Tuesday, September 8, 2009

Many are cold but few are frozen

Surgeon Rear Admiral Frank Golden OBE is a world authority on survival at sea and is credited with unravelling many of the mysteries surrounding immersion hypothermia. He talked to Eimear Vize about his acclaimed research and life in the Royal Navy
A born raconteur, Corkman Frank Golden vividly evokes one particular night spent at sea in near gale conditions. The waves were climbing to 13 feet and the sea’s incessant battering had caused the floor of his life raft to peel away, leaving him clinging to the inner-side of the raft tube, awaiting rescue. The story is even more remarkable when you realise that the Irish doctor didn’t have to be there. In fact, he volunteered for the entire experience.
Golden spent much of his career as a medical officer in the Royal Navy (RN) involved in cold-water survival research. He believed that the best and most accurate way to test the safety and endurance of a new life raft being proposed for Her Majesty’s sailing fleet was to spend a week inside, adrift on the open sea.
“Simulated conditions may be reproduced in a specialised laboratory ashore but all the variables likely to be encountered in a real life survival situation can only be satisfactorily replicated at sea. We were testing some new life rafts being introduced to the Royal Navy ships to determine the most appropriate type, in particular the thermal habitability qualities.
“In World War II, over two thirds of all Royal Navy fatalities escaped their sinking ships only to die subsequently in the survival phase from hypothermia. In wartime, modern search and rescue facilities may not be readably available so survivors may have to spend a considerable time afloat before rescue,” he explains.
The University College Cork graduate notes, with annoyance, that the thermal protection built into most modern life rafts is deficient for longer-term survival. However, these still meet existing, lax international standards.
Now retired, Frank recalls the life raft trials as hard, challenging but extremely satisfying. And, like many an old salt, he has a story to hand about a particularly hairy moment: “One night, in a Sea State Seven, the floor began to peel off the raft and we were quickly up to our armpits hanging on to the inner side of the raft tube while waiting to be rescued.”
Such assiduous methods were well rewarded, however. These real-life trials resulted in the thermal protective properties of the rafts being significantly modified and upgraded before they being fitted to the Royal Navy’s ships.
Indeed, Frank’s efforts over the decades has translated into a myriad of life-saving benefits for those who make their living or take their pleasure from the open sea. The high-ranking Naval Officer has come up with practical solutions to many of the critical factors leading to immersion-related deaths. His efforts have also significantly enhanced operational protocols for international air-sea rescues.
Dr Golden has received worldwide acclaim for his research and numerous awards, including an OBE for his work on sea survival; a Gilbert Blane Medal from the Royal College of Surgeons for his research in post-immersion death; and a Stewart Memorial Prize from the Royal Aeronautical Society for his work on the rescue of immersion victims.
Indeed, the name of Surgeon Rear Admiral Frank Golden is internationally synonymous with research into cold-water survival. He has quiet literally written the book on it with Survival at Sea being published in 2002, some nine years after he retired from his RN post.
Prior to hanging up his hat in 1993, the Munsterman spent 30 years in the Royal Navy, directing its survival medical research department whilst also acting as consultant advisor in applied physiology. He also advised government departments and interested bodies – including the UN International Maritime Organisation (IMO) – on matters pertaining to survival at sea.
He quips that it was his bank manager who acted as an inadvertent recruitment officer for the Royal Navy when the recently qualified medic was still struggling as a GP trainee.
“I was being paid a pittance and my bank manager said he’d like a chat with me, during which he pointed out that on looking at my monthly pay cheque and my essential outgoings, it was quite clear that I would be 80 before I could change the figures to black,” Frank laughs.
“He suggested – ever so politely – that I should go away and get a decent job! I decided then to do a short service job in the Navy to help reduce my overdraft.”
It seemed a sensible career choice by any standards until Frank readily confesses that he was petrified of the sea – a phobia that had been with him since childhood.
Born and raised in Cork city, like many children he enjoyed trips to the seaside and spent many happy family holidays fishing in Ballycotton. But the pernicious potential of the sea was brought home to him repeatedly as he weathered the trauma of the summer drownings of a number of friends and acquaintances.
“I was a very poor swimmer myself in my youth. I was tall and thin with negative buoyancy – I swam like a stone and thus became very phobic about water. I think that was what stimulated a latent interest in the nature and causes in immersion- related drowning deaths,” he muses.
Frank, who graduated from UCC in 1960 and travelled to the UK thereafter, recalls his life was ‘suddenly transformed’ when he donned the uniform of a Royal Navy Officer in 1963.
“It took me sometime to get over the transition from pauperism to the status of being a Naval Officer with an obvious solution to my monetary problems. The work was exciting and very stimulating. In addition to being paid a very good salary, over an 18 month period I cruised the world visiting locations that included the Mediterranean, Middle East, the Asian subcontinent, Africa, the Southern Atlantic (Tristan da Cunha, and South Georgia), Antarctica, and the east coast of South America.”
A subsequent posting to the Navy Air Station in Culdrose, Cornwall, offered a sample of air-sea rescue work. The young Irishman was soon hooked.
One of the major rescues he participated in involved the stricken oil super tanker, The Torrey Canyon, which went aground on the rocks between Lands end and the Scilly Isles on 18th March 1967.
I was flown out to The Torrey Canyon to provide immediate medical care to members of the salvage team who were injured following an explosion on board. The leader of the salvage team unfortunately died from extensive internal injuries before I could get him ashore. The remaining members of the salvage team all survived,” Frank recalls.
“It was that helicopter work which reawakened my interest in immersion deaths. It quickly became apparent that all the immersion/drowning casualties did not exactly conform to the information in the medical textbooks. A subsequent posting to the RN Air Medical School, which had a refrigerated pool, presented me with a opportunity to further my enquiries.”
