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• Hypothermia 1: Swim ends in death
• Hypothermia 101: When is it too cold?
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Hypothermia

'Routine' ocean swim ends in death

This horrifying report of the death of a swimmer in San Francisco, from suspected hypothermia, is a lesson to all swimmers. Below, we republish our guide to cold water swimming, but retired Snooze Doc, Howard Roby, a report was published originally in our oceanswims.com newsletter of April 19, 2018. 

By Amy Graff

From SFGate newsletter, San Francisco, Sept 23, 2022

Deadman's Point can be seen from China Beach, a cove tucked between Lands End and Baker Beach in San Francisco's Sea Cliff neighborhood. (DianeBentleyRaymond/Getty Images/iStockphoto)

The weather was stunning in San Francisco on the evening of Sept. 16, with clear skies and the sun blazing overhead. Conditions seemed perfect for members of the city’s open-water swimming community who had gathered informally at China Beach for a workout. Below the surface, though, the sea was turbulent, and cold enough to kill. 

Michael Ritter, a longtime San Francisco resident and highly experienced swimmer, entered the water with a group of a half-dozen or more people around 6 p.m. Ritter, 67, had been swimming in San Francisco Bay for the past eight years, and had recently started braving the chilly waters without a wet suit.
Three swimmers in the group, including Ritter, ran into trouble. Though they’d planned on swimming for around a half-hour, they fought a strong current to return to shore, and spent far longer in the churning sea than they’d intended. Two were able to swim back to the beach themselves, where they were treated for hypothermia. Ritter struggled and was heroically pulled from the water by a swimming companion; despite efforts by the San Francisco Fire Department and the U.S. Coast Guard, he died later that night.

'He grew up in the water' 

Dozens of people are rescued from San Francisco’s treacherous waters every year; last year the fire department pulled 228 people out of the ocean. Deaths, though rare, are a reminder of the dangers of swimming in this part of the Pacific, where waves can hit with the force of a car and temperatures are potentially deadly. 

Despite only recently joining the Dolphin Club, a 145-year-old group dedicated to swimming and boating in the open ocean, Ritter had been swimming all his life.

“He grew up in the water,” Ritter’s husband, Peter Toscani, told SFGATE. “He was always around water, he loved water, he loved to swim, he was swimming in the community pool for 25 years, he loved beaches.”

With friends, he swam along the California coast in Half Moon Bay, Santa Cruz, Monterey and La Jolla. In the summer of 2020, he began swimming two or three times a week at China Beach, the cove within Golden Gate National Recreation Area on the city’s northern tip just west of the Presidio and Golden Gate Bridge. A friend said he had swum there 50 to 80 times.

Although the coroner’s office told SFGATE Ritter’s cause of death has yet to be determined, at the hospital, his body temperature was 82 degrees; hypothermia begins when a person’s core temperature falls below 95 degrees. The condition is common among swimmers in the frigid waters off San Francisco.

A small 2000 study found that 5 out of 11 participants monitored by researchers in San Francisco’s New Year's Day Alcatraz Swim came out with hypothermia. In May, a member of the Dolphin Club developed hypothermia at China Beach and had to be taken to the hospital, Ward Bushee, president of the group, told SFGATE. 

Two months ago, Ritter “went into a state of shock” while swimming in the same spot, this time while wearing a wet suit, and friends had to help him out of the ocean, Toscani said. He was treated by paramedics at the beach and made a full recovery. Toscani said the reason for the medical emergency was not determined and it’s unknown whether he had hypothermia.  

Despite the risks, Ritter’s death marked the first fatality of a club member in recent memory, Bushee said.

“We were all so sad as members of the Dolphin Club to learn about his loss,” Bushee wrote in an email to SFGATE. 

Founded in 1877, the Dolphin Club, a nonprofit organization, serves as a special community for swimmers and rowers alike. (Blair Heagerty / SFGate)

'We need to get the word out'

Open-ocean swimming is a thrilling, physically demanding sport, one that many participants continue to do into old age. While it may be risky, it also comes with health benefits: Studies show that people who swim tend to be healthier and live longer. The sport also fosters tight-knit communities among people who have a passion for swimming in the wide-open water, including at China Beach, where regular swimmers grew especially close during the pandemic.

