Hypothermia

Marian Perera · Feb 15, 2014

Hey guys,

So my iceberg story is going very well (thanks Jim!) but I have a scene where my hero is pushed off a ship into freezing water. Once this happens, the villain instantly turns the surface of the water to ice. It's a tiny lake, so that traps the hero under the ice. Villain runs away and hero's crew breaks through the ice and saves him, but he's unconscious thanks to being in water too long.

If he's trapped under the ice for around two minutes before he's hauled back onto the deck, would he run the risk of hypothermia? This is all Age of Sail, so he's not wearing anything hi-tech. Even after he's back on the deck, he doesn't get warm right away because, well, it's freezing there too and the crew is more interested in getting him to breathe first.

And if there is such a risk of hypothermia, is there anything the ship's doctor can do? I've read an article on hypothermia, so I know the basics of what not to do - don't give alcohol, don't apply heat to limbs, but other than a warm bed and hot drinks, I don't know what the doctor might prescribe, especially given that it's not a modern ship (also, they don't have any magic; it's just the villain who does).

ETA : Also, how long might it take my hero to recover? Assuming he doesn't get pneumonia from the experience. I'd like to have him up and about in, say, 12 hours. Is that reasonable?

Thankee kindly in advance.

King Neptune · Feb 15, 2014

Yes, there is a good chance of hypothermia, but how badly that affects him depends on him. Even very rugged people can be done in by hypothermia; that's what killed Rasputin after e pulled himself out from under the ice on that river.

There isn't much to be done for hypothermia excapt cover and keep warm. Could there be a jug of warm water?

IncredibleSlime · Feb 15, 2014

Queen of Swords said:
If he's trapped under the ice for around two minutes before he's hauled back onto the deck, would he run the risk of hypothermia? This is all Age of Sail, so he's not wearing anything hi-tech. Even after he's back on the deck, he doesn't get warm right away because, well, it's freezing there too and the crew is more interested in getting him to breathe first.

In short, I think the answer is yes, very much so. Hypothermia can set in even if it's just a bit chilly, but it becomes a much greater danger when you add moisture to the mix, and especially so if he is trapped in a literally freezing lake. In freezing water alone you go into shock at about two minutes, and heat is lost much faster in water than in air. Once he is pulled out if he does not immediately remove his wet clothes and get warm then hypothermia and frostbite are almost a guarantee. Of course he'll most likely be not only unconscious but also have drowned and be in need of resuscitation, but I'm not sure if CPR was around at the time your story is set in. (Sorry if that last part is less than helpful...

)

Queen of Swords said:
And if there is such a risk of hypothermia, is there anything the ship's doctor can do? I've read an article on hypothermia, so I know the basics of what not to do - don't give alcohol, don't apply heat to limbs, but other than a warm bed and hot drinks, I don't know what the doctor might prescribe, especially given that it's not a modern ship (also, they don't have any magic; it's just the villain who does).

The most important thing is to get him dry immediately and then warm as soon as possible (assuming he is in fact breathing, as you said). The doctor would probably also treat him for shock, but, again, hopefully he's not soaking wet on the freezing deck for too long of you might also have to deal with the nastiness that is frostbite.

I can qualify that by saying I'm a certified lifeguard and an Eagle Scout! Hope that was at least a little helpful?

Marian Perera · Feb 15, 2014

IncredibleSlime said:
In freezing water alone you go into shock at about two minutes, and heat is lost much faster in water than in air. Once he is pulled out if he does not immediately remove his wet clothes and get warm then hypothermia and frostbite are almost a guarantee. Of course he'll most likely be not only unconscious but also have drowned and be in need of resuscitation, but I'm not sure if CPR was around at the time your story is set in. (Sorry if that last part is less than helpful... )

Wow, I forgot about shock. So... cold skin, elevated heart rate, dizziness, confusion?

My characters know CPR. Well, the doctor does. But he'll have to perform it right there on a snow-covered deck, without time to remove wet clothes, so that will increase the chances of hypothermia. Though I'd rather not have frostbite on top of that, so as soon as the hero starts breathing, it's off to his cabin to get dry and warm. Hot drink since he's conscious and into a hammock.

