not wearing a lifejacket. Preliminary research conducted in Maine and Massachusetts indicates lifejacket use is relatively uncommon among lobstermen due to barriers such as comfort, practicality, and social norms.Methods: This study highlights an initiative to: (1) trial various lifejacket designs with lobstermen; (2) identify the most popular designs; and (3) identify other features that could encourage use of lifejackets. In 2017, nine designs were trialed with lobstermen in Maine and Massachusetts during the winter and summer fishing seasons. Participants were recruited dockside, and lifejackets were randomly assigned. Participants completed surveys at 1 week and 4 weeks to assess positive and negative design features and to understand the importance of survival technology that can be used in conjunction with lifejackets.Results: 181 lobstermen in Maine and Massachusetts agreed to participate. Recruitment rates were 90.5%, while the survey completion rate was 88.4%. Survey results identified no clear preference for a specific lifejacket design; however, the ability to choose from many options appeared to be an important factor.Conclusion: Previous studies have indicated that lifejacket preferences are fisheries specific. In the Northeast lobster fishery, however, individual preferences varied. Our research demonstrates that a range of devices covering different buoyancies, wear type, and retrieval systems should be made more available to lobstermen.
Collapse
Affiliation(s)
- Julie A Sorensen
- Northeast Center for Occupational Health and Safety: Agriculture, Forestry, and Fishing, Cooperstown, NY, USA
| | - Rebecca Weil
- Northeast Center for Occupational Health and Safety: Agriculture, Forestry, and Fishing, Cooperstown, NY, USA
| | - Jessica Echard
- Northeast Center for Occupational Health and Safety: Agriculture, Forestry, and Fishing, Cooperstown, NY, USA
| | - Liane Hirabayashi
- Northeast Center for Occupational Health and Safety: Agriculture, Forestry, and Fishing, Cooperstown, NY, USA
| | - Melissa Scribani
- The Bassett Research Institute, Bassett Healthcare Network, Cooperstown, NY, USA
| | - Paul Jenkins
- The Bassett Research Institute, Bassett Healthcare Network, Cooperstown, NY, USA
| |
Collapse
|
7
|
Mole TB, Mackeith P. Cold forced open-water swimming: a natural intervention to improve postoperative pain and mobilisation outcomes? BMJ Case Rep 2018; 2018:bcr-2017-222236. [PMID: 29440051 DOI: 10.1136/bcr-2017-222236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Postoperative neuropathic pain exacerbated by movement is poorly understood and difficult to treat but a relatively common complication of surgical procedures such as endoscopic thoracic sympathectomy. Here, we describe a case of unexpected, immediate, complete and sustained remission of postoperative intercostal neuralgia after the patient engaged in an open-water swim in markedly cold conditions. Though an incidental chance association is possible, the clear temporal proximity linking the swim with pain remission makes a causal relationship possible. We discuss plausible mechanisms that may underlie the relationship and discuss the potential implications for postoperative pain management and patient-centred mobilisation. We recommend further evaluation of cold forced open-water swimming as a mobility-pain provocation challenge to see if the observed unexpectedly positive outcome can be replicated. With the poor response to traditional management, there is a need for novel, curative interventions for postoperative neuropathic pain and associated impaired mobility.
Collapse
Affiliation(s)
- Tom B Mole
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Pieter Mackeith
- School of Health Sciences, University of East Anglia, Norwich, UK
| |
Collapse
|
8
|
Schnitzler C, Button C, Seifert L, Armbrust G, Croft JL. Does water temperature influence the performance of key survival skills? Scand J Med Sci Sports 2017; 28:928-938. [PMID: 29059478 DOI: 10.1111/sms.12997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 11/29/2022]
Abstract
Aquatic survival skills may be compromised in cold water thereby increasing the likelihood of drowning. This study compared physiological, psychological, and behavioral responses of humans treading water and swimming in cold and temperate water. Thirty-eight participants were classified as inexperienced (n = 9), recreational (n = 15), or skilled (n = 10) swimmers. They performed 3 tasks: treading water (120 seconds), swim at "comfortable" pace, and swim at "fast" pace in 2 water conditions (28°C vs 10°C). Heart rate, oxygen uptake, psychometric variables, spatio-temporal (swim speed, stroke rate, and stroke length), and coordination type were examined as a function of expertise. Tasks performed in cold water-generated higher cardiorespiratory responses (HR = 145 ± 16 vs 127 ± 21 bpm) and were perceived about 2 points more strenuous on the Borg scale on average (RPE = 14.9 ± 2.8 vs 13.0 ± 2.0). The voluntary durations of both treading water (60 ± 32 vs 91 ± 33 seconds) and swimming at a comfortable pace (66 ± 22 vs 103 ± 34 seconds) were significantly reduced in cold water. However, no systematic changes in movement pattern type could be determined in either the treading water task or the swimming tasks. Water temperature influences the physical demands of these aquatic skills but not necessarily the behavior. Training treading water and swimming skills in temperate water seems to transfer to cold water, but we recommend training these skills in a range of water conditions to help adapt to the initial "cold-shock" response.
