WHY THE ICE BUCKET CHALLENGE CAN BE LETHAL

It seems like every celebrity is getting in on it, from pop stars to athletes to
politicians, as well as millions of ordinary people across the social media universe.
They're all pouring a bucket of ice water over their heads and challenging others to
do the same, all in the name of raising money for amyotrophic lateral sclerosis (ALS)
research and awareness.
In case you were on a deserted island during the last couple of weeks, the deal is
this: When challenged by a friend or colleague, you have 24 hours to either donate
$100 to the cause or post a video showing yourself dumping a bucket of ice water
on your head to get out of donating. Then, in turn, you challenge three others.
Actor Ben Affleck was nominated by Tyler Perry and did the challenge. He also
donated the money and then nominated Jimmy Kimmel, Neil Patrick Harris, Matt
Damon, and his wife, Jennifer Garner, who dumped the bucket of ice water on his
head before he tackled her into the pool. Chris Hemsworth, who plays Thor, was
nominated by Robert "Iron Man" Downey Jr., and then he challenged fellow Avengers
Jeremy Renner (Hawkeye), Mark Ruffalo (the Hulk), and Chris Evans (Captain
America).Tonight Show host Jimmy Fallon received several challenges and in turn
challenged the New York Jets, who complied as a group.
President George W. Bush, despite saying in the preamble to his video that having a
bucket of water dumped on his head is "not presidential," was soon soaked by ice
water at the hands of his wife Laura Bush. He went on to challenge his presidential
predecessor, Bill Clinton.
Even President Obama is reported to have been challenged by basketball star
LeBron James, although he apparently decided to make a donation instead.
Millions in Donations
The ALS Association credits Pete Frates, 29, a former Boston College baseball
captain who has lived with ALS since 2012, for launching the viral sensation some 3
weeks ago. Frates and his family have been fundraisers and advocates for the ALS
Association Massachusetts Chapter for a number of years.
Unfortunately, Frates' friend, Corey Griffin, 27, who was instrumental in having the
ALS challenge go viral, died in a diving accident in Nantucket, MA. The accident
occurred early in the morning of Aug. 16, when Griffin dove off a two-story building
into the harbor. It happened only hours after he had raised $100,000 for the cause,
news reports said.
Despite the widespread dumping of icy buckets, most people are clearly also
donating. From July 29 to Aug. 21, donations to the ALS Association, including
national and chapter revenue, totaled more than $53 million, which eclipses the
$2.2 million raised during the same period last year, according to figures released
by the association. The total is changing almost by the minute, though, and is being
updated daily on the association's web site. The association received $8.6 million on
Tuesday this week alone.

The Ice Bucket Challenge has raised an impressive amount of money and awareness
for motor neuron diseases like Amyotrophic Lateral Sclerosis (Lou Gehrigs Disease).
In just one month, the ALS Association has received $80m in donations.
But while the fundraising campaign should be praised, the tragic death of a Scottish
teenager reveals that the Ice Bucket Challenge can be dangerous and potentially
deadly.
Cold Water Kills
When you imagine the dangers of cold water, you probably think of hypothermia.
There was a bit of a preoccupation with hypothermia dating right back to the
Titanic, and then reinforced during the Second World War, says Professor Mike
Tipton, a physiologist at the University of Portsmouth and co-author of several
books on survival at sea.
But fatal hypothermia takes a relatively long time: starting from 37C/99F, it takes
half an hour for your core body temperature to fall below 35C/95F. Most deaths in
open water occur within minutes, as two-thirds of drowning victims are good
swimmers and over half die within 10 feet of safe refuge.
The first thing Ice Bucket challengers and those immersed in cold water experience
is a sudden drop in temperature, which triggers a reflex called the cold shock
response.
Its basically exactly the same as you would imagine if you stepped or jumped into
a pool they said was heated and it wasnt, or stepped under a shower that had just
run cold, Tipton explains. Its a gasp response followed by uncontrollable
hyperventilation.
That gasp for air and rapid inhalation completely destroys your ability to breathe.
Even if you can normally hold your breath for a minute in the bathtub, you would
only last a few seconds in cold water. The average volume an adult inhales is 2-3
litres, and the lethal dose for drowning is 1.5 litres of seawater or 3 litres of
freshwater.
If youre already underwater or waves are battering your face, the cold shock
response could kill you.
Death By Drowning
Drowning is the third-most common cause of accidental death
worldwide andunintentional drowning kills 10 Americans every day (one-fifth are
children).
There are many reasons why people lose their lives. Some cant swim while others
succumb to flash floods, for example. But Tipton believes that many drowning
victims are actually being killed from immersion in cold water. He estimates that
about 20% succumb to hypothermia, 20% of people die before, during or after being

