In deep water soloing (DWS), the danger of a fall is lessened, but the potential for injury is not eliminated. At least three DWS fatalities have been reported in Europe.

POTENTIAL INJURY TYPES

Drowning. Sudden immersion in cold water raises the risk of cold shock, a syndrome characterized by uncontrolled gasping, rapid breathing, panic, and even lethal heart rhythms. For climbers in the water longer than 15 minutes, there is also a risk of cooling in peripheral tissue, which causes loss of dexterity, gross and fine motor control, and overall strength, which in turn can contribute to drowning risk.

Impact injury due to entry. These injuries are usually due to entry that is too horizontal or that is head-first. See “Fall Safety” below.

Impact injury due to submerged hazards. These range from severe bruising to fractured limbs and head and spinal injury; such impacts also increase drowning risk due to entrapment or unconsciousness underwater.

FALL SAFETY

• Know how to swim!
• Don’t go solo. Watch each other’s landings and be prepared to assist if needed. If a climber is unconscious, you have only a few minutes for rescue.
• Consider the height. The higher you climb, the harder you fall and the greater the associated risk of injury.
• Practice safe entry. The regular entry is feet together, body loose, head upright, and arms tight to body. For short falls, the armchair (arms outstretched and knees bent) limits depth of entry.
• Do not look down. Doing so will cause the body to tip forward and increases the risk of head injury upon entry.
• Practice safe entry. The regular entry is feet together, body loose, head

LANDING ZONES

Always check the depth of the landing zone. This can fluctuate due to tide, lake levels, and rough seas. Check for submerged rocks or flotsam such as trees.

Calm water (such as an inland lakes) has greater surface tension and will make for a harder impact. Rough or interrupted water, while making for a softer landing, may make it difficult to exit the water.

Identify exit locations prior to climbing. Consider placing fixed exit ropes to assist egress, placing spotters with throw bags at key points for rescue, or having a boat available for rescues or rest time.

R. Bryan Simon, RN, and Seth C. Hawkins, MD, are co-authors of Vertical Aid: Essential Wilderness Medicine for Climbers, Trekkers, and Mountaineers.