I did a piece for the Lancet in response to this paper in 1999. Golden is a
recognised guru in near drowning research. The paper was interesting and while
experimental did suggest that drowning comes before hypothermia in temperate
waters. Thus your hypothermic drowned patient in temperate waters is most probably
dead.
Lancet 1999 Aug 21;354(9179):626-9
Immersion deaths and deterioration in swimming performance in cold water.
Tipton M, Eglin C, Gennser M, Golden F
Department of Sport and Exercise Science, University of Portsmouth, UK. [log in to unmask]
BACKGROUND: General hypothermia (deep body temperature <35 degrees C) has been
implicated in immersion-related deaths, but many deaths occur too quickly for
it to be involved. We investigated changes in swimming capability in cold water
to find out whether such changes could lead to swim failure and drowning. METHODS:
Ten volunteers undertook three self-paced breaststroke swims in a variable-speed
swimming flume, in water at 25 degrees C, 18 degrees C, and 10 degrees C, for
a maximum of 90 min. During each swim, we measured oxygen consumption, rectal
temperature, swim speed and angle, and stroke rate and length. Swim failure
was defined as being unable to keep feet off the bottom of the flume. FINDINGS:
All ten swimmers completed 90 min swims at 25 degrees C, eight completed swims
at 18 degrees C, and five at 10 degrees C. In 10 degrees C water, one swimmer
reached swim failure after 61 min and four were withdrawn before 90 min with
rectal temperatures of 35 degrees C when they were close to swim failure. Swimming
efficiency and length of stroke decreased more and rate of stroke and swim angle
increased more in 10 degrees C water than in warmer water. These variables seemed
to characterise impending swim failure. INTERPRETATION: Impaired performance
and initial cardiorespiratory responses to immersion probably represent the
major dangers to immersion victims. Consequently, treatment should be aimed
at symptoms resulting from near-drowning rather than severe hypothermia.
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