Collapse
Affiliation(s)
- C Schnitzler
- URePSS, EA 7369, University of Lille 2, Lille, France
| | - C Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - L Seifert
- Faculty of Sport Sciences, CETAPS EA3832, University of Rouen Normandy, Rouen, France
| | - G Armbrust
- URePSS, EA 7369, University of Lille 2, Lille, France
| | - J L Croft
- Centre of Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| |
Collapse
|
9
|
Barcala-Furelos R, Abelairas-Gomez C, Romo-Perez V, Palacios-Aguilar J. Influence of Automatic Compression Device and Water Rescue Equipment in Quality Lifesaving and Cardiopulmonary Resuscitation. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction The purpose of this study was to analyse how the rescue equipment and the automatic compression mechanism influenced the cardiopulmonary resuscitation (CPR) after a water rescue on the beach. Methods The sample of our research composed of a group of 65 lifeguards (51 men and 14 women). The lifeguards carried out a 5 minute CPR pretest. Afterwards, the sample was randomly divided into two groups. Both groups performed a test: a water rescue, and immediately afterwards 5 minutes of CPR. One group did not have any additional rescue material, while the other used flippers and a rescue tube to swim. The group with the rescue material performed a CPR with an automatic compression mechanism, the Lund University Cardiac Arrest System. Results The use of the automatic compression device improves the conditions in the correct compressions in CPR after a water rescue: (manual: 283±145.25; automatic: 352±119.74, p=0.042). There was no significant difference in the correct breathing (p=0.758). During the water rescue the lifeguards equipped with flippers and a rescue tube were faster (227±69.28 s) than the lifeguards who had not used any additional equipment (271±43.06 s, p=0.003). Conclusion The use of flippers and rescue tube improved the rescue time. The CPR quality when the lifeguard was exerted worsened significantly, but the use of the automatic mechanisms of compression improved the performance of quality chest compressions. This was not the case with the ventilations, these being of poor quality in both groups. (Hong Kong j.emerg.med. 2014;21:291-299)
Collapse
Affiliation(s)
| | | | | | - J Palacios-Aguilar
- University of A Coruña, Faculty of Sport Sciences and Physical Education, Av/Ernesto Che Guevara, n121 - Pazos Lians, CP: 15179 Oleiros - A Coruña, Spain
| |
Collapse
|
10
|
Risk of mortality during and after the 2011 Great East Japan Earthquake and Tsunami among older coastal residents. Sci Rep 2017; 7:16591. [PMID: 29185489 PMCID: PMC5707380 DOI: 10.1038/s41598-017-16636-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
The Japan Gerontological Evaluation Study is a nationwide cohort study of individuals aged 65 years and older established in July 2010. Seven months later, one of the study field sites was directly in the line of the 2011 Great East Japan Earthquake and Tsunami. Despite the 1-hour warning interval between the earthquake and tsunami, many coastal residents lost their lives. We analyzed the risk of all-cause mortality on the day of the disaster as well as in the 38-month interval after the disaster. Among 860 participants, 33 (3.8%) died directly because of the tsunami and an additional 95 people died during the 38-month follow-up period. Individuals with depressive symptoms had elevated risk of mortality on the day of the disaster (odds ratio = 3.90 [95% CI: 1.13, 13.47]). More socially connected people also suffered increased risk of mortality, although these estimates were not statistically significant. In contrast, after the disaster, frequent social interactions reverted back to predicting improved survival (hazard ratio = 0.46 (95% CI: 0.26, 0.82)). Depressive symptoms and stronger social connectedness were associated with increased risk of mortality on the day of the disaster. After the disaster, social interactions were linked to improved survival.