“While open-water swimming at China Beach has its share of risks like other outdoor sports, it is worth calling out that it has also been a lifesaver to many swimmers including myself during the lockdown,” SF resident and open-water swimmer Alden Yap told SFGATE by text. He was part of the group that went swimming with Ritter on Friday, and developed hypothermia. “Many swimmers found each other in a period when pools and facilities were closed and grew organically from there into the social group that we see today.”

The 1,925-member Dolphin Club has a facility, including a sauna and hot showers, on the sheltered cove at Aquatic Park. But during the pandemic, when the club was closed, some members began venturing out to the unprotected waters of China Beach, according to Bushee.

“In Aquatic Park you have a more controlled area,” Bushee told SFGATE on the phone. “You have escape hatches. There are enough swimmers out there that you can ask for help. You can grab a boat. The beach is close. That’s not necessarily so true at China Beach where you have some strong tides and conditions that are more difficult to navigate. We need to get the word out that you need to be careful and plan your swim well when you’re at China Beach.”

Having a plan isn’t necessarily enough, though. Ritter and his group were following best practices, including going out with other experienced swimmers, on a day when there were no National Weather Service warnings about unusually dangerous conditions. While Ritter was in top shape, Toscani said he had little body fat to protect him from the cold. 

“When you look at this incident, it’s horrible because somebody lost their life. It doesn’t sound like they did anything wrong, it doesn’t sound like they did anything that anyone out of their skill level would have done,” said Lt. Jonathan Baxter, a spokesperson for the fire department. “It seems this party had a plan, which shows that even if you plan for something, injuries can occur.”

Hypothermia is a sneaky thing. Although it’s most common in icy waters, it’s possible to become hypothermic in any water colder than 70 degrees. The closest National Weather Service buoy to China Beach indicated that the water temperature was about 58 degrees that night, and Baxter said the water off the beach was anywhere from about 49 to 57 degrees. 

Prolonged exposure to cold sucks up your body’s stored energy, sending your core temperature plummeting. If your core falls below 95 degrees, your body will go into shock, leading to disorientation, uncontrollable breathing and rapid heartbeat. That confusion is particularly dangerous in the open ocean.

'Right in front of me was a wave'

Ritter started Friday’s swim with several others, including Yap, who has been swimming long distances in the ocean since 2005. Yap told SFGATE that they had met up organically and decided to follow the usual route, swimming south to Deadman’s Point and back. Yap has done this same 1-mile swim a dozen times, usually taking about 25 to 30 minutes. Some in the group might turn around before Deadman’s depending on conditions.

Yap said that from shore they noticed conditions were a “a little bit choppy, but it wasn’t something that we thought we couldn’t overcome. … We’re used to swimming in those conditions.”

At some point, though, Yap was grabbed by an unusually strong current, which helped him reach Deadman’s Point faster than usual. When he tried to turn back, the current became problematic. Yap realized he’d lost the rest of the group. 

“Conditions changed when I got to Deadman’s,” Yap told SFGATE over the phone. “I realized no one was behind me and no one was in front of me. That’s when I panicked.”

He added, “You could see the Golden Gate Bridge. It was sparkling. The sky was clear, but right in front of me was a wave and it was high.”

Heading back toward China Beach, with winds picking up, Yap said that he swam as hard as he could for 15 minutes, but made little progress. 

“I’ve never experienced a current like that,” he said. “I was on a treadmill.”

By moving closer to shore, Yap managed to skirt the current, eventually making it back to China Beach after more than a hour in the water. He was treated for hypothermia by a paramedic, then released. He later posted GoPro footage of his perilous swim on YouTube.

Image by David Helsham (@glistenrr).

'His eyes became panicky'

On Tuesday, Toscani recounted what he’s learned about his husband’s final swim. 

In the water, Ritter stayed close to a woman in the group; the two of them were also grabbed by a powerful current. Ritter started to swim more slowly, Toscani told SFGATE; the woman told Toscani she realized something was wrong when she noticed Rittert “ looking blissful,” Toscani said. “It was treacherous. He was treading water, and she had to become more aggressive toward him, trying to direct him toward the shore.”

