PII S0736-4679(02)00438-9 Clinical Communications HYPOTHERMIA FROM PROLONGED IMMERSION: BIOPHYSICAL PARAMETERS OF A SURVIVOR Thomas J. Nuckton, MD,* Daniel Goldreich, PhD,† Kenneth D. Rogaski, MS,* Tonia M. Lessani, DO,‡ Paul J. Higgins, MD, USPHS,§ and David M. Claman, MD* *Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute, University of California, San Francisco, California, †The Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, , ‡Department of Internal Medicine, Peninsula Hospital, Burlingame, California, and §Office of Health Services, United States Coast Guard Headquarters, Washington, DC, Reprint Address: Thomas J. Nuckton, MD, Cardiovascular Research Institute, University of California, San Francisco, 505 Parnassus Avenue, Box 0130, San Francisco, CA 94143-0130 e Abstract—We report a case of survival following pro- longed immersion and hypothermia. The patient survived for over 9 h in open water, after his vessel capsized and sank in the Pacific Ocean off the coast of Northern California. Water temperature on the day of the sinking was 14.4°C (58.0°F). Although he did have adequate flotation, the patient did not wear a survival suit. On initial physical examination in the Emergency Department (ED), the patient’s rectal tempera- ture was 30.0°C (86.0°F). With active rewarming, his temper- ature returned to normal (37.0°C {98.6°F}) within 5 h. Body fat of the patient was 19.6%, near the 50th percentile for his age (19.0%). Surface/volume ratio of the patient (.0228 m 2 /L) was 19% smaller than a predicted average (.0282 m 2 /L). We believe that the patient’s large body habitus contributed to survival and that surface/volume ratio was likely the biophys- ical variable most closely associated with decreased cooling. © 2002 Elsevier Science Inc. e Keywords— hypothermia; immersion; rewarming; re- suscitation; near-drowning INTRODUCTION Survival of prolonged immersion is based on many fac- tors. Time spent in the water, sea state, water tempera- ture, and individual behavior all have been related to cooling rate and to the chance of survival (1– 8). The relationship between body habitus and immersion cool- ing rate also has been studied. Body fat has long been associated with cooling rate, and individuals with greater amounts of body fat are known to cool more slowly than leaner counterparts (8 –11). Overall body size, which can be reflected by surface/volume ratio, is also an important factor for predicting the rate of cooling (5,7,10 –13). Despite numerous controlled studies, there are few data from actual immersion survivors. We report the detailed biophysical parameters of a patient who survived pro- longed immersion and hypothermia. We believe that the patient’s large body habitus, as reflected by these bio- physical parameters, contributed greatly to his survival. CASE REPORT In September 2000, a 50-foot fishing vessel capsized and sank in the Pacific Ocean off the coast of Northern California. Water temperature on the day of the sinking was 14.4°C (58.0°F). Large (approximately 5–7 foot) RECEIVED: 19 June 2001; FINAL SUBMISSION RECEIVED: 20 November 2001; ACCEPTED: 5 December 2001 The Journal of Emergency Medicine, Vol. 22, No. 4, pp. 371–374, 2002 Copyright © 2002 Elsevier Science Inc. Printed in the USA. All rights reserved 0736-4679/02 $–see front matter 371