Ice Mile Dilemmas – VIII – The Dangers

I’ve said previously that open water swimming is dangerous. Ice Mile swimming is even more dangerous.

I don’t think the IISA website, which is how most people are going to interact with and learn about the IISA or Ice Mile swimming, is anywhere near as comprehensive as it needs to be on its message about the extreme nature of Ice Mile swimming and there are few locations where this message is noticeable. Mostly Ice Mile and extreme cold water swimming is merely described as some variety of difficult, rather than life threatening.

The IISA needs to categorically state that Ice Mile swimming is inherently dangerous and should also do its best to provide a suitable and comprehensive safety framework for Ice Mile aspirants, which as I write this does not currently exist as I have proven in the IISA rules discussion.

Danger, Danger

All this talk of danger but it hasn’t been quantified.

This is a significant list. Some items are extreme versions of similar risks associated with open water swimming, but exaggerated because of the extreme cold. This list has been reviewed by two experts in cold water and hypothermia (one M.D. and one Ph.D.).

  1. Drowning due to involuntary water aspiration. In the first couple of minutes of very cold water, Cold (immersion) Shock can promote hyperventilation and gasping and actually lead people to aspirate water in the lungs, and drown quickly. This is the absolute and essential reason why it is best to get into cold water slowly, to allow your body to control the gasp reflex. Images of swimmers diving into near-zero degree water absolutely send out the wrong message to aspirants. I’ve been writing now for years that people shouldn’t do it. This gasp-aspiration danger exists in all cold water (which in research terms is water under 15 Celsius), but at such cold temperatures as under five degrees the risk is greater. It’s just one of the reasons why experience is so important and why the IISA should immediately introduce prior experience requirements for Ice Mile aspirants.

  2. Initial cardiac arrest. The body’s cold protective system, peripheral vaso-constriction, because it reduces overall blood flow, consequently quickly increases blood pressure. A sudden jump in blood pressure could lead to cardiac arrest in a small number of cases. In younger people this may be caused by sudden-onset ventricular fibrillation. Older people would be more likely to have a myocardial infraction (heart attack) as a result of decreased blood flow to the coronary arteries.

  3. Acute hypothermia. This should be obvious. Acute refers to the time taken for the drop to occur. If lethal temperature is reached in an hour, which is a good rule of thumb for almost freezing waters even for most trained individuals, then being immersed for more than half the time leads to acute hypothermia. Hypothermia takes some time to kill you, it can’t kill you from heat loss in 15 minutes even in these temperatures but kill you it eventually will if you don’t rewarm. Simply standing from the prone swimming position will cause the very cold peripheral blood, which can drop to a mere ten degrees as it lays under your skin, to flow into your core. Another reason the acute aspect is important is because in chronic hypothermia, which develops over a longer time, the body becomes dehydrated, reducing the volume and constitution of blood. In acute hypothermia, since one isn’t dehydrated, the blood pressure increase and therefore associated risk is greater. The onset of acute hypothermia is time based and why time limits are extremely useful in Ice Mile swimming but they are not currently in the IISA rules.

  4. Loss of fine and later coarse motor control/muscle failure. Peripheral vaso-constriction is something I’ve been writing about on LoneSwimmer.com since the site’s inception. It’s how your body protects core temperature by shutting off circulation to the extremities. That means fine motor control is quickly affected. Moderately hypothermic people have real difficulties with or are unable to get dressed. With the extreme cold of Ice Mile swimming, muscle control for such simple tasks as walking can become difficult or impossible. Muscle failure is the term Tipton and Golden, best known for hypothermia studies, use to describe the loss of muscle motive force. One cannot speak, or know what to do. I don’t know numbers (neither does the IISA,) but my experience has shown that most Ice Mile swimmers are unable to dress themselves afterwards. My partner Dee has taken to occasionally calling me The Joker, because of what she describes as the manic rictus manifested on my face as muscle control was lost after my Ice Mile.

  5. Acute Pain. The pain experienced once a swimmer is well into an Ice Mile, particularly in the hands and feet, is significant and sustained, possibly seven on a pain scale. It’s a precursor to number six.

  6. Temporary or permanent nerve damage. Within the community of extreme cold water swimmers there are cases of nerve damage or loss of sensation, particularly in the fingers. This problem can manifest as lasting from a couple of weeks to two years in different people. One medical doctor with whom I’ve spoken, who has direct knowledge in the area of hypothermia primary treatment, says that this is the range from frostnip to frostbite.