When she realized China Beach was out of reach, Toscani said, she told Ritter that they needed to swim to the closer Hidden Beach, a strip of sand surrounded by steep cliffs. 

“She was trying to push him using her feet,” Toscani told SFGATE. “She said his eyes became panicky.”

The turbulence was so bad that Ritter was swallowing a lot of water.

By the time they reached Hidden Beach, Ritter was unconscious. The woman administered CPR, but she was unable to revive him. She swam back to China Beach, ultimately spending an hour and a half in the water. One of the other swimmers in the group had already called 911, and waiting medics treated her for hypothermia, Toscani said. 

The fire department said it first received a report of a swimmer with a medical emergency at 7:20 p.m, and deployed five rescue swimmers who swam in the dark from China Beach to Hidden Beach. The swimmers used a board to bring Ritter to a waiting U.S. Coast Guard boat, where medics immediately started life-saving measures, Baxter said. 

“Once the Coast Guard got to Michael, they said they felt a pulse, they tried to revive him there,” said Toscani, adding that the woman who helped Ritter is a hero.

Baxter agreed, telling SFGATE that Ritter’s companion “heroically rescued this person, to a point where CPR could be administered.” 

Ritter was transported by boat to Horseshoe Bay in Marin County, and then to Marin General Hospital. On arrival, doctors connected him to a respirator, and to machines designed to warm up his blood, according to Toscani.

“The blood would come out and pass through these heating machines and go back through the body, they did that for two and a half hours or so. They were able to get his body temperature up to 86 degrees,” he told SFGATE. An ER doctor then checked for a pulse, but couldn’t find one. “They gave me the choice on whether to continue with this. There was no chance. I said, ‘Turn everything off.’”

Ritter was pronounced dead just before midnight Sept. 16, about six hours after he’d entered the water.

After Michael Ritter died Sept. 16, 2022, an email to friends read, "The world is brighter for having had Michael's light, kindness, generosity, tolerance, acceptance and unconditional love; an example for how to live on this planet for the short time we inhabit here." (Courtesy Eric Smith)

'The model of morality'

Ritter grew up in Florence (South Carolina), and graduated from the College of Charleston with a degree in psychology and counseling. Toscani said that he loved to travel; he passed through San Francisco in the 1970s and ended up staying. 

Ritter spent more than 30 years as a member of the faculty at San Francisco State, teaching classes to students majoring in counseling, as well as providing mental health services to students, including creating the school’s substance abuse prevention program. In the mid-’80s, Ritter founded the AIDS Coordinating Committee on campus, addressing AIDS prevention and education and advocating for people living with the virus, including staff and faculty. It “set an example for AIDS policies and programs on college campuses throughout the country,” the Golden Gate Xpress, the university’s newspaper, reported. 

“He promoted the well being of marginalized communities (particularly those impacted by homophobia and racism) throughout his career as a counselor and educator in social services before his long tenure at SFSU,” Bita Shooshani, a colleague of Ritter, wrote in an email. “To me he embodied the spirit of San Francisco and why I moved to the Bay and stayed here and continue to live here. 

“He was a teacher, an activist, committed to social justice, a person of the highest moral values who was trying to make a difference in this world,” Ritter’s long-time friend Eric Smith wrote in an email to friends, which he shared with SFGATE. “He was truly ‘walking the walk.’”

Michael Ritter, left, with his husband of 35 years, Peter Toscani. Courtesy Eric Smith

Ritter’s death has left the open-water community in shock; the flag at the Dolphin Club was lowered to half-mast for three days. His friends and family, meanwhile, are mourning the loss of a man who they say lived with good intention and grace.

“I can’t think of one instance where he talked cruelly about anyone. He was the model of morality,” Toscani said.

“Michael was an extraordinary person and friend to many people from many different walks of life,” Smith wrote. “When you were with Michael, you felt like you were the most important person in the world.”

On Oct. 1, the Swimming for Sueños Dream Team is holding its ninth swim from Alcatraz to San Francisco to raise scholarship dollars for undocumented students at SF State. This year, the swim is in Ritter’s honor.

Hypothermia 101

When is cold too cold?