Collapse
|
11
|
Barcala-Furelos R, Abelairas-Gómez C, Domínguez-Vila P, Vales-Porto C, López-García S, Palacios-Aguilar J. Policía costera de Vigo. Estudio piloto cuasi-experimental sobre rescate y RCP / Coastal Police of Vigo. A Quasi-Experimental Pilot Study about Rescue and CPR. REVISTA INTERNACIONAL DE MEDICINA Y CIENCIAS DE LA ACTIVIDAD FÍSICA Y DEL DEPORTE 2017. [DOI: 10.15366/rimcafd2017.66.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
12
|
Schmidt AC, Sempsrott JR, Hawkins SC, Arastu AS, Cushing TA, Auerbach PS. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning. Wilderness Environ Med 2016; 27:236-51. [PMID: 27061040 DOI: 10.1016/j.wem.2015.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 02/02/2023]
Abstract
The Wilderness Medical Society convened a panel to review available evidence supporting practices for the prevention and acute management of drowning in out-of-hospital and emergency medical care settings. Literature about definition and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded evidence supporting practices according to the American College of Chest Physicians criteria, then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking.
Collapse
Affiliation(s)
- Andrew C Schmidt
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL (Dr Schmidt).
| | - Justin R Sempsrott
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston Salem, NC (Dr Sempsrott)
| | - Seth C Hawkins
- Department of Emergency Medicine, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC (Dr Hawkins)
| | - Ali S Arastu
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA (Dr Arastu)
| | - Tracy A Cushing
- Department of Emergency Medicine, University of Colorado Hospital, Aurora, CO (Dr Cushing)
| | - Paul S Auerbach
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA (Dr Auerbach)
| |
Collapse
|
13
|
Bowes H, Eglin CM, Tipton MJ, Barwood MJ. Swim performance and thermoregulatory effects of wearing clothing in a simulated cold-water survival situation. Eur J Appl Physiol 2016; 116:759-67. [PMID: 26825101 PMCID: PMC4819756 DOI: 10.1007/s00421-015-3306-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Accidental cold-water immersion (CWI) impairs swim performance, increases drowning risk and often occurs whilst clothed. The impact of clothing on thermoregulation and swim performance during CWI was explored with the view of making recommendations on whether swimming is viable for self-rescue; contrary to the traditional recommendations. METHOD Ten unhabituated males (age 24 (4) years; height 1.80 (0.08) m; mass 78.50 (10.93) kg; body composition 14.8 (3.4) fat %) completed four separate CWIs in 12 °C water. They either rested clothed or naked (i.e. wearing a bathing costume) or swum self-paced clothed or naked for up to 1 h. Swim speed, distance covered, oxygen consumption and thermal responses (rectal temperature (T re), mean skin temperature (T msk) and mean body temperature T b) were measured. RESULTS When clothed, participants swum at a slower pace and for a significantly shorter distance (815 (482) m, 39 (19) min) compared to when naked (1264 (564) m, 52 (18) min), but had a similar oxygen consumption indicating clothing made them less efficient. Swimming accelerated the rate of T msk and T b cooling and wearing clothing partially attenuated this drop. The impairment to swimming performance caused by clothing was greater than the thermal benefit it provided; participants withdrew due to exhaustion before hypothermia developed. CONCLUSION Swimming is a viable self-rescue method in 12 °C water, however, clothing impairs swimming capability. Self-rescue swimming could be considered before clinical hypothermia sets in for the majority of individuals. These suggestions must be tested for the wider population.
Collapse
Affiliation(s)
- Heather Bowes
- Extreme Environments Laboratory, Department of Sport and Exercise Science, University of Portsmouth, Spinnaker Building, Cambridge Road, Portsmouth, PO1 2ER, England, UK
| | - Clare M Eglin
- Extreme Environments Laboratory, Department of Sport and Exercise Science, University of Portsmouth, Spinnaker Building, Cambridge Road, Portsmouth, PO1 2ER, England, UK
| | - Michael J Tipton
- Extreme Environments Laboratory, Department of Sport and Exercise Science, University of Portsmouth, Spinnaker Building, Cambridge Road, Portsmouth, PO1 2ER, England, UK
| | - Martin J Barwood
- Department of Sport, Exercise and Rehabilitation, University of Northumbria, Northumberland Road, Newcastle upon Tyne, NE1 8ST, England, UK.
