1. You’re as cold as ice:
the dangers “and benefits?”
of drowning in cold water
Gordon Giesbrecht
University of Manitoba

2. Relevance to you as:
1) a potential victim
2) a rescuer
3) an educator
12-03-26 4) a policy maker
Gordon Giesbrecht

3. U.S. Drowning Stats 2006
1600
1400
1200
1000
800
600
400
200
0
Temp oF
30-39 40-49 50-59 60-69 70-79 80-89 90+
accidents fatalities

4. Understand Cold Exposure:
Immersion vs Submersion
Immersion - Head Out!
Giesbrecht Hypothermia Therapy 4

5. Estimated time to hypothermia
%
50
45
40
35
30
25 Correct
20 Answer
15
10
5
*
0
0 to 5 6 to 10 11 to 15 16 to 20 21 to 30 30

6. 4 Phases of Cold Water
Immersion
 Cold Shock (~ 1 min)
 Cold Incapacitation (5-15 min)
 Hypothermia ( 30 min)
 Circum Rescue Collapse

7. When and How You Can Die in Cold Water
1) Cold Shock Response
(0-2 minutes)
⇓ Keep head out of water
Gasp  Drown Enter slowly?
Thermal protection
⇓
Hyperventilation  Faint
Don t panic, keep calm
 Drown
⇓
 Cardiac Work  Cardiac Arrest If existing heart problems

8.  Cardiac Work à Cardiac Arrest (If existing heart problems)

9. When and How You Can Die in Cold Water
2) Cold Incapacitation (2-15 minutes)
Local cooling of nerves and muscle fibers
Swim failure,
Can t hold on,
Can t perform survival tasks
If you can t get out in 5-15 minutes, you might not get out on
your own power!
If so, prepare to survive.
Widen window of opportunity for rescue.
Thrashing around will:
- increase heat loss
- cause exhaustion (Drowning)

10. When and How You Can Die in Cold Water
3) Onset of Hypothermia
 Human body is a large mass
 Thermally protected by VC and SHP
 Mild Hypothermia (35°C) 30 minutes
 Cooling to UNCONSCIOUSNESS (~30°C)
 If head goes under
 Drowning (within 30-120 minutes)
 If head above water… (i.e., with floatation)
 Cooling to CARDIAC ARREST (28-25°C)
 Death (90-180 minutes)

11. When and How You Can Die in Cold Water
4) Circum-rescue collapse
Just before, during or after rescue
Collapse – ranging from faint to death
May be caused by:
- Mental relaxation, and
- Decreased output of stress hormones
(epinephrine/adrenaline)
- Drop in blood pressure (faint)
- Extra cardiac work (cardiac arrest)

12. 1 – 10 – 1 Principle
Refers to first three phases of
cold water immersion

13. DROWNING PREVENTION
1 - 10 - 1 Principle
DO NOT PANIC, because you have:
 1 minute to get your breathing under
control
 10 minutes of meaningful movement
 1 hour before you become
unconscious due to hypothermia

14. 1 - 10 - 1 Principle
Regarding the
Cold Shock Responses…
Consider the following:
 DO NOT PANIC
 If possible, enter the water slowly and
try to keep your head from being
submerged
 Focus on surviving the first minute by
getting control of your breathing

15. 1 - 10 - 1 Principle
Regarding
Cold Incapacitation…
Consider the following:
 You have 10 minutes of meaningful
movement for self rescue
 Once you start becoming weaker,
prepare to wait for rescue

16. 1 – 10 – 1 Principle
Regarding
Hypothermia
Consider the following:
Delaying the Onset of Hypothermia
 HELP position
 Groups of individuals (HUDDLE)
 Exit water as soon as possible
 If exit is not possible, get as far out
of the water as possible

17. So What?
Cold Water Immersion
 Don’t panic
 Don’t drown
 1-10-1 Principle
 Heart
 Long time until cold
enough to stop
Giesbrecht Hypothermia Therapy 17

18. Cold Water Drowning (Submersion)
Brain cooling protects
the brain from anoxia.
 Drowning in a swimming pool
 Irreversible brain damage after ~4 minutes
 Drowning in cold water
 Successful recovery after up to 66 minutes
Giesbrecht Hypothermia Therapy 18

19. Mechanisms of cold protection
for the anoxic brain
 Decreased CMRO2 (Q10)
 Human tissue = 2
 Brain = 3 (37-27°C), 4.8 (27-17°C)
 Moderate cooling of rat brain to
35-33°C
 Considerable ischemic protection
 Not based on CMRO2
 Other Mechanisms
 During ischemia
 Reperfusion
Giesbrecht Hypothermia Therapy 19

20. So What?
Cold Water Immersion
 Don’t panic
 Don’t drown
 1-10-1 Principle
 Heart
 Long time until cold
enough to stop
Giesbrecht Hypothermia Therapy 20

21. So What?
Cold Water Drowning
 Don’t give up
 Don’t warm
 Ventilation/CPR
 Cold brain
 Can survive longer
period of anoxia
Giesbrecht Hypothermia Therapy 21

25. Do children have an advantage?
 Adult will cool slower  Adult will cool slower
 Advantage - adult
Giesbrecht Hypothermia Therapy Advantage – child?
 25

26. What is hypothermia good for?
 Cold water near drowning
 Cardiopulmonary resuscitation
 Traumatic Brain Injury
 Stroke
Giesbrecht Hypothermia Therapy 26

27. Summary
 Head out  Head in
 Hypothermia  CW Drowning
 Heart  Brain
 Prevent  Focus on
Drowning Treatment
 Don’t panic  Don’t give up
 Don’t drown  Don’t warm
 1-10-1  Oxygenation
 Heart stops  Cold Brain
 Long
Giesbrecht time Hypothermia Therapy  May survive
27

28. On line sources:
www.umanitoba.ca/kinrec/giesbrecht
www.beyondcoldwaterbootcamp.com