Exposure Health Issues during expeditions



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Sun burn, sun poisoning, sea ulcers and immersion injuries are effects of continued exposure to the elements. When on expeditions, these issues can cause debilitating problems that need to be addressed.




When you can get out of the conditions causing a medical problem and back to civilization where professional attention is readily available, many of these problems are small annoyances. When daily conditions compound otherwise mild problems they can pose a serious threat to both the individual and the group

SUN BURN

When you are kayaking you are exposed to the sun. There is no shade other than what you wear. Unabated solar radiation can significantly damaged your skin. Given continued exposure, it can damaged cells below the skin. Dehydration and heat exhaustion are associated complications. ( See also Database 'Seakayak', View 'CourseList', Document '10 - Other Medical Considerations'. ) Repeated unprotected exposure leads to increased skin cancers in later life. Many novice kayakers do not understand the dangers of sun exposure and can cause serious problems in group activities.





FIRST DEGREE

Prevention: The most effective protection from sunburn is opaque clothing. On areas where this is either impossible or undesirable, use a high SPF rated water proof sunscreen. Pay particular attention to areas that are seldom considered such as top of the feet, lips, eyelids and ears. Don't forget to wear sun glasses to prevent sun burn of the eyeball which can cause temporary blindness. Wear a wide brimmed hat with neck and ear protection. Keep well hydrated and use lotions to reduce dryness and cracking of skin. Prior moderate long term sun exposure provides some natural protection.

Treatment: If the person is conscious, give them water. All burns can dehydrate the body. Never give anything by mouth to someone who is unconscious or semi-conscious. First aid lotions can be applied to the burn for temporary relief. If blisters appear, the burn is more serious (see below ) - the person needs to seek medical help. A time-tested home remedy is found in the Aloe plant- smear the juice from the leaves on the area. It really does work to soothe the pain. Time will heal the burn. Sometimes the burned skin will start to flake off- don't pull it off. This may cause healthy skin to tear as well and can cause scarring.





SECOND DEGREE

The skin has been burned to the point the body is trying to protect itself. In doing so, the body sends fluid to the skin in order to try to stop the burning process. This causes the blisters seen with second- degree burns.

Prevention: Same as first degree.

Treatment: Never open or break these blisters- this causes fluid loss to the body that it can ill afford. If the person is conscious, give sips of water and watch for signs of heat exhaustion or worse. Get the person out of the sun and apply cool water mist to the skin. Do not try to wrap the blistered skin with anything- the wrap will stick to the skin and tear it off.This person needs to seek medical attention as soon as possible. Dial 911 if the person says they feel "cold" or if they seem groggy or nauseous. If the burn covers a large (more than a third) portion of their body, call 911. Do not bathe this person in ice or pour ice water on them. This extreme temperature change has the potential to send the person into shock. Putting ice directly on the burned skin is equally as damaging.





THIRD DEGREE

Although this is rare, it is serious. The burn damage has gone so far the body is out of fluid and deep cell damage has occurred. Cracks that may appear as small fissures will appear in severely burned and "dried-looking" skin. If the person is conscious, which is unlikely, they will state they don't feel anything - this is because the nerve endings have been destroyed. It is more likely the person is unconscious and nothing anyone does seems to have an effect on waking them. Combined with other problems of marine environment, infection and ulcers, this can be deadly.

Prevention: Same as first degree.

Treatment: Summon help immediately - this is truly a life or death emergency. Do not try to move this person. Get shade over them and provide only cool water over the skin- no ice, no ice water. Keep the person's airway open so they can breathe. Make sure someone can guide the ambulance crew to the person. Heat stroke may also be present. Providing shade and cool water on the skin and maintaining an open airway is all the first aid that can be provided without a medical license. ( for kayakers, all this requires being on land.)


SUN POISONING


    Polymorphous light eruption (PMLE). PMLE is a reaction that does not appear to be linked to drugs or diseases. It happens in people who are at risk and who are exposed to intense sunlight that they're not used to. For example, people living in northern climates could experience this if taking a winter vacation in a tropical climate.