| |
Collapse
|
14
|
Castellani JW, Tipton MJ. Cold Stress Effects on Exposure Tolerance and Exercise Performance. Compr Physiol 2015; 6:443-69. [PMID: 26756639 DOI: 10.1002/cphy.c140081] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cold weather can have deleterious effects on health, tolerance, and performance. This paper will review the physiological responses and external factors that impact cold tolerance and physical performance. Tolerance is defined as the ability to withstand cold stress with minimal changes in physiological strain. Physiological and pathophysiological responses to short-term (cold shock) and long-term cold water and air exposure are presented. Factors (habituation, anthropometry, sex, race, and fitness) that influence cold tolerance are also reviewed. The impact of cold exposure on physical performance, especially aerobic performance, has not been thoroughly studied. The few studies that have been done suggest that aerobic performance is degraded in cold environments. Potential physiological mechanisms (decreases in deep body and muscle temperature, cardiovascular, and metabolism) are discussed. Likewise, strength and power are also degraded during cold exposure, primarily through a decline in muscle temperature. The review also discusses the concept of thermoregulatory fatigue, a reduction in the thermal effector responses of shivering and vasoconstriction, as a result of multistressor factors, including exhaustive exercise.
Collapse
Affiliation(s)
- John W Castellani
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Michael J Tipton
- Extreme Environments Laboratory, Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, Hampshire, England, United Kingdom
| |
Collapse
|
15
|
Nathanson AT, Young JMJ, Young C. Pre-Participation Medical Evaluation for Adventure and Wilderness Watersports. Wilderness Environ Med 2015; 26:S55-62. [DOI: 10.1016/j.wem.2015.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
"Float first and kick for your life": Psychophysiological basis for safety behaviour on accidental short-term cold water immersion. Physiol Behav 2015; 154:83-9. [PMID: 26592137 DOI: 10.1016/j.physbeh.2015.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/23/2015] [Accepted: 11/20/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Accidental cold-water immersion (CWI) evokes the life threatening cold shock response (CSR) which increases the risk of drowning. Consequently, the safety behaviour selected is critical in determining survival; the present advice is to 'float first' and remain stationary (i.e. rest). We examined whether leg only exercise (i.e., treading water; 'CWI-Kick') immediately on CWI could reduce the symptoms of the CSR, offset the reduction in cerebral blood flow that is known to occur and reduce the CSR's symptoms of breathlessness. We also examined whether perceptual responses instinctive to accidental CWI were exacerbated by this alternative behaviour. We contrasted CWI-Kick to a 'CWI-Rest' condition and a thermoneutral control (35°C); 'TN-Rest'. METHOD Seventeen participants were tested (9 males, 8 females). All immersions were standardised; water temperature in cold conditions (i.e., 12°C) was matched ±/0.5°C within participant. Middle cerebral artery blood flow velocity (MCAv) and cardiorespiratory responses were measured along with thermal perception (sensation and comfort) and dyspnoea. Data were analysed using repeated measures ANOVA (alpha level of 0.05). RESULTS MCAv was significantly reduced in CWI-Rest (-6 (9)%; 1st minute of immersion) but was offset by leg only exercise immediately on cold water entry; CWI-Kick MCAv was never different to TN-Rest (-3 (16)% cf. 5 (4)%). All CWI cardiorespiratory and perceptual responses were different to TN-Rest but were not exacerbated by leg only exercise. DISCUSSION Treading water may aid survival by offsetting the reduction in brain blood flow velocity without changing the instinctive behavioural response (i.e. perceptions). "Float first - and kick for your life" would be a suitable amendment to the water safety advice.