Thanks for answering.

jclarkdawe · Feb 15, 2014

Fresh or salt water? Fresh water under a layer of ice will be from 31 to 35 degrees F. Salt water under a layer of ice will be probably somewhere between 20 to 30 degrees. Yeah, those little differences matter.

During World War II, sailors in the high North Atlantic could die within 30 seconds of immersion in the ocean. However, more modern research indicates about 15 to 30 minutes is normally the time before irreversible hypothermia sets in. This means a drop in body temperature below 95 degrees, at which point a person in water can no longer reverse the process without outside assistance.

Using a little bit of math, this would indicate that a one degree drop in body temperature takes from four to eight minutes. Clothing will make a difference. Mammalian diving reflex will kick in. Be aware that many people suddenly immersed in very cold water will start to hyperventilate, which can lead to inhaling water.

Recovery is just a matter of time and keeping warm. Although CPR may be indicated (more likely after two minutes he wouldn't have any breathing but will still have a heart beat), warming him up is even more indicated. He'll probably be fully recovered in 12 hours, although will probably need an extensive nap.

Best of luck,

Jim Clark-Dawe

Marian Perera · Feb 15, 2014

King Neptune said:
There isn't much to be done for hypothermia excapt cover and keep warm. Could there be a jug of warm water?

Sure. They were expecting the battle, so they're prepared to treat injuries and take care of the survivors. Warm water, hot chicken broth, what have you.

Hopefully the hero will be good to go after some of this and a long rest in a warm cabin.

Marian Perera · Feb 15, 2014

jclarkdawe said:
During World War II, sailors in the high North Atlantic could die within 30 seconds of immersion in the ocean.

Oh, if only that had happened to the main characters in Titanic. I would have paid good money to see that.

In the story, it's salt water. Though given that the lake is salt water held inside a giant bowl of ice, the salt concentration is probably less than that in the ocean around the iceberg.

Be aware that many people suddenly immersed in very cold water will start to hyperventilate, which can lead to inhaling water.

Plus, finding out that he's suddenly under a ten-inch-thick layer of ice, that he can't possibly break through under the circumstances, finally pushes him over the edge into panic.

Recovery is just a matter of time and keeping warm. Although CPR may be indicated (more likely after two minutes he wouldn't have any breathing but will still have a heart beat), warming him up is even more indicated. He'll probably be fully recovered in 12 hours, although will probably need an extensive nap.

Yay! Thank you, Jim, that's just what I needed. Something hot to drink, a warm cabin and a long nap, coming up.

jclarkdawe · Feb 15, 2014

Probably 20% of the Titanic victims died within two minutes of hitting the water.

Ten inches of ice is not going to be chopped in two minutes. Nor are they going to be able to see him through that sort of ice. I'd guess more like ten minutes or so to get him out, assuming they find the right place the first time.

What's happening to the hull of the boat with all this ice? Ice expands, and should be pushing against the hull, crushing it.

Best of luck,

Jim Clark-Dawe

Marian Perera · Feb 15, 2014

jclarkdawe said:
Ten inches of ice is not going to be chopped in two minutes.

They drop the ship's anchor. I'm guessing that would not have much difficulty smashing through the ice. Someone sees him fall, so they know where he is. ETA : They'd have to be careful not to drop it on him, of course...

What's happening to the hull of the boat with all this ice? Ice expands, and should be pushing against the hull, crushing it.

Hmm, good point. Maybe I'll have a very narrow margin of water around the ship. The villain causes the ice to form but he doesn't want the ship damaged, so perhaps he could control the ice formation to that extent.

jclarkdawe · Feb 15, 2014

Ship's anchor weighs about a ton. Ten inches of ice will support a small pickup. Anchor stands a marginal chance of going through. It drops fast, but the chain limits the speed.

I'd make the ice about four inches. Enough to be a problem, enough to walk on, easy for the anchor to break through, and not thick enough to crush a ship.