Early this season (oss.c: Season 2017/18), writes Howard Roby, controversy raged after the Bondi to Bronte swim was modified to allow swimmers to use wetsuits. This came about because of unseasonably cold water temperatures and the concerns of the officials about the possibility of some swimmers developing hypothermia. Snooze Doc Howard, an anaesthetist, offers this guide to dealing with hypothermia...

The term hypothermia refers to a core body temperature of below 35 degrees C, whereas normal core body temperature is around 37 degrees C.

Despite the change in the rules at Bondi-Bronte, some swimmers did need to be transported to hospital with hypothermia. I have seen different estimates of the water temp that day and have been told by the officials that the temperature during the swim was actually 13.7C. Due to the interest created by this swim, and as a committed ocean swimmer, I have been asked to write a piece on hypothermia. I am not an expert on hypothermia but I have qualifications in anaesthesia and intensive care where I spend a lot of my time and energy preventing patients from becoming hypothermic. I swam that race without a wetsuit and was very cold but I still felt as though I was functioning normally after it. I had a coffee an hour after the Bondi to Bronte swim with my friend, PJ, who is very fit but doesn’t have much fat. He was still slurring his speech and appeared drunk, although he kept telling me he felt normal.

First, some physiology

The human body functions well only within a narrow temperature range. A core temperature drop of 2 degrees C is dangerous and a 3 degreesC drop can kill you. Every cell in your body is a heat making machine. The act of burning energy creates heat. Even if you sit absolutely still, you are still using energy to keep your body functioning and thus producing some heat. The more exercise you perform, the more heat you produce.

Body temperature depends on a balance between heat production or gain and heat loss. In air, most heat is lost or gained by radiation as in warming from the sun. In water though, heat is lost mostly by conduction to the water. The colder the water, the more rapidly you lose heat and the faster your body temperature falls. In water below 34 C your body temperature will fall. The colder the water, the faster you’ll cool.

The major physiological defence mechanism you have to reduce heat loss is to constrict your surface blood vessels. This is why your skin is white when you’re cold and pink when you’re warm. In the cold, blood is shunted away from the skin and diverted towards your core. This increases blood flow to your kidneys which is one reason why you need to empty your bladder so often when you get cold. Shivering is an attempt by your body to increase heat production. It usually starts at a core temperature of around 34C but beware that it usually stops if your temp falls below 32C. Fat is an insulator, offering some protection against heat loss as well as increasing buoyancy.

Noice aspect of the ManaFijiSwimFest over the years is the development of local kids as swimmers. James Song (2nd left) Had never swum an event longer than 400m (pool) till 5km in the Mana Fiji SwimFest on September 17. He’s also a very new swimmer. Cobbers Reuben Taylor (l), Joshua Mara (2nd right), and Jeremiah Faktaufon (r) swam out to escort him in at the end, which would have been some comfort as the poor kid could barely stand up at the end.

Ocean swimmers are at particular risk of hypothermia because they are typically fit and muscled, with large surface veins. These carry blood just below the skin – which increases heat loss. Swimmers also typically have little fat to insulate them, also predisposing to rapid loss of body heat.

Swimming increases heat production in the muscles, but because it also increases blood flow to the muscles, and through the superficial veins, it increases the loss of heat through the skin. Moving the limbs through the water increases the flow of water across the skin, further increasing heat loss. The net effect is that swimming increases heat loss more than heat production; temperature falls faster when swimming than when floating still in the water.

Survival time in water depends on many factors, including water temperature. This makes estimating survival time difficult and often inaccurate. Published “survival tables” refer to specific conditions, but are hard to relate to different conditions of water and air temperature, wind strength, wave speed and height, presence or absence of clothing or wetsuit, flotation, head coverage or lack thereof, degree of physical activity, as well as physical factors such as muscle mass, natural insulation by body fat, natural buoyancy and proportion of the body on or above the surface – all of which affect rate of cooling.

SUDDEN IMMERSION in cold water causes marked and dangerous physiological responses. Most obvious is the gasp response: rapid, deep and uncontrollable breathing. Maximum breath hold time is reduced, and coordination between breathing and swimming action is lost. These contribute to a high risk of drowning within a very short period, even before getting to the first turning buoy.

Sudden cooling of the skin causes widespread constriction of the surface vessels, shunting blood to the body core. The sudden increase in blood flow back to the heart can cause a dramatic increase in blood pressure, and an irregular heart beat. There is an increase in production of adrenaline and noradrenaline, pushing the blood pressure and heart rate up even more.