rescued (a phenomenon called circum-rescue collapse) and the remaining 60% are
killed by the cold shock response.
The Ice Bucket Challenge has been linked with two deaths so far. The Scottish
teenager, 18-year-old Cameron Lancaster, supposedly drowned after jumping into a
flooded quarry. Another victim, 40-year-old father Willis Tepania from New
Zealand, had a heart attack after drinking a bottle of bourbon.
(Although not a consequence of the challenge itself, Corey Griffin, a 27-year-old who
raised $100,000 for his friend Pete Frates the college baseball player with ALS who
made the campaign go viral died after diving into Nantucket Island harbor.)
A teenager died after diving into a
flooded quarry (CC BY-SA 2.0
Thomas Stenhouse / Geograph)
Most Ice Bucket Challenge
participants dont submerge
themselves, so how can cold water
immersion be dangerous to them?
The problem occurs when youre
holding your breath and your face
gets wet.
Immersing yourself in cold water
triggers two powerful physiological
responses: cold shock and another
reflex, the diving response.
Cold water becomes particularly dangerous when the two coincide. If youve got
those two responses co-activated then youve got a response trying to accelerate
the heart the cold shock response at the same time as youve got a response
trying to slow it down, the diving response, says Tipton.
He calls this autonomic conflict because both the cold shock and diving responses
send signals to the heart via nerves that control involuntary body functions
(including breathing), the autonomic nervous system.
Cardiac Conflict
The diving response is vital to marine mammals such as seals and dolphins, but
humans have it too.
Its the reflex that tells your heart to calm down and redirects blood flow to the most
crucial organs, like the brain. Its what prompts you to hold your breath underwater
and enables you to conserve oxygen.
Both the cold shock and diving responses are triggered by receptors in the skin
nerve endings of the autonomic system.
The diving response is stimulated by receptors on your face (near the eyes, nose
and mouth) while cold shock is triggered by thermoreceptors all around the body.
Because these nerve endings are 0.2mm below the surface of the skin, body fat
which insulates against hypothermia wont stop you detecting a temperature drop.

When cold water is sensed by your face and rest of the body simultaneously,
autonomic conflict is the result. Both the cold shock and diving responses relay
sensory information (via the brain) to the heart, but their messages contradict each
other. Submerge your face alone and heart rate should fall from the normal 60-100
to about 40-50 beats per minute, whereas cold water will boost the rate above 100.
To the heart, autonomic conflict is like pushing the gas pedal to accelerate while
also vigorously and repeatedly applying the brakes.
Electrocardiogram
(CC BY-SA Glenlarson
/ Wikimedia)
Autonomic conflict
creates an abnormal
heart rhythm
arrhythmia and can
occasionally lead to
the most dangerous
outcome of cold
water immersion:
sudden cardiac
death.
After holding your
breath, an
arrhythmia will start
within 10 seconds,
and this can be detected on an electrocardiogram (ECG). I would be really
interested in having an ECG on all these people who are doing the Ice Bucket
Challenge because I pretty well guarantee there will be a fairly significant number of
them having an arrhythmia while they do it, says Tipton.
Cardiac arrhythmias are common. If you swim or snorkel, you probably experience
them all the time.
In Tiptons previous studies, 2% of fit and healthy subjects experienced an
arrhythmia when their body was immersed in cold water, but the proportion goes up
to 82% when the face is wet too. The problem gets worse in stressful situations:
among people who train to escape from submerged helicopters, including those
who work on offshore platforms or for the military, 25% have an arrhythmia during a
10-second drill..
Risks Of Arrhythmia
On their own, most cardiac arrhythmias wont show symptoms and probably arent
hazardous to health, but other factors can predispose an individual to a lethal
rhythm.
People with a pre-existing cardiovascular problems, such as a heart condition or
hypertension, are at particular risk from sudden cardiac death especially if those

