In Kodiak, Alaska, Coast Guard flight surgeon Dr. Martin Nemiroff was watching TV news reports on the crash with intense professional interest. Nemiroff, 41, is probably this country’s leading expert on a little-known medical phenomenon: the resuscitation of people who have apparently died of drowning in cold water. A Brooklyn-born M.D. who previously taught at the University of Michigan, Nemiroff is a Navy-trained medical diver—often the first to reach survivors when a plane goes down in waters near his base. In Michigan and Alaska, he has been personally responsible for reviving 35 victims of submersion in cold water, some of whom had been under for as much as an hour. Dr. Nemiroff discussed his specialty and how it might have been applied in Washington with PEOPLE’S Jeanne Abbott and Rebecca Bricker.
How long after the Air Florida crash could the victims have been saved?
There are many variables. The colder the water, the better. The Potomac was optimally cold—about 31°F. In water warmer than 70°F, victims do not do well after four to six minutes. Generally, if victims are retrieved from water colder than 70°F within an hour, their potential for survival is good, assuming they haven’t sustained serious injuries.
How is that possible?
Cold water slows the heartbeat, stops the breathing and redistributes the blood flow toward the organs that need most of the blood and oxygen—the heart, lungs and brain. This is called “the diving response.” Cold reduces the brain’s need for oxygen and permits it to survive longer during an airless period.
Are most emergency medical personnel familiar with your research?
It’s widely known. There are teams of dive-rescue specialists around the country who are skilled at diving quickly, getting people out of the water in an hour or less and starting resuscitation. There’s an international association of dive-rescue specialists based in Colorado. These rescuers are most prevalent in Michigan, Alaska, Colorado and Washington State.
Is there such a squad in Washington, D.C.?
Not to my knowledge.
Could such a squad have made a difference there?
I certainly think so. Dive-rescue specialists would have been able to get to at least some of the victims. I was very frustrated watching the news of the crash, which is in no way a criticism of some of the heroic rescues that occurred.
How long could the survivors have stayed conscious and afloat in such icy waters?
About five to 10 minutes. But even when they become unconscious, they are liable to stay afloat and would be recoverable for up to an hour.
What is the longest known submersion time for a cold-water drowning victim who has fully recovered?
Forty minutes. We’ve attempted to revive patients who have been in the water for one or two hours without complete success. Those victims had brain damage and only lived a few hours.
What factors determine a victim’s recovery?
How long the victim has been in the water, the water temperature, the victim’s age, how quickly cardiopulmonary resuscitation [CPR] was started and how well it was done. Another factor is how clean the water was—if it was muddy, we have poorer results because of impurities that have gotten into the victim’s system.
Does age make a big difference?
Statistically, the younger the victim, the better the survival rate. Children often die first, but they’re the easiest to save because they’re more resilient in being able to withstand a low-oxygen period. But in late December we received a report from Muskegon, Mich, of a 70-year-old man who was underwater for 40 minutes and had a complete recovery.
What is the resuscitation technique for cold-water drownings?
Restart the heart using CPR, which also includes removing water from the lungs, but don’t rewarm the body at the scene of the accident. Rewarming too quickly can cause shock, heart problems and sometimes skin burns. Once the victim is at the hospital, give him heated humidified oxygen to rewarm the lungs and heart. When the blood starts to circulate more normally, the body generates enough heat to rewarm itself. The body’s rewarming process generally takes one to three hours.
How long should you attempt to revive a victim?
I’ve tried to resuscitate victims up to 15 hours. One rule of thumb is that if we rewarm them to somewhere near normal body temperature without response, we cease our efforts.
Can CPR be given to victims while they’re still in the water?
The Coast Guard and various universities have been working on this. With current methods, too much time is lost from the moment we see a body until we start circulating that person’s blood more normally and start breathing for him. If I get in the water behind the victim, I can compress his chest against mine to restart the heart. In one air crash recovery I made in Alaska, I dove into a submerged cockpit and removed the pilot. When I brought him to the surface, I started CPR right away. He turned pink and had all the signs of success. But the pilot had un-survivable brain damage from the accident itself.
When did you first become interested in cold-water drownings?
In 1975 I treated a 2-year-old boy who had been missing for 20 minutes when a rescuer found him floating face down in a cold lake near Ann Arbor. But his mother refused to believe her son was dead and began mouth-to-mouth resuscitation and chest massage. By the time he reached me at the University Hospital the boy was fully revived, and he went home the next day.
First reports indicated that many of the Air Florida passengers died from crash injuries, not drowning. How will we ever know if more of them could have been saved?
Autopsies could show how long the victims lived, how long they were potentially recoverable and what actual effect the water temperature had on their efforts to exit from the plane. I’m not involved in the investigation, so it’s hard to make a firm statement. But I’m less inclined than others to accept reports that the victims died of injuries. In this type of accident, a faster response by specialized personnel might have saved some of the victims.