Confusingly, sudden immersion in cold water can also cause the dive reflex, a sudden slowing of the heart, and a rush of cold water up the nose can exacerbate this or even cause the heart to stop. The competing effects of these contradictory drives can cause a dangerous, even lethal, irregular heart rhythm.

All of these responses occur when the body surface is first exposed to cold water; the core temperature has not yet changed at all - the person is not hypothermic.

For these reasons, cold water should be entered slowly. Before a cold swim, wade into the water, or allow water to enter your wetsuit just before you start the swim. This reduces the effects of sudden immersion in cold water.

Do the effects of sudden immersion decrease with repeated exposure? – a little, after a long period. Do not think you are immune!

Recognition of hypothermia

The initial response to cold water is constriction of the surface blood vessels, reducing heat loss via the skin. The initial feeling of cold on the skin lessens over a few minutes, as the temperature sensors in the skin become accustomed to the stimulus. As the tissues of the body lose heat, the body core temperature starts to fall. By 35oC there is reduced awareness of cold, often a feeling that everything is fine. Muscle strength is reduced. Muscular activity is less efficient, swimming less coordinated and less powerful. There is reduced ability to recognise the deterioration in function. Speech is slurred, reflecting impaired brain function – people like this have been mistakenly assumed to be drunk. Between 34 and 35oC mental acuity is markedly impaired. Judgement and memory are impaired, and with it the ability to remember training, to recognise danger, and to act logically. Swimmers are likely to miss buoys, change direction the wrong way, fail to avoid waves or swell, and are unlikely to signal for assistance. At this stage they may be seen to be swimming, but not making any headway.

Mentally there is a determination to keep swimming, without any understanding of what is happening. There is no awareness of the need for immediate rescue. By 34oC thinking, reason, memory and awareness are very limited. Extreme lethargy gives way to a desire to sleep; this precedes a decrease in conscious level, predisposing to a quiet, un-noticed disappearance below the water and drowning.

Because the hypothermic swimmer does not recognise that they are becoming hypothermic, control of the swimmers must be exercised by people who are not in the water. (Tasmania Police Rescue divers in water of 12 - 13C, wearing two layers of thick wetsuit with hood and boots, are under the control of a diver in the mother boat for this reason.)

What water temperature is safe?

To a small degree this depends on acclimatisation. People in Canada and Europe tolerate lower water temperatures than we do, but usually for shorter swims. They often have higher body fat content, and may use artificial insulation.

The physiological effects are dramatically increased in water below 15oC so this might be a reasonable absolute minimum. Between 15 and 20oC an acceptable water temperature would depend on the wind, waves, wetsuits and head covering, sunshine, individual physical makeup, the length of the swim, and the other variables mentioned earlier.

Does gender make a difference? Females have a slightly higher total body fat percentage, so a little more insulation, and have a higher surface area to mass ratio. Males typically have a higher muscle mass, so producing more heat. The net effect is probably a small difference between male and female ocean swimmers, with females at slightly more risk.

We're just back from the Mana Fiji SwimFest. This is what it's like in our early morning swims. Next year's dates are October 17-22.

Prevention of hypothermia

Make assessment of water and weather conditions a formal part of every swim GO or Postpone decision. Ensure you have a club doctor who is well informed on hypothermia, is part of the decision-making process, and listen to his or her advice.

In cold conditions, keep as warm as possible before starting the swim. The warmer you are before you start, the longer it takes to become cold. DO NOT walk around uncovered, thinking you are getting yourself ready / used to the cold.

Make sure you are well hydrated.

• In cold water, below about 20C, always wear at least one swim cap. In lower temperatures, wear two.
• When to wear a wetsuit depends on water temperature, degree of warmth from the sun, wind strength, wave height and velocity, and how far the swim is, as well as your physical characteristics. Some examples -
• a swim of 1.5 km in water 0f 17C, without a wetsuit, is likely to leave a swimmer mildly hypothermic, looking pale, shivering, and feeling cold;
• a swim of 5 km in water of 20C, by a swimmer with a little body fat, no wetsuit, is likely to leave him or her mildly hypothermic, looking pale, shivering, and feeling cold;
• the same 5 km swim, but in water of 21C, by a thin muscular swimmer with large surface veins, without wetsuit, is likely to leave the swimmer very cold, visibly affected and under-performing;
• an 8 km swim in water of 20C, without wetsuit, is likely to cause moderate, and dangerous hypothermia in many of the swimmers;
• a 10 km swim in water under 20C is likely to leave most swimmers moderately hypothermic, and some in hospital.