Collapse
|
17
|
Pendergast DR, Moon RE, Krasney JJ, Held HE, Zamparo P. Human Physiology in an Aquatic Environment. Compr Physiol 2015; 5:1705-50. [PMID: 26426465 DOI: 10.1002/cphy.c140018] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Water covers over 70% of the earth, has varying depths and temperatures and contains much of the earth's resources. Head-out water immersion (HOWI) or submersion at various depths (diving) in water of thermoneutral (TN) temperature elicits profound cardiorespiratory, endocrine, and renal responses. The translocation of blood into the thorax and elevation of plasma volume by autotransfusion of fluid from cells to the vascular compartment lead to increased cardiac stroke volume and output and there is a hyperperfusion of some tissues. Pulmonary artery and capillary hydrostatic pressures increase causing a decline in vital capacity with the potential for pulmonary edema. Atrial stretch and increased arterial pressure cause reflex autonomic responses which result in endocrine changes that return plasma volume and arterial pressure to preimmersion levels. Plasma volume is regulated via a reflex diuresis and natriuresis. Hydrostatic pressure also leads to elastic loading of the chest, increasing work of breathing, energy cost, and thus blood flow to respiratory muscles. Decreases in water temperature in HOWI do not affect the cardiac output compared to TN; however, they influence heart rate and the distribution of muscle and fat blood flow. The reduced muscle blood flow results in a reduced maximal oxygen consumption. The properties of water determine the mechanical load and the physiological responses during exercise in water (e.g. swimming and water based activities). Increased hydrostatic pressure caused by submersion does not affect stroke volume; however, progressive bradycardia decreases cardiac output. During submersion, compressed gas must be breathed which introduces the potential for oxygen toxicity, narcosis due to nitrogen, and tissue and vascular gas bubbles during decompression and after may cause pain in joints and the nervous system.
Collapse
Affiliation(s)
- David R Pendergast
- Center for Research and Education in Special Environments, University at Buffalo, Buffalo, New York, USA
- Department of Physiology and Biophysics, University at Buffalo, Buffalo, New York, USA
| | - Richard E Moon
- Center for Hyperbaric Medicine and Environmental Physiology, Duke University, Durham, North Carolina, USA
| | - John J Krasney
- Department of Physiology and Biophysics, University at Buffalo, Buffalo, New York, USA
| | - Heather E Held
- Biomedical Hyperbarics Research Laboratory, Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Paola Zamparo
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
18
|
Abstract
A request for a preparticipation medical evaluation for wilderness watersports may be made by guiding agencies, instructional camps, or by patients presenting for an annual visit. Although guidelines have been published regarding preparticipation physical evaluation for traditional competitive high school and collegiate sports, little has been written about medical evaluations for those wishing to engage in wilderness and adventure watersports. In this article, we offer guidance based on literature review and expert opinion. Watersports are among the most common recreational activities in the United States and are generally safe. Drowning, however, is a significant risk, particularly in small, self-propelled craft, and among children. Medical counseling before participation in watersports should include screening for medical conditions which may impair swimming ability, including a history of seizures, heart disease, and lung disease. Physicians should also promote preventive health measures such as use of lifejackets and sun protection, as well as alcohol avoidance. Swim testing tailored to specific activities should be strongly considered for children and those with questionable swimming ability.
Collapse
|
19
|
Button C, Croft JL, Cotter JD, Graham MJ, Lucas SJE. Integrative physiological and behavioural responses to sudden cold-water immersion are similar in skilled and less-skilled swimmers. Physiol Behav 2014; 138:254-9. [PMID: 25447338 DOI: 10.1016/j.physbeh.2014.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/17/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Abstract
We examined the initial physiological responses and subsequent capacity to swim following cold-water immersion. An ecologically-valid model was used whereby immersion was sudden (<2s) and participants had to actively remain afloat. Participants (15 skilled swimmers, 17 less-skilled swimmers) undertook four experimental test sessions: a physiological test and a swimming test in both cold (10°C) water and temperate (27°C) water in a swimming flume (temperature order counter-balanced). For physiological testing, measures of brain perfusion [flow velocity (MCAv, Doppler) and oxygenation (NIRS)] and cardiorespiratory function [ventilation parameters and end-tidal PCO2 (PETCO2)] were recorded whilst treading water for 150s. The swimming test involved treading water (150s) before swimming at 60% (up to 120s) and 90% (to intolerance) of pre-determined maximum velocity. Multifactorial analysis revealed that swimming duration was influenced most heavily by water temperature, followed by respiratory variables and MCAv in the first 30s of immersion. The time course and severity of cold shock were similar in both groups (p=0.99), in terms of initial physiological changes (MCAv down ~20 ± 11%, respiratory frequency increased to 58 ± 18 breaths·min(-1), PETCO2 dropped to 12 ± 9 mmHg). Treading water following cold-water immersion increased MCAv by 30% above resting values despite maintained cold-shock-induced hyperventilation. In comparison to temperate water, swimming capacity was also reduced similarly between groups in the cold (i.e., distance decreased by 34 ± 26% skilled; 41 ± 33% less-skilled, p=0.99). These integrative findings verify that sudden cold-water immersion followed by physical activity leads to similar physiological responses in humans when contrasting between skilled and less-skilled swimmers.