    Symptoms are a severe skin rash, usually appearing several hours after going out in the sun. The rash may be itchy and include:

    • Small bumps over the sun-exposed areas of the body
    • Dense clumps of bumps
    • Hives, usually on the arms, lower legs, and chest

    Solar urticaria. Symptoms may develop within minutes of exposure to sun. If large areas of skin are involved, symptoms may include:

    • Itchiness
    • Redness
    • Raised areas on the skin (wheals) or blisters
    • Wheezing
    • Dizziness
    • Loss of consciousness

    Although the blisters usually go away within hours, you may experience the reaction off and on throughout the years. Antihistamines can treat some cases, but see your doctor for advice.

    Other treatment or prevention for PMLE or solar urticaria may include:

    • Steroids that go on your skin
    • Sunscreen that says "broad-spectrum" on the label, which means it protects against the sun's UVA and UVB radiation
    • Phototherapy with psoralen UV light (PUVA) to desensitize skin to UV light


IMMERSION INJURIES




SEA ULCERS

This problem usually starts small and gets serious over a period of 3 or more days. Small cuts, punctures and abrasions that on land form scabs and heal normally will not heal as consecutive scabs are floated off in the wet conditions. A deepening ulcer forms that will not stop, going as far as the bone. It can easily get infected.

Treatment: The most effective option is to stay on land until it scabs and heals, approximately a week. As this is impossible or impractical on most expeditions, the remedies are to keep it clean and dry, a notoriously difficult task. When on land, make sure the wound is clean, remove all bandages and let the wound dry until the next launch. Apply an antiseptic ointment, a waterproof flexible bandage and then cover the site with duct tape, preferably in such a way as the tape is wrapped all the way around the body part to overlap itself. Another option is to apply Liquid Bandage or super glue to the wound before the waterproof bandage. If located on a foot or hand, consider using latex gloves or socks to protect the wound further from water and abrasion.






IMMERSION FOOT / TRENCH FOOT

Immersion foot occurs with prolonged exposure to wet and cold conditions. Also known as trench foot due to its significant occurrence in the trenches of World War I, it is a result of decreased circulation of a body protecting itself from the cold. The cure is keeping the foot dry and warm. Trench foot can occur in extended kayaking expeditions in cold conditions. Recovery time is four to six weeks. Scarring is common. Keeping the core of the body warm while keeping the damaged area cool is recommended. Frostbite and gangrene are related injuries.




TROPICAL IMMERSION FOOT / PADDY FOOT

Long immersion in wet conditions even in warm conditions can lead to serious problems. This is a problem seen in large numbers on the feet during the Vietnamese War. Symptoms are swelling, inflammation, tenderness and pain in the affected area. These problems can occur in other areas, ( armpits, crotch ) that remain wet for long periods of time. Keeping the area dry is critical to prevention and cure of this problem. Twenty four hours of drying for every 48 hours of exposure are required for recovery.



GENERAL WATER IMMERSION

Warm water immersion injury is the result of hyper hydration of the skin leading to painful cracking of the skin. Usually seen on the foot in solders, this problem is more likely to appear on the hands of kayakers, especially those using gloves. Keeping the hands dry is particularly difficult for kayakers as they are so close to the water on each stroke and water runs down the paddle shaft frequently keeping then constantly wet.

Drip rings or drips nubs will help. Drying overnight and use of silicone protective greases can help. Gloves and footwear with wicking liners, good drainage and/or air access is recommended.

Recovery time for severe cases may be as long as three weeks.


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EVEN THE BEST BOATERS CAN FIND THEMSELVES IN SERIOUS TROUBLE ON THE MILDEST OF DAYS ON THE WATER. PARTICIPATION IN THIS SPORT IS A STRENUOUS ACTIVITY. CONSULT YOUR PHYSICIAN BEFORE UNDERTAKING ANY SUCH ACTIVITY. PLEASE BE AWARE THAT EACH BOATER TAKES FULL RESPONSIBILITY FOR HIS OR HER OWN SAFETY, AND IS TOTALLY RESPONSIBLE FOR ASSESSING THE DANGER LEVEL AND ACCEPTING THE CONSEQUENCES OF PARTICIPATING IN THIS SPORT.


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