Hypothermia and afterdrop following open water swimming: The Alcatraz/San Francisco swim study

To determine whether or not participants in open water swim events experience hypothermia and afterdrop, rectal temperature was measured for up to 45 minutes in 11 subjects following the New Year's Day Alcatraz Swim. This event was held in open water (11.7°C [53.0°F]) in the San Francisco Bay, and participants did not wear wetsuits or other protective clothing. Biophysical parameters, including surface/volume ratio, body mass index, and percent body fat were measured before the swim, and statistical analysis was done to determine predictors of temperature decrease and afterdrop duration. Applying the American Heart Association definition of hypothermia (less than 36.0°C [96.8°F]), hypothermia was seen in 5 of the 11 subjects. Using a more rigorous and traditional definition (less than 35.0°C [95.0°F]), hypothermia was seen in only one subject. Afterdrop, defined as continued cooling following removal from cold stress, was seen in 10 of the 11 subjects. Surface/volume ratio (S/V) and body mass index (BMI) predicted the lowest recorded temperatures (P < .05; r(S/V) = −.71, r(BMI) = .72) and afterdrop duration (P < .05; r(S/V) = −.75, r(BMI) = .69). These results suggest that hypothermia and afterdrop can occur commonly after recreational open water swimming, and that participants should be observed for signs of temperature decrease following removal from cold stress. (Am J Emerg Med 2000;18:703-707.