Wednesday, March 23, 2011

Should Canoers wear helmets?


As an avid skier, I have watched the transformation of the heads in lift lines go from day glow head bands and mohawks, to wool beanies, to what we see today--helmets. It makes sense. The speed and the likelihood of falling are high. Why not protect our noggins. This same transformation has been seen with many sports--motorcycles, biking, and climbing to name a few.

Standard issue for kayakers, helmets are, however, often not worn by canoers. The reasons for this are complex. There is certainly an element of tradition and culture that comes into play. Another factor is comfort.

When learning to canoe, it is often done on lakes or gentle streams. These safe, slow moving environments do not necessarily warrant the use of a helmet. It is very unlikely that the canoe will flip, and if it does, it is even more unlikely that the passenger will strike a rock. With this logic, then, helmets do not need to be worn in these environments by canoers, right?

I see a problem with that. As we learn an activity we develop habits. Our mind creates mental scripts that will effect our future actions taken during that activity. We do this for efficiency. Take the act of driving your car. This is an action that most of us have done a thousand times. When we were learning we had to think about every step. First, I put my seat belt on. Now I turn the ignition, next I put the car in drive, now use my right foot to accelerate. Now imagine if we had to think about each of those (overly-simplified) steps every time we set foot in a car. We would be paralyzed by the process. The mental scripts that we create, then, serve the purpose of allowing us to take action.

Apply this to canoeing. If we learn to canoe on the lake up the road and never wear a helmet, then our future actions may very likely put us in a different situation (a fast flowing river) where the script we have learned does not apply. This is not to say, however, that we do not have the ability to see through this script and realize that, hey, a helmet would be a good idea here. However, this can be difficult, especially if the script we are using is powerful and well intrenched. Why not, then, set ourselves and our students up for success? If we always wear a helmet when canoeing, on a lake or a river, we will never encounter this problem.

In addition to the mental scripts that we develop, we create an identity based on the activity we choose. The activity of canoeing is not the same as the activity of kayaking. Kayaks have been labeled extreme by our society, while canoes are more docile and a tool used by the sightseer. Extreme sports require helmets, while more recreational sports do not, right? The problem is that a canoe and a kayak function in the same environment and the hazards are the same for both activities. This is a cultural problem or rather, a group think problem, and is very difficult to remedy. As individuals choosing to participate in an activity, it is important to realize that the group and the customs of the group are not always correct. To best battle this, we should attempt to make as many decisions concerning our own personal safety in isolation and prior to the event. If you come with the firm resolution that you will be wearing a helmet for this canoe trip, you will be less likely to be dissuaded by your peers.

The last problem with the non-use of helmets is comfort. Many helmets are not comfortable. Either they are too tight, the chin strap is constricting or they are hot. It is important, therefore, to find a helmet that fits you well, and that does not constrict or irritate you. The more comfortable it is, the less likely you are to take it off.

While I do believe that each individual should maintain the right to choose whether or not they should wear a helmet on a given day, as an instructor of novice river users, I find it my responsibility to set my students up for a successful and safe future. By creating an environment where comfortable helmets are used at all times, I know that my students will have the tools to make the proper decision when the time comes.

Tuesday, March 15, 2011

Four Case Studies by Dr. Amtmann


Case Study #1
Month: Mid July
Time: Midafternoon
A commercial solo raft on the Rollercoaster section of the Alberton Gorge was flipped at the rock/hydraulic in the middle of the rapid. A customer sitting in the front was knocked backwards and struck her head on either the rock or oar frame, it was unknown which. The guide was unable to get the customers back in the boat – but was able to get them to river-right just below Mermaid rock/above Fang. The woman was responsive but was complaining of severe head and neck pain and was unable to move. At that time a guided riverboarding/rafting group approached and was able to offer assistance.
What would you do?
Outcome: EMTs were taken to the scene by local river guides where a combination of the guides/EMTs were able to transport her to a nearby takeout. Life-flight transported her to Missoula.
Relevant Questions:
Are solo trips riskier than multi-craft trips?
True or False Most medical emergencies can be handled by a solo responder, if their skills are proficient enough.