Best of luck,

Jim Clark-Dawe

Marian Perera · Feb 15, 2014

jclarkdawe said:
I'd make the ice about four inches. Enough to be a problem, enough to walk on, easy for the anchor to break through, and not thick enough to crush a ship.

The moment the ice freezes, the villain calls a retreat. He and about a dozen of his men who boarded the ship get off the deck and run across the frozen surface of the lake to the (relative) safety of the iceberg. Would four inches' thickness support their weight as they run?

It's a small matter, though, since the characters aren't going to stop to take measurements.

jclarkdawe · Feb 15, 2014

Five inches supports a snowmobile. Four inches supports ice fishing activities. Somewhere around that measurement is probably what you want.

Best of luck,

Jim Clark-Dawe

asroc · Feb 15, 2014

Hypothermia can happen, but if he's only been in the water for two minutes it's probably not that big of a problem. Serious hypothermia usually takes longer to develop. The problem with sudden immersion in cold water is the so-called cold shock response that jclarkdawe already alluded to. You involuntarily hyperventilate and you're not capable of holding your breath. If your character is stuck under ice with no access to air for two minutes chances are he's drowned by the time they pull him out. Being unconscious after two minutes is not a good sign in any case.

I'm not sure what IncredibleSlime means about going into shock.That doesn't happen, unless he means cardiogenic shock due to vasoconstriction. Which can happen, but it's hardly a given.

What level of tech are we talking about here and what does the doctor have available? CPR doesn't restart breathing. If this guy is in actual cardiac arrest you'll need drugs/a defibrillator for him to survive. However people who got immersed in cold water can appear to be in cardiac arrest, so you have to warm him up. (You're not dead until you're warm and dead.) Get him into a warm area before starting CPR.

Warming up needs to be done carefully. If you suddenly introduce heat to a cold body you can cause a drop in blood pressure, called rewarming shock, as well as a continued drop in body temperature, called afterdrop. Don't just fill him up with hot fluids as fast as possible.

Marian Perera · Feb 15, 2014

asroc said:
The problem with sudden immersion in cold water is the so-called cold shock response that jclarkdawe already alluded to. You involuntarily hyperventilate and you're not capable of holding your breath.

He knows he's being pushed over the side, so he holds his breath for as long as he can... not feasible?

What level of tech are we talking about here and what does the doctor have available?

Whatever a ship's surgery in, say, 1820 might have. The doctor's good at his work, but he's not going to be inserting an IV.

CPR doesn't restart breathing.

My bad. I was thinking of mouth-to-mouth. The hero isn't actually in cardiac arrest, because we don't have an AED on board.

Or, for that matter, heat packs. Maybe they could use heated stones wrapped in flannel.

asroc · Feb 15, 2014

Queen of Swords said:
He knows he's being pushed over the side, so he holds his breath for as long as he can... not feasible?

Well, it's an involuntary response. You can train for it, though. So if the hero has gone swimming in cold water before it might not happen.

Queen of Swords said:
My bad. I was thinking of mouth-to-mouth. The hero isn't actually in cardiac arrest, because we don't have an AED on board.

Mouth-to-mouth is part of CPR

(rescue breathing). If the hero's heart is actually still beating with a regular rhythm, this could work, though.

Heat stones should work, too. By the way, another often overlooked rewarming method is skin-to-skin contact, i.e. for someone else to get into the blanket with the patient and snuggle up.

MDSchafer · Feb 15, 2014

Just a few thoughts.

If by "age of sail" you mean 1400 to late 1800's then I don't really believe your doc would know CPR. There are some medical journals from the the early 1700's that recommend the use of mouth to mouth for drowning victims but chest compressions weren't documented until around the turn of the twentieth century. CPR as we know it didn't come about until the 1950's or so. Also, the stethoscope wasn't widely available until the later quarter of the 1800's. Those are the two of the most common medical mistakes I see in historical fiction.