Collapse
Affiliation(s)
- Chris Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, New Zealand.
| | - James L Croft
- Centre for Exercise and Sports Science Research, Edith Cowan University, Perth, Australia
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, New Zealand
| | - Matthew J Graham
- School of Physical Education, Sport and Exercise Sciences, University of Otago, New Zealand
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, United Kingdom
| |
Collapse
|
20
|
Barcala-Furelos R, Abelairas-Gomez C, Romo-Perez V, Palacios-Aguilar J. Effect of physical fatigue on the quality CPR: a water rescue study of lifeguards: physical fatigue and quality CPR in a water rescue. Am J Emerg Med 2012; 31:473-7. [PMID: 23085007 DOI: 10.1016/j.ajem.2012.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/14/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The purpose of the study is to analyze the influence of the fatigue caused by a water rescue on the cardiopulmonary resuscitation (CPR) performance. METHODS The sample of our research is composed of a group of 60 lifeguards (30 men and 30 women) who have been trained at the Universities of A Coruña and Vigo. Two tests were conducted: the first test involved the execution of 5 min of CPR (rested), and the second one in performing water rescue and subsequent CPR (exhausted) for 5 minutes. The quality of the CPR at rest and at fatigue condition was compared. The recording instrument was the Laerdal Resusci Anne manikin. The time of the water rescue was also registered. RESULTS Gender does not significantly influence CPR, either at rest or at fatigue condition. However, the fatigue caused by rescue has a significant influence on the total quantity of chest compressions: rested (380 ± 38.64); exhausted (411 ± 56.09; P < .001) and ventilations: rested (24 ± 2.97); exhausted (26 ± 3.92; P < .001). Also in correct chest compressions: rested (285 ± 82.67); exhausted (246 ± 122.08; P = .02) and ventilations: rested (14 ± 7.09); exhausted (9 ± 6.67; P < .001). As far as the water rescue is concerned, men are faster (261 ± 34.58 s) when compared to women (326 ± 99.87 seconds; P = .001). CONCLUSION The accumulated fatigue during a water rescue performed by lifeguards reduces the quality of chest compressions and ventilations on the CPR.
Collapse
|
21
|
Wanscher M, Agersnap L, Ravn J, Yndgaard S, Nielsen JF, Danielsen ER, Hassager C, Romner B, Thomsen C, Barnung S, Lorentzen AG, Høgenhaven H, Davis M, Møller JE. Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Præstø Fjord boating accident. Resuscitation 2012; 83:1078-84. [PMID: 22634431 DOI: 10.1016/j.resuscitation.2012.05.009] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 04/28/2012] [Accepted: 05/11/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Resuscitation guidelines for the treatment of accidental hypothermia are based primarily on isolated cases. Mortality rates are high despite aggressive treatment aimed at restoring spontaneous circulation and normothermia. METHODS The present report is based on a boating accident where 15 healthy subjects (median age 16 (range 15-45) years) were immersed in 2 °C salt water. Seven victims were recovered in circulatory arrest with a median temperature of 18.4 °C (range 15.5-20.2 °C). They were all rewarmed with extracorporeal membrane oxygenation (ECMO) and were subsequently evaluated with advanced neuroradiological and functional testing. The remaining 7 had established spontaneous circulation without the use of ECMO. One victim drowned in the accident. RESULTS The victims that survived the accident without circulatory arrest were predominantly females with a higher body mass index. Victims with circulatory arrest pH on arrival was a median of 6.61 (range 6.43-6.94), with ECMO being established a median of 226 (178-241)min after the accident. Magnetic resonance spectroscopy showed neuronal dysfunction in five. In five victims initial normal white matter spectra progressed to show evidence of abnormal axonal membranes. Based on the seven-level Functional Independence Measure test functional outcome was good in six circulatory arrest victims and in all without circulatory arrest. Mild to moderate cognitive dysfunction was seen in six and severe dysfunction in one circulatory arrest victim. CONCLUSION Seven patients with profound accidental hypothermic circulatory arrest were successfully resuscitated using a management approach that included extracorporeal rewarming, followed by successive periods of therapeutic hypothermia and sedated normothermia and intensive neurorehabilitation. Seven other hypothermic victims (core temperature as low as 23 °C) that did not suffer circulatory arrest also survived the accident.