Case Study #2
Month: Mid-May
Time: Mid-afternoon
Lucas and his cousins, the Amtmann girls, were kayaking the canyon section of the Big Hole. Lucas Flipped on an eddy line and was unable to roll up. The girls were able to get Lucas and his kayak to an eddy behind a large rock and just upstream of a drop containing hazards from the remains of an old dam. The eddy where Lucas was located was about 40 feet from river-right. Lucas was unable to swim the 40 feet to shore.
How would you get uninjured but stranded Lucas and his kayak back to shore?
Outcome: First, a kayaker reached a river-right eddy and got to shore. A waist carried throw rope was thrown to Lucas and he attached it to the kayak, which was pulled to shore. Lucas then held on to the same rope and was swung to shore in pendulum fashion.
Relevant questions:
What age is appropriate for kids to be recreating on rivers?
What age is appropriate for kids to be learning about river safety?
What age is appropriate for children to learn river rescue skills?
True or False It’s okay to take children on the river, but they probably shouldn’t swim in the river – it’s too dangerous.

Case Study 3
With a cooler packed to the gills, Tom, and his friends were looking forward to having a great run down the Alberton Gorge on a beautiful Saturday afternoon. Tom, who was a little gassed by the time the group passed Triple Bridges, allowed the raft to hit Split Rock sideways dumping everyone. Everyone was able to get to shore, except Tom. He swam Tumbleweed and finally washed ashore on river right about 200 yards below Tumbleweed. Tom was not moving and was not responsive to verbal calls to him from across the river. The River Ranger, who observed this from across the river was unable to reach the victim but called 911. Local guides were below Tom and were able to capture his raft and some of his gear. Tom remained unmoving.
What would you do?
Outcome: Tom was exhausted but uninjured. Private boaters stopped and picked up various members of the group, including Tom and brought them down to their raft. A detailed assessment showed no injuries – just exhaustion and the call for SAR/EMS was cancelled. Tom expressed disappointment that the beer he kept in the pocket of his PFD was lost during the swim.
Relevant questions:
True or False Physical fitness plays a role in self-rescue
True or False Physical fitness doesn’t play much of a role in your ability to rescue others?

Case Study #4
A group of six friends gathered on the Alberton Gorge in April for a recreational run. Two weeks prior, the same group had gone down the gorge at about 5,000 CFS. Though the water was significantly higher this day – about 17,000 CFS – the group felt their experience and attention to safety would carry them through this section. The group had older gear, including bucket-bailing rafts, but were excited about the day of whitewater ahead of them nonetheless. The high level made for a quick run of the upper section to Triple Bridges. Once the group got to Split Rock they were unable to avoid a large hydraulic in the middle of the river – causing them to take on water. Unable to bail the water out, they lost control through Boat Eater – eventually capsizing. One of the group, was unable to self-rescue.
What are your options to assist in the rescuing the individual?
Outcome: After a long, cold swim, he was brought to shore but was unable to be revived.
More to the story: Because of the cold weather and the level of the river that day the local commercial outfitters were concerned about their safety, but the group stated their comfort in running the river because of how well they did two weeks prior.
Relevant Questions:
Having a previously successful run on a river is assurance that the next run will be successful? Why?

Wednesday, March 9, 2011

Use it or Lose it: Basic Cardio Training for the Swiftwater Rescue Professional


John Amtmann, Ed.D., Professor, Applied Health Science, Montana Tech


The phrase “use it or lose it” is never more appropriate then in January when it comes to cardiovascular conditioning after taking time off of training for the Christmas/New Year holidays. It’s also applicable to river folks during the off-season: don’t wait until the spring to think about conditioning for spring run-off. Improving fitness through cardiorespiratory training will have a positive impact on overall functional capacity and will have a direct impact on improved maximal oxygen uptake as well as decreased myocardial oxygen cost and rate-pressure product at a given submaximal intensity. This means any physical act performed will become easier, and the cumulative effects of physical activity throughout a long day on the river becomes easier when cardiorespiratory fitness improves. On the other hand, the effects of detraining begins within only a few days of your last exercises session, and cardio training must be continue on a regular basis to maintain the training effects.