As far as medical treatment. Age of sail, common wisdom probably would have been to give a belt of Whiskey or some dark liquor, even though that's probably the last thing you should do. If your doc is really on it and it's post 1830ish he could use gastric lavage to bring up someone's internal temperature. You can also run in warm fluids via IV. Lower tech things could include getting the pt to breath warmed air. I've read where putting the hands and feet in warmed, but not hot, water can help. Victorians probably would have used hot blankets and alcohol though.

What a Victorian era doc probably would do is get the patient inside, strip off their clothes and kneel down with the their keens touching the floor, or use pillows if it's that kind of ship to elevate the patient, which isn't really the smartest thing, but whatever.. They would then then grab the pt's wrists, put their hands on the pt's chest and then draw out the pt's arms like they were making snow angels. It's not entirely stupid, it would get the chest expansion and use negative pressure in order to start respirations. They'd try to do it 15 to 30 times a minute. It's not that effective, but appears to have worked, sometimes.

While Hypothermia varies for the individual I don't think two minutes in cold water would be enough to put someone at risk for hypothermia, it's also likely he'd stay conscious longer than two minutes as well. The biggest risk would be being exposed in wet clothes, it normally takes 10-15 minutes to bring down the core temp that far.

Also remember, brain damage starts after four minutes without oxygen, and hypothermia can possibly extend that a little bit.

Marian Perera · Feb 15, 2014

asroc said:
By the way, another often overlooked rewarming method is skin-to-skin contact, i.e. for someone else to get into the blanket with the patient and snuggle up.

I considered this, because it's a romantic fantasy, and the heroine is on board.

The problem is getting someone to suggest this rewarming method. It might come across as a sleazy suggestion, if the doctor makes it to her, and it's not the kind of thing she'd think of on her own - partly because they haven't been intimate yet. Plus, I'm worried it's a cliche in romance.

jclarkdawe · Feb 15, 2014

Dinghy sailors (small boats) do a sport late into the fall, sometimes into the winter, and early in the spring called "frostbiting." This involves going sailing when the water temperature is below 40 degrees. In other words, very cold water.

We wear a variety of clothing choices, such as wet suits and dry suits. We know what the water is going to feel like if we capsize.

I've capsized a lot in my lifetime. Cold water, warm water, nice days, lousy days. I know the risks, I know the dangers, and am usually a clear thinker when things are going wrong.

A sudden capsize into cold water and all that knowledge, all that preparation, goes right out of your head. I wear a good life jacket and pop to the surface.

In the circumstances you describe, with all that knowledge and practice, I'm not sure I could hold my breath. I think you're very optimistic to think your sailor would.

And remember in your time period most sailors did not know how to swim.

Warm bodies next to a cold one is often used in the field before we can get someone to safety.

Best of luck,

Jim Clark-Dawe

Marian Perera · Feb 15, 2014

jclarkdawe said:
In the circumstances you describe, with all that knowledge and practice, I'm not sure I could hold my breath. I think you're very optimistic to think your sailor would.

I'm afraid the reason I need him to hold his breath is because the scene's told from his POV and I need him to find out about the ice. He thinks he can resurface but he feels the ice above his head, searches for where the ice stops, realizes it doesn't, tries to break through it, fails and starts breathing water. So the suspense is drawn out. It wouldn't be as tense if he started breathing immediately, sucked in water and lost consciousness without knowing about the ice.

It's more a stylistic choice than a realistic one, that's for sure.

If it comes off as really unbelievable, I'll reconsider.

King Neptune · Feb 15, 2014

Queen of Swords said:
They drop the ship's anchor. I'm guessing that would not have much difficulty smashing through the ice. Someone sees him fall, so they know where he is. ETA : They'd have to be careful not to drop it on him, of course...

Hmm, good point. Maybe I'll have a very narrow margin of water around the ship. The villain causes the ice to form but he doesn't want the ship damaged, so perhaps he could control the ice formation to that extent.

Dropping the anchor many times might get through, but ten inches of ice is a lot of ice. As the squirrel suggested, four inches would make it workable.

jaksen · Feb 15, 2014

Does the diving reflex come into play here? It was first believed to happen only with babies and children, but I think there are instances where it happens in adults, too.

