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Times Online.

 

How to survive the cruel sea

 

August 12 2004

After the rescue of The Times's Jonathan Gornall and the The Pink Lady crew, our health expert says the sudden shock of icy water is the main danger

THE AVERAGE survival time for those who were thrown into the sea off the decks of the Titanic was a few seconds. The cold, iceberg-haunted sea ensured that death for many of the passengers, who had come from a warm, cosseted environment, came swiftly.
Falling into a chilly sea, colder than 5C (41F), induces vagal shock. The sudden cold causes the shipwrecked sailors to gasp — and with that gasp they may inhale water. The shock induces violent shivering, the muscles contract so that they curl up, and as a result they are unable to swim. Other people suffer immediate cardiac arrest as a result of the shock; it is said that this is more likely if the cold water splashes their faces.
The Titanic passengers and crew might also have been wining and dining too well before their ship sank. Recent alcohol consumption is notorious for increasing the death rate for those who are plunged — or who plunge voluntarily — into cold water. Likewise, lack of physical fitness militates against survival. The secret of surviving a cold sea is to stay still so as not to dissipate energy, and therefore heat, by pointless activity.

After the cruise liner Lakonia sank in 1963, the rescuers were surprised to find that, despite their lifestyle, those more likely to survive were the passengers who were content to bob around in their life jackets rather than striking out for the African shore.
Jonathan Gornall and those rowing the Atlantic with him had been on a survival course and there was nothing aboard the Pink Lady that could have sapped their fitness by over-cossetting them. Without this fitness, training and a huge slice of good fortune, together with Peter Bray’s ability to dive to recover the life-raft and the grab bag that contained their survival equipment, it is unlikely that they all would have lived. As it was, Gornall might have sacrificed his chances by unbuttoning his survival suit. The suit became waterlogged and presented a danger akin to that experienced by fishermen whose waders fill with water. His crewmates helped to keep him afloat until he could clamber aboard the life-raft.

Few travellers experience quite such a life-threatening adventure as that of the Pink Lady’s crew, but Richard Dawood’s book Travellers’ Health includes all the grim facts on hypothermia: how to avoid it and how to treat it.

Hypothermia is divided into two categories. Chronic hypothermia is the sort experienced by stallholders who spend long, windy, icy February days in the Whitechapel market, or pensioners sitting by a single-bar electric fire. Acute accidental hypothermia is that suffered by those who, for instance, fall into a cold sea or river. The sea off the east coast of England last weekend was a balmy 20C (68F). The shipwrecked mariner can stay afloat at this temperature for many hours.

Anyone plunged into cold water should conserve as much energy as possible

 The Atlantic would have been rather chillier. Survival time if the sea is at 10C is three hours, on average, for those who are fit, not excessive drinkers and have not recently had a heavy meal. Having been immersed in cold water and thoroughly soaked, a rescued person needs to be so treated that any continuing loss of heat is prevented as far as possible.
 Before help arrives, the patient should ideally be taken out of the wind, their wet clothes should be removed and they should huddle against their companion to benefit from their body warmth.

Chronic accidental hypothermia is often the result of soaked clothes and hours spent exposed to high wind chill. Fortunately, Gornall would have been spared the latter problem by the design of the life-raft. If the consequences of the rowers’ shipwreck had been different, and if Gornall’s shivering had given way to sleepiness, confusion, problems with speech, breathing and circulation, he would have needed all the resources of the cardiologists to whom the expedition had been dedicated.

As someone’s core temperature falls, lethargy and confusion are superseded by a slow, irregular heartbeat and eventually a rhythm that may herald cardiac arrest. Patients who reach this state of hypothermia, whether acute or chronic, need careful control of the blood gases and electrolytes together with all the usual facilities of a unit skilled in pulmonary resuscitation. While patients are being re-warmed, their blood electrolytes and gases may change rapidly and need careful monitoring.

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