Basic Training Guidelines

The American College of Sports Medicine (ACSM) has established guidelines for promoting cardiorespiratory and musculoskeletal components of fitness (2006). For cardiorespiratory fitness, the ACSM recommends activities that can be sustained for a prolonged period of time, including walking, jogging, stationary cycling, rope-jumping, rowing or similar activities. Rescue professionals should participate in these activities 3-5 days per week for anywhere from 20-60 minutes per session. Intensity of exercise is monitored by heart rate and, according to ACSM, exercise intensity could be anywhere between 40% to 85% of heart rate reserve (HRR) to improve cardiorespiratory fitness depending on your physical fitness. Heart rate reserve is the difference between maximum heart rate (HRmax) and resting heart rate (RHR). An easy way to estimate maximum heart rate HRmax is by using the formula 206.3 – (.711 x Age). Subtract RHR from the predicted HRmax and the result will be the HRR. Calculate an appropriate percentage range of the HRR and add it back to the RHR to determine target heart rate range:

Predicted HRmax = 206.3 – (.711 x Age)
HRR = HRmax - RHR
HRR intensity = HRR X 40% - 85%
Target Heart Rate Range = HRR intensities + RHR

See Table 1 for an example of how to calculate target heart rate range for a 50 year old river rat who has a resting heart rate of 71 beats/min. An individual who is deconditioned or is in poor physical condition may need to start with a lower intensity, and 40-60% of HRR may be a realistic starting point for anyone who has not exercised in over one year.

Table 1: Calculating Target Heart Rate Range
206.3 – (.711 x 50)= 170.7
171-71 = 100
100 X .4 + 71 = 111
100 X .6 + 71 = 131

The goal of exercise is to expose the body to an overload stimulus in a safe manner. The body, given appropriate rest and recovery, will respond by becoming stronger, improving endurance or enhancing efficiency in the activity that caused the stimulus. As you improve physical fitness, the intensity may be increased to continue improving cardiorespiratory function. Increasing the intensity to 60-70% of HRR for the same river rat would change the target heart rate range to 131-141, assuming the RHR remained unchanged.


Warm-up and Cool-Down
To prevent injury it’s important to pay attention to the warm-up and cool-down. The warm-up increases the body’s temperature and prepares the body for the more intense training to follow. An effective warm-up is to perform the activity you have chosen as your fitness activity, but at an easier intensity. So, if mountain biking is what you’ve chosen to improve cardiorespiratory fitness, then biking a slower pace on a gentle grade (or lower intensity) for 5-10 minutes will be a good warm-up. The cool-down gently guides the body back toward a resting state by lowering the intensity of exercise for 5-10 minutes. During the warm-up you can palpate your pulse to ensure that your heart rate is increasing toward the target range, and decreasing toward resting levels during the cool-down. It is during the cool-down that stretching exercises can be done to improve flexibility and reduce soreness from exercise.

RPE
If monitoring heart rate during the exercise session is difficult, the rate of perceived exertion (RPE) scale could be used as an adjunct to adjusting exercise intensity. An RPE scale is a measure of perceived exertion, and is defined as the degree of heaviness and strain according to a specific rating method. One scale that is often used is a 15 – grade scale ranging from 6-20 (Borg, 1998, pg. 31):

No exertion at all
Extremely light

Very light

Light

Somewhat hard

Hard (heavy)

Very hard

Extremely hard
Maximal exertion

To use the scale the individual simply assigns a number to how hard they feel the exercise work rate is. The average RPE range associated with improvements in cardiorespiratory fitness is 12-16.

Progress at a logical pace. As your fitness improves the same level of exercise intensity may no longer be enough to increase your heart rate to within your target heart rate range. This means that you are adapting to the exercise training by improving cardiorespiratory fitness – that’s the whole point! These improvements will be more pronounced in lower fit individuals. Updating your program by gently increasing the intensity of your exercise and/or the duration will allow improvements to continue. When you’ve reached your optimum fitness level you can continue that program to maintain the cardiorespiratory fitness changes you achieved.