"A reflex of humans, other mammals, reptiles, and birds, triggered by immersion in cold water, that slows the heart rate and diverts blood flow to the brain, heart, and lungs: serves to conserve oxygen until breathing resumes and to delay potential brain damage."

jclarkdawe · Feb 15, 2014

More realistic:

As he's dropping, he's thinking of holding his breath, but as soon as his body hits the cold water, panics at the shock, theh he let's out his breath, swallows some water, starts coughing. This won't cause him to become unconscious. He tries to surface, hitting his head on the ice.

He gets the coughing under control, and shuts his mouth. He isn't holding his breath, but he's keeping water out of his system, so it's a reaction that a trained swimmer will do. You have enough oxygen in your system to go for about 30 seconds at this point.

Panic will gradually start setting in as he realizes his situation. Being trapped under the ice (I've never been) is disorienting, and even for trained divers is difficult to deal with. Smart approach is to go deeper and see if you can see any openings. Second best approach is going around in ever widening circles to find an opening.

However, as your oxygen level drops in your blood stream and your carbon dioxide increases. This causes an almost over-whelming need to breath, which quickly becomes over-whelming. This feeling is claustrophobic and leads to panic, especially as the brain does not have enough oxygen to think clearly.

His thoughts are going to become very disoriented right before he passes out, but writers have ignored this problem for decades.

Best of luck,

Jim Clark-Dawe

frimble3 · Feb 15, 2014

Queen of Swords said:
I considered this, because it's a romantic fantasy, and the heroine is on board.

The problem is getting someone to suggest this rewarming method. It might come across as a sleazy suggestion, if the doctor makes it to her, and it's not the kind of thing she'd think of on her own - partly because they haven't been intimate yet. Plus, I'm worried it's a cliche in romance.

Who said it had to be a woman? Especially as women in a romantic fantasy are usually smaller than men. You want a big ol' sailor, someone with a lot of warm surface area to warm up your almost-frozen character. So much for 'cliché in romantic fiction.'
If you must involve the heroine, have her imagine being in that position, and blush, etc. (As she would probably not be allowed in the cabin because there's a naked man in there.)

Marian Perera · Feb 16, 2014

frimble3 said:
Who said it had to be a woman? Especially as women in a romantic fantasy are usually smaller than men. You want a big ol' sailor, someone with a lot of warm surface area to warm up your almost-frozen character. So much for 'cliché in romantic fiction.'

That would work in terms of warming the character up, but are there any M/F romances where the hero gets naked with another guy who's cuddling up close? Even if it's to warm him up?

I don't think I could pull it off, I'm afraid. In an M/M romance I'd jump for it, and in this book it would definitely not be a cliche, but at the same time it just wouldn't work for me. Sorry.

If you must involve the heroine, have her imagine being in that position, and blush, etc. (As she would probably not be allowed in the cabin because there's a naked man in there.)

She wouldn't react that way (imagining being in that position and blushing), but thanks for the suggestion.

Marian Perera · Feb 16, 2014

jclarkdawe said:
As he's dropping, he's thinking of holding his breath, but as soon as his body hits the cold water, panics at the shock, theh he let's out his breath, swallows some water, starts coughing.

That could work. It's not such a big change to the scene as I've already written it, for him to swallow some water - and that way I can mention the taste of salt.

I didn't know you could swallow water and cough underwater without simultaneously, well, opening up your air passageways, swallowing more water and losing consciousness, though.

Panic will gradually start setting in as he realizes his situation. Being trapped under the ice (I've never been) is disorienting, and even for trained divers is difficult to deal with. Smart approach is to go deeper and see if you can see any openings. Second best approach is going around in ever widening circles to find an opening.

Which might not work with about 30 seconds of air remaining, even if the ice didn't extend across the surface of the lake.

His thoughts are going to become very disoriented right before he passes out, but writers have ignored this problem for decades.

I can see why. A bunch of rambling random thoughts at the end would undercut the tension. Thanks for your help.

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