The Perils of Hypothermia

Words by iSWIM member, surfer and medical professional, Dr Dave Baglow

Hypothermia should not be dismissed as something that kills the weak and naive. It has the potential to catch us all off guard at some point. It kills. How it kills depends on the situation. Most of us can hopefully spot when we’re starting to ‘slow down’ and then catch the next one in. But then what? The risk isn’t necessarily over.

There was a sad tragedy in South West England not so long ago, when a few lads died while on their way home. They stayed in their wetties in their van, presumably to try and keep warm (only works for very short distances), and came off the road with horrific consequences. The accident was thought to be caused by hypothermia. Not the most cheery start to an article but it highlights a point, that hypothermia is to be respected.

What is Hypothermia?

Think of it as a scale, not an endpoint. As your body cools the number of side-effects and their severity increases. Most cold water swimmers put themselves on this scale during each session. If you read the books they will give you core body temperatures at which it occurs, but I find that pointless in practice. Who surfs with a thermometer?

The key is to be aware of the points on the ‘hypothermia scale’ and try and recognise when you (or others) are moving along it, so you can act to warm yourself. This really is the key to surviving hypothermia.

Your feet feeling like ice blocks, your hands not responding and ice cream headaches are not signs of hypothermia. They’re just signs that your environment is cold, and perhaps you’re not as well covered in neoprene as you could be. These signs could be occurring, however, alongside more subtle signs of the killer.

Your body relies on a complex and dynamic array of chemical reactions that need to be constantly occurring to survive and function normally. Cooling slows these reactions and prevents the body from functioning normally.

What are the signs of hypothermia?

Apply common sense to this! If you jump in the North Atlantic in February naked, the signs are going to come on thick and fast (dead in 10-15 minutes). They would be less rapid if you were wearing a well-fitting good quality wetsuit and accessories. Interestingly, the reflex reaction to sudden emersion in cold water is a rapid rise in your breathing rate. This can make breath-holding tricky, and paired with sheer panic, it’s attributed to why people drown so quickly when plunged into freezing water.

When cold, your body will try and keep your body at normal temperature (normo-thermic) for as long as possible (by shivering and burning off easily accessible energy stores). It can’t do this indefinitely (everyone is different), and the decline after this initial compensation can be rapid, even in a decent wetsuit.

The following are signs that you are starting to develop mild hypothermia and should be looking to catch a wave in:

– Shivering. Your body is trying to generate more heat to keep your core (not your toes) warm. A good test is to see if you can stop yourself shivering. If you can you only have mild hypothermia.

– Purple extremities. Your body is no longer wanting blood to go to the cold bits.

The following are signs that you need to urgently get out, get dry and get warm and tell someone you’re struggling:

– Tiredness. This is subtle at first and gets more and more severe. Don’t just put it down to the pumping surf and the fact you got up at 5am.

– Delayed thoughts. You know what I mean. When you are maybe aware that you’re slowing down, maybe, but the very act of thinking about your thoughts slowing down isn’t that easy, maybe. This is called dazed consciousness. Don’t be an idiot. Paddle in, get dry and get warm.

– Slurred speech. Don’t think your mouth isn’t working because it’s cold. Your brain is not working properly (not an insult) and it can’t give your mouth clear instructions.

– Bad surfing! You start to loose your fine motor control. Don’t just think you’re having a bad day or that your wettie is too thick. Get out, get dry & get warm.

– Irrational behaviour. If your mate starts doing more weird things than usual, be suspicious!

– When the shivers begin to get more severe, then start having pauses between them, things are getting serious.

Everyone’s different right?

I was amazed last year in the Maldives watching an American pull on a long sleeve neoprene rashie on an overcast day to ‘keep warm’. I thought he was on glue! I was roasting! But then I live in the UK where we live in neoprene all year round. He told me he rarely had to wear neoprene at home.

Everyone reacts to the cold differently. There are fast coolers, who are most at risk, and slow coolers, who retain heat for longer, their metabolism being able to generate different levels of heat over different lengths of time. In addition, people carry different amounts of insulation on them, and it's clearly possible to acclimatise (to warm or hot) to some extent, however, I've seen no concrete evidence with regards to how this effects likelihood of hypothermia.

What Tips are there to keep warm?

– Make sure you’ve eaten (at least an hour before) and are well hydrated.

– Some of my mates swear by driving to the surf in a dry wetsuit to save losing heat by changing outside. Don’t drive home in a wet one.

– Have plenty of dry layers to put on when you get out.

– Thermos of a hot sweet drink when you get in.

– Wee in your suit. I can’t find any evidence that this actually makes any difference in keeping you warm in the long run. That’s not going to stop me doing it! There is evidence that too much caffeine makes you loose lots of heat through your urine.

– Never surf after drinking booze. Alcohol makes you lose heat quicker. Beware the morning after.

– Inhaling and swallowing cold water drops your body temperature. This can cause your heart to have problems beating properly.

Wetsuits

I’ve always tried to buy the best wetsuit I’ve been able to save up for. Apart from being super stretchy or whatever, a good one could save your life. I’m not going to mention what to look for in a good wetsuit. Others are more qualified to tell you that. There’s no doubt though that improvements in wetsuit technology means has meant that cold water surfing frontiers have been expanding over the last few decades. Perhaps you’re not a frontier swimmer/surfer (like me!) and a good wetsuit just means that you can stay in the surf for longer. But you still need to be vigilant for the signs of hypothermia in yourself and those with you.