  7. Cognition impairment and memory loss. As blood cools, it becomes more viscous. Combined with the aforementioned peripheral vaso-constriction, necessary oxygen flow to the brain is reduced. The person loses speed of thought, ability to verbally respond and their memory is impaired. I can remember the end of my Ice Mile, but as soon as I stood up, everything became hazy and a series of disjointed episodes. One Ice Miler who did their Ice Mile in a group of four, said three out of the four did not remember finishing. This isn’t Hollywood; severely hypothermic people don’t retain the ability to think clearly. It’s why assistants and safety personnel aren’t just important, they are essential. The most common test we use for moderate hypothermia in swimmers is simply someone’s ability to give their own name. Most people with no experience of hypothermia can’t imagine this being a difficulty.

  8. Muscle pains, swelling or bruising, chronic fatigue and lack of concentration. These are symptoms which are displayed after extreme cold water swimming and rewarming. They only show after rewarming is mostly complete or even from the following day and may persist for several days. While some are minor, they are indicative of the extreme effort. The chronic fatigue and lapse in mental acuity are not related to the swim distance but the cold and could have significant immediate impact for swimmers who is driving themselfaway from an Ice Mile swim.

  9. Swimming Induced Pulmonary Edema, aka SIPE. Pulmonary edema occurs when fluid (usually blood) collects in the lungs and breathing is impaired to various degrees of severity. SIPE can be related to heart problems or infection, in the case of extreme cold water, while the mechanism isn’t fully understood, it’s likely that the increased blood pressure mentioned above is implicated.

  10. Cardiac arrhythmias. There are two types. Atrial fibrillation is irregular electrical activity which mainly affects the smaller upper chambers of the heart (atria) causing less blood to be pumped. It may even go unnoticed, or if noticed can result in heart palpitations and shortness of breath. One Irish swimmer who is already an Ice Mile swimmer wisely pulled out early in their second Ice Mile swim because of a sensation of heart palpitations. Ventricular fibrillation is also an irregular electrical activity, which affects the larger lower chambers (ventricles) of the heart. An incorrectly rewarmed person (such as through sudden application of heat or excess movement) will receive the full brunt of the almost ice-cold external blood into their core and around their heart too quickly. This can cause the heart to go into ventricular fibrillation. It is the leading cause of sudden cardiac death (SCD) and is the primary cause of death due to hypothermia. Stories of death through hypothermic ventricular fibrillation abound.

  11. Post-rescue Collapse/Afterdrop. With post-rescue collapse, the person can initially seem to be fine while exiting or after being removed from the water, but may later collapse or even expire. Tipton and Golden1 identify a number of post-rescue collapse deaths. In a study of 269 shipwreck victims, 160 were rescued. 17% rescued from water under 10 C. died within 24 hours of rescue whereas when the water was over 10 C. none died. One of many reported cases is the sinking of the SS Empire Howard. Twelve conscious survivors were rescued. The Captain reported that nine later died when taken into the warmth of the rescue trawler. In Ireland, three of the 15 fatalities during the infamous Fastnet Race disaster in 1979, occurred during rescue in water of 15 to 16 Celsius. The physiology has not fully been explained to date. Two of the all time great marathon swimmers, Ted Erikson and David Yudovin both suffered post-swim cardiac arrest from chronic hypothermia in water that wasn’t as cold, but in which immersion time was longer.

Ice Mile swimming is dangerous and so is post Ice Mile swimming as shown by numbers eight, nine and ten.

Items number nine and ten also portend something else.

Since SIPE, atrial and ventricular fibrillation can also be symptoms of heart disease or other coronary problems, the only acceptable standard that the IISA can set is to require a declaration of medical history and to preclude anyone with any history of coronary problems.

In Part VI, I mentioned that the IISA, which has a stated objective of promoting medical research, doesn’t even include any medical guidelines or medical barriers for an Ice Mile attempt it doesn’t even a require a medical application despite an apparent existing rule. In the light of these specific dangers, this is indefensible and must be addressed immediately.

Related articles:

Ice Mile Dilemmas I – The Trap

Ice Mile Dilemmas II – Surprisingly Cold

Ice Mile Dilemmas III – Black Rain

Ice Mile Dilemmas IV – Local Context

Ice Mile Dilemmas V – Rule 1 – Something Terrible Is Going To Happen

Ice Mile Dilemmas VI – Rules 2 – Safety and Experience

Ice Mile Dilemmas VII – Rules 3 – Failure To Apply Best Practice

References:

1 Review of rescue and immediate post immersion problems, prepared for the UK Health and Safety Executive, by the University of Surrey (Tipton & Golden, 1997)

 

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