So, there are no good rules, but it would seem sensible to consider wearing a wetsuit in any swim under 17C, or any swim over 5km.

Ocean swimming is meant to fun, not a trial of survival!

Management of hypothermic swimmers

• Recognise that their performance is impaired;
• Understand that they may not realise this, and argue with you;
• Get them out of the water;
• Shelter them from wind;
• Dry them, cover the whole body in dry clothing / blankets, particularly the head. If they are conscious, keep them wrapped up, and allow them to warm themselves by their own heat production. They must be carefully observed, as their core temperature may continue to drop and they may lose consciousness;
• Give them warm, not hot, sweet drinks. Warmed blankets are useful, as is body-to-body contact;
• The ubiquitous space blanket that looks like a giant piece of aluminium foil may not be all that good for treating hypothermia. If you’re warm, they are good at keeping you warm. They won’t rapidly warm up someone who is cold;
• Active heating with a specially designed forced air warming blanket is preferable to a space blanket;
• DO NOT leave them alone;
• DO NOT use hot water bottles or chemical heating packs, as these are likely to result in burns;
• DO NOT put them in a hot shower or bath; rapid warming causes the superficial vessels to dilate rapidly; blood pressure falls dangerously, cold blood trapped in the periphery is suddenly released, and a bolus of cold blood returning to the heart can cause a fatal irregular heart beat.
• Once they are rewarmed, their swim for the day is over. Do not allow them to re-enter the water.

Unconscious or semi-conscious people should be treated as above, on their side in the coma position with airway support, and transported by ambulance to hospital for more intensive management.

Should Bondi-Bronte have been cancelled?

I’m not smart enough to know the answer to that but I hope the organisers understood the dangers. Swimmers may rapidly get hypothermic and have breathing and heart difficulties before they even get to the first buoy (as happened to one of my colleagues) or they may start to act irrationally midway through the swim. They may turn out to sea and start swimming away from then land or they may drown.

In summary, if you are thinking of swimming in cold water -

• Consider how long you’ll be in the water for;
• Consider the weather conditions;
• Wear at least one bathing cap;
• Consider wearing a wetsuit;
• Keep yourself warm leading up to the swim but make sure you’ve entered the water slowly when you do get in;
• Make sure someone who is not in the water is keeping an eye on you.

Howard Roby is a recently retired anaesthetist at St Vincents Hospital in Sydney, a former water poloist, and a regular ocean swimmer. Howard has two Cole Classic plates.

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We're continuing our 'never-before' offer of View gogs. The folks at View have adjusted their prices in a small way recently, so we have had to adjust ours correspondingly, but we've kept prices down at sale levels. This keeps them at the world's best value gog (in our experience, which goes on a bit). 

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Not a bad joint for a swim.

2022 Heron Island

Dates open for Oct, Nov

Our Heron Island oceanswimsafaris have been heavily booked. We've had some terrific groups come with us so far this year, although the weather has not always been at its best. We're looking forward to tip top conditions in October and November. This time of year traditionally has produced ideal swim and tropical holiday conditions.

October dates are October 19-24. November dates are November 6-11.

Best get in quick and smart. It would be good to have you with us.

We'll be ready soon to take bookings for our 2023 Heron Island dates –

• October 25-30
• November 8-13

Find out more and book… Click here

Fish school.

New model Swipes

Prescription gogs now in Swipes

Big news from View: our very popular prescription goggles now also come with high-anti-fog Swipe technology.

Our Swipes, so far in both Selene and Wide-Eyes versions, have been a big hit, offering what View (the makers) describe as 10 times the anti-fog capacity of other gogs. We've been using them for almost two years now, and we know that it works. We've sold over 1,000 pairs of Swipe gogs since their release just prior to Xmas 2019, so many of you must agree, too.

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