Collapse
Affiliation(s)
- Michael Wanscher
- Department of Anesthesiology and Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Teulier L, Dégletagne C, Rey B, Tornos J, Keime C, de Dinechin M, Raccurt M, Rouanet JL, Roussel D, Duchamp C. Selective upregulation of lipid metabolism in skeletal muscle of foraging juvenile king penguins: an integrative study. Proc Biol Sci 2012; 279:2464-72. [PMID: 22357259 DOI: 10.1098/rspb.2011.2664] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The passage from shore to marine life of juvenile penguins represents a major energetic challenge to fuel intense and prolonged demands for thermoregulation and locomotion. Some functional changes developed at this crucial step were investigated by comparing pre-fledging king penguins with sea-acclimatized (SA) juveniles (Aptenodytes patagonicus). Transcriptomic analysis of pectoralis muscle biopsies revealed that most genes encoding proteins involved in lipid transport or catabolism were upregulated, while genes involved in carbohydrate metabolism were mostly downregulated in SA birds. Determination of muscle enzymatic activities showed no changes in enzymes involved in the glycolytic pathway, but increased 3-hydroxyacyl-CoA dehydrogenase, an enzyme of the β-oxidation pathway. The respiratory rates of isolated muscle mitochondria were much higher with a substrate arising from lipid metabolism (palmitoyl-L-carnitine) in SA juveniles than in terrestrial controls, while no difference emerged with a substrate arising from carbohydrate metabolism (pyruvate). In vivo, perfusion of a lipid emulsion induced a fourfold larger thermogenic effect in SA than in control juveniles. The present integrative study shows that fuel selection towards lipid oxidation characterizes penguin acclimatization to marine life. Such acclimatization may involve thyroid hormones through their nuclear beta receptor and nuclear coactivators.
Collapse
Affiliation(s)
- Loic Teulier
- Université de Lyon, UMR5023 Ecologie des Hydrosystèmes Naturels et Anthropisés, Université Lyon 1, ENTPE, CNRS, 6 rue Raphaël Dubois, 69622 Villeurbanne, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Venema AM, Groothoff JW, Bierens JJLM. The role of bystanders during rescue and resuscitation of drowning victims. Resuscitation 2010; 81:434-9. [PMID: 20149515 DOI: 10.1016/j.resuscitation.2010.01.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 12/20/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bystanders make a critical difference in the survival of drowning victims. Little information on their role before arrival of the Emergency Medical Services (EMS) is available in the scientific literature. In a descriptive study, this role is investigated. METHODS AND RESULTS We studied 289 rescue reports (1999-2004) available from the Dutch Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning), an organisation that, since 1767, acknowledges awards to bystanders who have contributed to the survival of a drowning victim. There were 138 variables retrieved from these reports. The Utstein Style for Drowning (USFD) was used as a guideline. Of the 26 USFD parameters on victim and scene information, 21 were available for analysis. Eight non-USFD parameters, defined by the authors of this research, were available in >60% of the cases. There were 343 victims, rescued by 503 rescuers. 109 victims were resuscitated by bystanders. Of the 18 victims who first received resuscitation from bystanders and then consequently from pre-hospital professionals, 14 survived. Rescues often occurred in dangerous circumstances: multiple victims (n=90/343), cold or ice-cold water (n=295/341), deep water (n=316/334), swimming to the victims (n=262/376), young age of rescuers (the youngest rescuer was 5 years of age). CONCLUSIONS Bystander rescue and resuscitation of drowning victims seems to contribute to a positive outcome. Bystanders are prepared to take responsibility to rescue a drowning victim in spite of significant dangers. The USFD is helpful in understanding the role of bystanders in drowning situations, but may need modification to become more instrumental.
Collapse
Affiliation(s)
- Allart M Venema
- Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, Netherlands
| | | | | |
Collapse
|
24
|
Cappaert TA, Stone JA, Castellani JW, Krause BA, Smith D, Stephens BA. National Athletic Trainers' Association position statement: environmental cold injuries. J Athl Train 2009; 43:640-58. [PMID: 19030143 DOI: 10.4085/1062-6050-43.6.640] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present recommendations for the prevention, recognition, and treatment of environmental cold injuries. BACKGROUND Individuals engaged in sport-related or work-related physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk. RECOMMENDATIONS These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.
Collapse
|