Try This
If you have been exercising on a regular basis and would like to challenge yourself by increasing the intensity of your cardio training, try interval training. Interval training combines higher intensity work segments with lower intensity active recovery/rest segments. The work to rest ratio can vary depending on individual preference. For example a 2:1 ratio may involve 20 second, 60 second, or 2-minute second sprint followed by 10 seconds, 30 seconds or 1-minute at a slower pace, respectively. Developing an interval training program to suit you allows you to be creative with your program. The higher intensity segments of interval training increases metabolic demand, which means you’ll be expending more calories during and following the training session.

For example, if you can jog comfortably at a 5 mile/hour pace for an extended period of time, then try this 11-minute interval training session:

6 miles/hour for 2-minutes
5 miles/hour for 1-minute
6.5 miles/hour for 2-minutes
4.8 miles/hour for 1-minute
6.8 miles/hour for 2-minutes
4.8 miles/hour for 1-minute
7.0 miles/hour for 1-minute
4.8 miles/hour for 1-minute

The objective of interval training is to increase intensity so only add this if you have been exercising on a regular basis for at least four months. Also, the speeds involved in developing an interval training session would be experimental – it’s always advisable to be conservative! Don’t do too much too soon, but don’t be afraid to push yourself a little as you improve your physical fitness. Interval training can be implemented using any mode of exercise: cycling, stairstepping, swimming, rope-jumping or any other aerobic activity.

Conclusion
Improving cardiorespiratory fitness is one step in improving overall health status and can greatly improve the functional ability of rescue professionals and these general guidelines should help any rescue professional improve cardiorespiratory fitness. The key to developing fitness should be safe and logical progression in the methods used. By this we mean that you should not progress too quickly. Listen to your body, and only increase volume and/or intensity if you feel absolutely comfortable in doing so.

The principle of overload states that when demands are made on body systems that the systems are not normally accustomed to, instead of “wearing out” or becoming weaker, the system responds by becoming stronger given appropriate nutrition and recovery time. That’s the objective of the guidelines for cardiorespiratory training outlined in this article. On the other hand the principle of reversibility states that physiological gains are lost when the load against which a system is working is reduced. The common term for this situation is, “use it or lose it”, and is appropriate to all of us, including rescue professionals.


References

American College of Sports Medicine. (2006). ACSM’s Guidelines for Exercise Testing and Prescriptio 7th Edition. Baltimore, MD: Lippincott, Williams & Wilkins.

Borg, G. (1998). Borg’s Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics.

Londeree, B.R., Moeschberger, M.L. (1982). Effect of age and other factors on maximal heart rate. Research Quarterly for Exercise and Sports. Vol. 53 (4), pp. 297-304.

Wednesday, March 2, 2011

How to Buy Swift Water Rescue Equipment


Swift water poses many dangers to the rescuer. It is a dynamic environment, and one small mistake or misjudgment can snowball into catastrophe.

In past years, one third of drowning victims in the United States were would-be rescuers. Many of these victims either lacked proper training or equipment. It is paramount, then, for rescue teams to not only purchase the proper equipment, but also to train and practice in swift water.

Levels of Training

NFPA standard 1670 outlines three levels of training for swift water rescue:

Awareness
Operations
Technician

Before purchasing equipment, your agency should decide which level of training you will pursue, for there is a different equipment list for each.

Equipment list for each level

Awareness: This level of training is designed for Agencies and rescuers who have a minimal exposure to swift water. Typically, the requirements to reach this level of training are an 8 hour course. Awareness level rescuers will not be entering the water, but may be operating in proximity to the water.

Minimum Equipment:
  • Helmet
  • Personal Floatation Device (PFD)
  • Proper Footwear
  • Throw-bag

Operations: This level of training is designed for agencies and rescuers who will be assisting in-water rescues and could be exposed to accidental swims. Typically, the requirements to reach this level of training are a 16 hour course.

Minimum Equipment:
  • Helmet
  • PFD
  • Thermal Protection
  • Proper Footwear
  • Throw-bag


Technician: This level of training is designed for agencies and rescuers who will be conducting in-water rescues, either swimming or by boat. Typically, the requirements to reach this level of training are a 24 hour swift water course and 24 hour technical ropes course.