problems havent been identified. Medicines (certain antihistamines, antibiotics and

antipsychotic drugs) can also increase risk.
Even athletes arent safe. Figures from 2003 to 2011 show that 30 out of 43 or70%
of fatal incidents during US triathlons occurred during the swim phase of a race.
Because strong emotions like anger increase heart rate and athletes have no
trouble while training alone, Tipton believes that competition (through mass starts
and collisions) also raise the risk of arrhythmia. These are all relatively young, fit
individuals who are also having a problem with sudden cardiac death.
Autonomic conflict between the cold shock and diving responses might also be
behind fatalities where cause of death has been misdiagnosed as hypothermia or
drowning, because the electrical disturbances that lead to arrhythmia cant be
detected in post-mortem examinations.
The safe way to do the Ice
Bucket Challenge (CC BYNC-ND 2.0 Kevin Pyle /
thinktk /
https://flic.kr/p/ozeuMY)
Sudden cardiac death is
impossible to predict, but
highlighting the dangers of
cold water can help prevent
more people dying from the
Ice Bucket Challenge.
Most wont suffer from the
symptoms of cardiac
arrhythmia, but theres still
a real risk that some will. All
it takes is for one person to die and the money for worthy causes will quickly dry up.
Fundraising campaigns are a fun way to help charities, but some people especially
celebrities must participate responsibly.
You could argue that rich celebrities should accept a forfeit instead of the
dare.Charlie Sheen and Sir Patrick Stewart are great examples of this. On the other
hand, the Ice Bucket Challenge probably wouldnt have gone viral if we didnt enjoy
seeing others especially famous people in discomfort from being drenched by
ice-cold water. Its pure Schadenfreude, that pleasure you get from someone elses
misfortune.
Safer Soaking
Not using cold water removes the danger, but who wants to watch the Lukewarm
Bucket Challenge?
Making the Ice Bucket Challenge safe is simple. Professor Mike Tiptons advice for
minimising the chances of a heart attack is straightforward: Dont hold your breath,
and tuck your chin into your chest so your face stays dry.

Participants should also avoid total immersion. If you go into cold water then the
physiological responses will be much more profound and prolonged than if you just
have a bucket of water thrown over the top of your head.

HOW DID THE ALS ICE BUCKET START?

In 2012, baseball player Pete Frates was diagnosed with Amyotrophic lateral
sclerosis (ALS) also known as Lou Gehrig's Disease.
ALS attacks the neuromotor system of the human body disabling all senses,
sensation and the ability to move.
Frates was only 27 years old when he was diagnosed with ALS.
He started campaigning against ALS through speaking engagements, but thought
he was not doing enough to raise awareness about ALS.
Last month after being introduced to the ice bucket challenge by a friend, Pete
adapted this challenge and turned it into what is known now as the ALS ice bucket
challenge.

Filipino celebrities who have done the challenge include Dingdong Dantes and
Marian Rivera, Aga Muhlach, and Lea Salonga. So Kris Aquino was not the first
Filipino celebrity to do the challenge.
ABS-CBN news broadcaster Anthony Taberna and It's Showtime host Vice Ganda
also did the ice bucket challenge on live television after being nominated by Kris.
Other celebrities who have also done the ice bucket challenge include actresses
Bianca King and Rhian Ramos.
Anne also posted her ice bucket challenge video on Tuesday, August 26, after being
challenged by James Reid and It's Showtime co-host Billy Crawford. Boyfriend
Erwan Heussaff poured the ice cold water on Anne for the challenge. She nominated
Regine Velasquez-Alcasid, Luis Manzano and Angel Locsin, and Sarah Geronimo and
Matteo Guidicelli.
Popular teen love teams Daniel Padilla and Kathryn Bernardo also did the challenge
and they nominated Robin Padilla and Mariel Rodriguez, Angelica Panganiban and
John Lloyd Cruz, Bea Alonzo and Zanjoe Marudo, and Bench chairman Ben Chan to
do the challenge.
James and Nadine took on the ice bucket challenge during a mall show in Taguig
City on Monday, August 25. They nominated, among others, Anne Curtis, Cristine
Reyes, and Sam Milby. James also asked ABS-CBN entertainment reporter Mario
Dumaual, who was covering the event, to do the challenge on stage as well.
Dumaual nominated senator Grace Poe, among others.