Through personal experimental investigation Frank learned a great deal about ‘hypothermia’. Although the problem of hypothermia in sea survivors was well recognised by the end of World War II, there were still a great number of associated unanswered questions. These included the most basic one: Why did people die after just a few minutes of cold-water immersion?
“The popular belief was it was due to hypothermia but I knew from my experiments that even in ice-cold water, body temperature took some time to start dropping following immersion,” says Frank.
And the medical officer was troubled by many other questions. “Following cold water immersion, what was causing the muscular incapacitation, even in people who could swim, which prevented them swimming even five to ten meters to a safe refuge?
“Why did competent swimmers die after 20 or 30 minutes of swimming? Why did people who were wearing approved lifejackets drown?
“Why did about 20 per cent of those rescued alive – especially by helicopter – die during or shortly after rescue?” 
These puzzling phenomena were what drove Frank’s search for an understanding that he knew could be used to save countless lives at sea. In 1979 he undertook a PhD at the University of Leeds focusing on the physiological changes in immersion hypothermia with special reference to factors that could be responsible for death in the early re-warming phase. 
He explains that it was only after years of detailed studies at the Air Medical School and in open water situations that he was able to provide the heretofore-elusive answers (see panel right).
Another area of Dr Golden’s research involved studying the problems associated with escape from submerged vehicles, particularly helicopters. A key collaborator in this work was Frank’s PhD student at the time, Mick Tipton, now Professor of Human and Applied Science, University of Portsmouth.
Their pivotal research led to the development of an underwater escape device that provides the individual involved with sufficient air to facilitate escape, and it is now used extensively in the offshore oil industry.
Frank is rightly proud of his work. He has not just identified critical factors leading to immersion-related deaths, but used this new understanding to deliver practical solutions. One of many involves devising a simple method of lifting a victim in a horizontal attitude. Frank’s technique is now used worldwide by many helicopter sea rescues.
The information derived from the Irish pioneer’s many tests and experiments has also played a significant role in the design of much of the modern maritime lifesaving equipment, and he is frequently consulted by a variety of national and international organisations on matters related to survival at sea.
“My respect for the sea has increased enormously. I despair of many users who don’t follow the advice that is readily available, or who fail to learn the lessons from all those situations where lives have been repeatedly lost by inaction, carelessness, and the ‘it’ll never happen to me’ attitude. I could go on and on.
“The first and most important thing is to understand and respect the environment, and never think ‘it’ll never happen to me’. Identify potential disaster scenarios and rehearse the most immediate and essential actions required to prevent them worsening,” he advises.
Of course, the nature of some of Frank’s experimental work has precluded him for taking his own advice at times. A case in point was outlined at the outset of our interview when he recalled clinging helplessly to a disintegrating life raft with the sea surging around. But Frank is not one to go overboard without purpose. Asked if any of his perilous encounters were truly touch and go, he replies sagely: “Not really, although I’ve had several exciting ones.”
Essentials of Sea Survival
In 2002 Frank Golden co-authored the authoritative international handbook on survival at sea with his friend Prof Michael Tipton of the Department of Human and Applied Science at the University of Portsmouth.
Each year, 140,000 water-related deaths occur worldwide and Essentials of Sea Survival is a compelling, informative, and comprehensive guide that can help avoid disaster, even in worst-case scenarios.
Drawing on historical anecdotes as well as published scientific research, it examines the nature of the many threats confronting the survivor at sea and outlines, in lay terms, the methods that can be used to prevent or minimise the dangers.
Essentials of Sea Survival is a fascinating blend of historical anecdote, scientific fact, and practical application, including step-by-step explanations of how to safely abandon ship, board a life craft, dispense water and rations, divide duties, conserve energy and strength, and proceed with a successful rescue.
Scientists and academic readers are likely to find the technical research of interest, whilst the real-life scenarios will be striking for recreational water sport participants.
The sea survival mysteries unravelled by an Irish doctor
Surgeon Rear Admiral Frank Golden’s research has offered vital explanations for many of the mysteries that surrounded sea survival and hypothermia.
He discovered that difficulties experienced on initial cold-water immersion are associated with cardiac and respiratory reflexes resulting in tachycardia, intense peripheral vasoconstriction, hypertension and arrhythmias. These responses may result in an incapacitating cardiovascular accident or cardiac arrest in susceptible individuals.
“The respiratory response included an immediate, uncontrollable, substantial inspiratory gasp response, followed by hyperventilation during which breath-holding is impossible, frequently resulting in aspiration and drowning, especially in turbulent water,” the sea survival expert adds.
Frank also discovered that the swim failure, which often saw strong swimmers fail to make it five or ten metres to safety, is due to peripheral neuromuscular cooling before deep body temperature fell substantially (>2°C).
He established that longer term sea survival problems were associated with general hypothermia, leading to an inability to perform basic lifesaving actions, such as paddling to keep ones back to the oncoming waves, or providing additional support to keep one’s airway clear of the water in lifejackets. The lifejackets on many who lost their lives were “poorly fitted and without a crotch strap”.
Frank also realised that the puzzling collapse of many seas survivors on rescue was not – as Nazi experimenters in Dachau believed – due to the continued fall of deep body temperature, but was in fact related to the sudden removal of the hydrostatic support provided by the water pressure around the immersed body.
“In the absence of effective cardiovascular pressor receptors, due to cooling, the blood pressure collapses and cardiac arrest may ensue,” he adds.

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