May 1998
113
Drowning - Immersion Casualties
In 1739 Tobias Smollett served as surgeon’s mate in HMS Cumberland.
He vividly described his experiences in the novel Roderick Ransom. The
following is an eye witness account of life at sea in bad weather.
”During such furious storms the spray of the sea, raised by the violence
of the wind, is dispersed over the whole ship: so that people breathe,
as it were, in water, for many weeks together.
The tumultuous waves incessantly breaking upon the decks, and wetting
those who are on duty, as if they had been drenched in the sea, are also
continually sending down great quantities of water below: which makes it
the most
uncomfortable wet lodging. From the labouring of the ship, it generally
leaks down in many places, directly on the Sailor’s bunks. There being
no fire or sun to dry or exhale the moisture, and the hatches necessarily
kept shut, this most stagnating confined air below becomes most offensive
and intolerable. When such weather continues long attended with sleet and
rain, as it generally is, you may figure for yourselves the condition of
the poor men who are obliged to sleep in wet clothes and damp beds, the
deck swimming with water below them, there to remain only four hours at
a time ’till they are called up to hard labour, fresh fatigue, and exposed
to the washings of the sea and rains.”
Such
descriptions of 18th century conditions at sea may be offset by improvements
in 20th century engineering materials, clothing, navigation and meteorology.
Nevertheless the description highlights the essential features of immersion
casualties, exhaustion, hypothermia, and drowning. In a shipwreck situation,
it is advisable to assume all survivors are suffering from hypothermia
and drowning to varying degree. Initial treatment should therefore be aimed
at the restoration of adequate circulation and breathing, with the prevention
of further heat loss. The major problem is sudden collapse on, or within
a few minutes of rescue with concommittant ventricular fibrillation and
cardiac arrest. This may be due to hypothermia exacerbated by wind chill
or fall in blood pressure with reperfusion of peripheries.
Whatever
the mechanism of post rescue collapse, great care should be exercised in
the management of survivors, keeping them lying down, especially during
the early phase of rewarming. Survivors who are hypothermic may be shivering,
confused, semi conscious or unconscious. Removing wet clothing they should
be placed in a warm bunk and insulated with blankets. During rewarming
the conscious casualty may be given warm drinks but NO alcohol. All immersion
cases should be admitted to hospital on return to port. Even those who
initially appear to have made an uneventful recovery from their ordeal,
may have inhaled water, and are at risk of infection.
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