Correction factors for assessing immersion suits under harsh conditions

Acute Anxiety Predicts Components of the Cold Shock Response on Cold Water Immersion: Toward an Integrated Psychophysiological Model of Acute Cold Water Survival

Introduction: Drowning is a leading cause of accidental death. In cold-water, sudden skin cooling triggers the life-threatening cold shock response (CSR). The CSR comprises tachycardia, peripheral vasoconstriction, hypertension, inspiratory gasp, and hyperventilation with the hyperventilatory component inducing hypocapnia and increasing risk of aspirating water to the lungs. Some CSR components can be reduced by habituation (i.e., reduced response to stimulus of same magnitude) induced by 3–5 short cold-water immersions (CWI). However, high levels of acute anxiety, a plausible emotion on CWI: magnifies the CSR in unhabituated participants, reverses habituated components of the CSR and prevents/delays habituation when high levels of anxiety are experienced concurrent to immersions suggesting anxiety is integral to the CSR.

Purpose: To examine the predictive relationship that prior ratings of acute anxiety have with the CSR. Secondly, to examine whether anxiety ratings correlated with components of the CSR during immersion before and after induction of habituation.

Methods: Forty-eight unhabituated participants completed one (CON1) 7-min immersion in to cold water (15°C). Of that cohort, twenty-five completed four further CWIs that would ordinarily induce CSR habituation. They then completed two counter-balanced immersions where anxiety levels were increased (CWI-ANX) or were not manipulated (CON2). Acute anxiety and the cardiorespiratory responses (cardiac frequency [f_c], respiratory frequency [f_R], tidal volume [V_T], minute ventilation [_E]) were measured. Multiple regression was used to identify components of the CSR from the most life-threatening period of immersion (1^st minute) predicted by the anxiety rating prior to immersion. Relationships between anxiety rating and CSR components during immersion were assessed by correlation.

Results: Anxiety rating predicted the f_c component of the CSR in unhabituated participants (CON1; p < 0.05, r = 0.536, r²= 0.190). After habituation immersions (i.e., cohort 2), anxiety rating predicted the f_R component of the CSR when anxiety levels were lowered (CON2; p < 0.05, r = 0.566, r²= 0.320) but predicted the f_c component of the CSR (p < 0.05, r = 0.518, r²= 0.197) when anxiety was increased suggesting different drivers of the CSR when anxiety levels were manipulated; correlation data supported these relationships.

Discussion: Acute anxiety is integral to the CSR before and after habituation. We offer a new integrated model including neuroanatomical, perceptual and attentional components of the CSR to explain these data.

Survival suit volume reduction associated with immersion: implications for buoyancy estimation in offshore workers of different size

RATIONALE

It is currently unknown how body size affects buoyancy in submerged helicopter escape.

METHOD

Eight healthy males aged 39.6 ± 12.6 year (mean ± SD) with BMI 22.0-40.0 kg m^-2 wearing a standard survival ('dry') suit undertook a normal venting manoeuvre and underwent 3D scanning to assess body volume (wearing the suit) before and after immersion in a swimming pool.

RESULTS

Immersion-induced volume loss averaged 14.4 ± 5.4 l, decreased with increasing dry density (mass volume^-1) and theoretical buoyant force in 588 UK offshore workers was found to be 264 ± 46 and 232 ± 60 N using linear and power functions, respectively. Both approaches revealed heavier workers to have greater buoyant force.

DISCUSSION

While a larger sample may yield a more accurate buoyancy prediction, this study shows heavier workers are likely to have greater buoyancy. Without free-swimming capability to overcome such buoyancy, some individuals may possibly exceed the safe limit to enable escape from a submerged helicopter. Practitioner Summary: Air expulsion reduced total body volume of survival-suited volunteers following immersion by an amount inversely proportional to body size. When applied to 588 offshore workers, the predicted air loss suggested buoyant force to be greatest in the heaviest individuals, which may impede their ability to exit a submerged helicopter.

Habituation of the cold shock response is inhibited by repeated anxiety: Implications for safety behaviour on accidental cold water immersions

INTRODUCTION

Accidental cold-water immersion (CWI) triggers the life-threatening cold shock response (CSR) which is a precursor to sudden death on immersion. One practical means of reducing the CSR is to induce an habituation by undergoing repeated short CWIs. Habituation of the CSR is known to be partially reversed by the concomitant experience of acute anxiety, raising the possibility that repeated anxiety could prevent CSR habituation; we tested this hypothesis.

METHOD

Sixteen participants (12 male, 4 female) completed seven, seven-minute immersions in to cold water (15°C). Immersion one acted as a control (CON1). During immersions two to five, which would ordinarily induce an habituation, anxiety levels were repeatedly increased (CWI-ANX_rep) by deception and a demanding mathematical task. Immersions six and seven were counter-balanced with another high anxiety condition (CWI-ANX_rep) or a further control (CON2). Anxiety (20cm visual analogue scale) and cardiorespiratory responses (cardiac frequency [f_c], respiratory frequency [f_R], tidal volume [V_T], minute ventilation [V̇_E]) were measured. Comparisons were made between experimental immersions (CON1, final CWI-ANX_rep, CON2), across habituation immersions and with data from a previous study.

RESULTS

Anxiety levels were sustained at a similar level throughout the experimental and habituation immersions (mean [SD] CON1: 7.0 [4.0] cm; CON2: 5.8 [5.2] cm cf CWI-ANX_rep: 7.3 [5.5] cm; p>0.05). This culminated in failure of the CSR to habituate even when anxiety levels were not manipulated (i.e. CON2). These data were different (p<0.05) to previous studies where anxiety levels were allowed to fall across habituation immersions and the CSR consequently habituated.

DISCUSSION

Repeated anxiety prevented CSR habituation. A protective strategy that includes inducing habituation for those at risk should include techniques to lower anxiety associated with the immersion event or habituation may not be beneficial in the emergency scenario.