Photo by Linda Thompson

Cold Water Drowning | June 12, 2012

Cold water drowning

By David McEvoy, Aerie Backcountry Medicine

Montana has one of the highest per-capita drowning rates in the country. Considering we’re landlocked, that’s sobering.

We’re one of 10 states where drowning is the most common cause of death for people under 14. Not all of these occur in our rivers (many happen at home), but a number do.

This spring, we’ll read about too many people drowning in Montana’s rivers and streams. Many of these deaths are preventable—not in the sense of avoiding water, but preventable because many of the events leading to these deaths are predictable and therefore avoidable.

Please enjoy spring on our beautiful rivers and streams. Just do it with some caution, preparation and respect for the power of cold, moving water. Like most things in medicine, prevention of drowning is far more effective than its treatment.

Here are a few basic ideas that might keep us safer this year:

Cold water is debilitating.

The water in many of Montana’s rivers is above 70 degrees F for less than a month. Quite a few never even reach that temperature. Seventy is the somewhat arbitrary threshold below which many experts define “cold water.” Immersed in this water, muscles and brains do not function well over time. We may not have the strength to get through a difficult rapid or the judgment to avoid it altogether. Plan your day on the water with adequate clothing and food in mind to maintain your body temperature.

In addition, sudden immersion in very cold water— like falling out of a boat or jumping in a river to rescue a drowning person—causes unavoidable, reflexive gasping and intense hyperventilation. If your head is underwater when this happens, the result is often rapid unconsciousness and death from lack of oxygen.

Moving water is relentless.

It’s difficult to appreciate the power of even slow-moving water until it pins you against a root or log. Often at this point, to borrow a phrase, resistance is futile. Planning routes through the water that avoid obstructions, particularly at high water, is critical.

Life jackets and helmets save lives.

It’s difficult to drown if your head doesn’t go underwater. Life jackets need to fit and stay on in strong currents; they don’t do you any good under your seat or at home. Helmets keep you conscious if you hit your head, enabling you to think about protecting yourself from further harm.

Even capable swimmers drown.

Cold, moving water levels the playing field. Swimming in a relatively warm pool with no current is entirely different than swimming for your life in a moving, cold river.

Alcohol kills.

Many drowning victims are intoxicated. It’s really no different than drinking and driving. The idea of floating the river with friends and a six-pack appeals to many of us. However, we need to add to that image to the possibility of an emergency—which with cold, moving water can happen at any moment—when you need all of your judgment and skill.

Drowning victims panic.

Few things are more terrifying than being unable to breathe while struggling against an unrelenting force. Unsuspecting rescuers, even close friends, will be used as a means of escape, meaning the drowning person will unceremoniously drag them underwater. For this reason, it’s far better to reach for the person from shore, throw something to them, or row to them from a boat. In some years, more rescuers drown than initial drowning victims.

Drowning victims often hit their heads, injure their spines, and vomit. Depending on how they entered the water, drowning victims often have incapacitating head and spinal injuries. If you’re pulling somebody out of the water safely, do it efficiently but with as little excess movement as possible. This is much easier said than done and requires forethought, teamwork and practice.

If they do vomit, turn them on their side and get the food and water out of their mouths. There is little you can do to get the water out of their lungs. Your job is to keep the air heading in that direction without obstructions.

If they aren’t breathing, CPR is necessary. Realize, however, that a drowning victim requiring CPR rarely survives. We tend to have a false sense of the efficacy of CPR in an outdoor setting, away from more advanced care. While you should work to get the person to a hospital quickly while providing the best CPR possible, this is often futile.

David McEvoy is a paramedic and the director of Aerie, a wilderness medicine training organization based in Missoula. For outstanding swiftwater rescue classes in the Bozeman area, he suggests the Whitewater Rescue Institute.

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