Minimum Equipment:
  • Helmet
  • PFD
  • Thermal Protection
  • Gloves
  • Proper Footwear
  • Throw-bag

What to look for in Swift Water Rescue Equipment
Helmets: There are many manufacturers of water sports helmets, each with its own strengths and weaknesses. The most important factor when deciding on a helmet is comfort. An uncomfortable helmet will usually end up unbuckled or taken off, either way, it will not be doing its job.

After comfort, the helmet should be assessed for coverage. There are an assortment of styles, from full face to over the ears. One of the most important aspects of coverage is that of the forehead. Many helmets will slide back, leaving the forehead exposed. This is not acceptable in whitewater.

The final consideration for helmets should be whether or not a skull cap or beanie will fit underneath it. In the west, many rescues occur during spring run-off, when the water is 30-40 degrees fahrenheit. Extra warmth is a necessity during these rescues. Many helmets allow you to easily adjust the padding inside to accommodate this.

Personal Flotation Devices (PFDs): The U.S. Coast Guard has developed standards for PFDs. It is necessary that the PFD chosen is designed for whitewater use and is a Type III or V (Type V will generally provide more floatation).

The PFD should fit comfortable on the rescuer, and should be snug when adjusted. The typical way of testing this is by pulling the shoulder straps upwards. If the PFD pulls up the torso and covers the rescuer’s chin, then it should be tightened.

A Swift Water Rescue Technician should consider purchasing a rescue PFD. These PFD’s are outfitted with a quick release harness, allowing the rescuer to perform a tethered swim. Caution: Tethered swims require training to perform. If your agency does not have a Technician level rescuer, avoid the purchase of a rescue PFD. This will prevent the misuse of the harness.

All PFD’s should have a whistle and knife attached to them.

Beware of purchasing a PFD with too many pockets. Although they can be convenient during rescue operations, they can often become a nuisance or entrapment hazard in the water.
Thermal Protection: There are really only two choices here: wetsuit or drysuit.

Wetsuits:
Benefits:
  • Relatively inexpensive
  • Provides abrasion and impact protection
  • Provides warmth in the water
  • Relatively comfortable
  • Durable
Weaknesses:
  • Does not provide significant warmth out of the water
  • Can be restrictive and increase difficulty with swimming

Drysuits:
Benefits:
  • Provides for maximum warmth in and out of water
  • Non-restrictive and ease with swimming
  • Provides Body Substance Isolation
  • Entire body coverage (except for hands and head)
Weaknesses:
  • Expensive
  • Latex gaskets around neck and wrists can be uncomfortable
  • No impact/abrasion protection
  • Can tear and become ineffective in water

For rescue teams functioning in cold water, the decision is fairly simple. Drysuits provide for the maximum amount of thermal protection.

Gloves: Simple neoprene gloves will protect hands from rope burns and provide warmth. Avoid other materials.

Footwear: Footwear is the most overlooked, and perhaps most important part of the swift water ensemble. Most injuries on the river occur, not in the water, but on loose, jagged rocks on shore. Proper footwear should be worn by all members of the rescue team.

There are many options for river shoes. Most are constructed out of neoprene. Rescuers must balance foot protection with flexibility for swimming. Large lace up water rescue boots are great for walking and working on shore, but can be difficult to swim with. Thin neoprene booties are great for swimming but provide little protection for walking.

If swimming fins are a consideration for the rescue team, then assure that the river shoes fit inside the fins.

Throw-Bags: Throw-bags come in many different shapes and sizes, and are made of many different materials. The minimum length for a rescue team should be 50-60 feet of rope. Consider purchasing a more expensive low-stretch rope like spectra or dyneema. This will allow the rescuer to use as a tensioning tool if necessary. Technician level rescuers should consider a belt-bag. These bags fit around the waist, allowing the rescuer to swim while transporting the bag.

Conclusion

There are many choices in swift water gear. It is important that each agency and individual assess their potential use of the gear, and choose appropriately. Keep in mind, though, even the best, most expensive gear is only as good as the rescuer using it. Swift water rescue requires training and practice.