THE HAZARDS OF WHOLE BODY CRYOTHERAPY
The death of a spa manager, Chelsea Ake, back in October 2015 in Las Vegas found inside a Cryosauna machine was tragic and it sparked much needed information on the safety protocols of liquid nitrogen…the stuff which makes the Cryosauna so cold.
As usual, the media got the story of Ake’s death wrong. She did not die from freezing; rather the Clark County coroner’s report said she died of simple asphyxiation due to inhaling too much liquid nitrogen vapor.
The biggest contributing factor in Ake’s death was that she decided to use the Cryosauna machine alone. The number one rule of WBC is; one must never freeze thyself alone.
Liquid nitrogen is a fascinating substance. It is made by fractional distillation of the air we breathe which is made up of 78% nitrogen. Nitrogen is an inert gas which is odorless, tasteless, nontoxic, and slightly lighter than air. Liquid nitrogen expands 696 times its liquid volume. The US Military uses liquid nitrogen to put out fires because of its rapid expansion rate and as a simple asphyxiate it robs the fire of its oxygen.
In a spa setting with a Cryosauna, liquid nitrogen is pumped from its tank at very low pressure into the Cryosauna machine where a heater, turbine, plumbing and a computer gasifies the liquid nitrogen into a very cold fog of minus 220 degrees Fahrenheit.
When I opened iceland Cryo two and a half years ago I was number 36 in America to have a Cryosauna machine. Today, there are over 250 Cryosauna operators, and we’re growing exponentially. Of course, as Cryosauna operators we are constantly checking each other’s websites to see what new things are going on.
Here is the problem I see in so many Cryosauna offices. I see photos of their Cryosauna machine and right next to it is a full tank of liquid nitrogen…the problem is storing a full tank of liquid nitrogen in an open area where there are people.
Liquid nitrogen is fairly stable as it’s sitting in a tank which is a bit like a large thermos bottle. But since liquid nitrogen boils at minus 320 degrees and even a very good tank cannot keep it that cold, liquid nitrogen is constantly boiling inside the tank and as it boils it is releasing nitrogen gas.
That is why you hear this constant hiss coming from the relief value on top of the tank. This is very normal. But sometimes an ice ball forms inside the relief valve and a greater volume of nitrogen is released with a very loud sound. By pouring a little water on the valve and tapping it lightly it usually dislodges the ice ball and the valve quiets down and the amount of nitrogen released is back to normal.
But if this happens at night when no one is around it is possible, and it’s happened to me, where a massive discharge of nitrogen occurs and the entire room is engulfed with nitrogen…and the room is devoid of oxygen…the stuff our bodies need to live.
If overnight the a/c was turned off and the room is enclosed, and the first Cryo spa employee arrives in the morning to open shop, they will not smell or taste anything different in the air. Within a few seconds they will feel very light headed because of the lack of oxygen and very soon after that they will pass out…a minute or two later they will be dead.
Liquid nitrogen tanks are designed for safety. They have a burst disk installed into the tank. If for some reason like overfilling a tank or very hot temperatures the liquid nitrogen tank cannot expel enough nitrogen gas through the relief valve and so much pressure builds up that it has nowhere to go but out the burst disc.
This happened at my office as the tank was sitting on the delivery truck and all of a sudden the burst disc ruptured and 230 liters of liquid nitrogen hit the atmosphere in a flash. Being outside it was very loud and spectacular.
Now, if the same thing were to happen inside to a tank sitting next to the Cryosauna machine…it would immediately displace all of the room’s oxygen and people inside would only have a second or two to evacuate outside.
This is how it could happen: When the burst disk ruptures a plume of liquid nitrogen is released into the room. The liquid nitrogen immediately vaporizes and becomes a gas. A 230-liter tank of liquid nitrogen when expelled like this and as a gas now would occupy 5,300 cubic feet of space in a flash…that’s a room 18 x 30 x 10 feet high. That is a large room with people in it and now they have no oxygen to breathe…the result is tragic.
In my office, I built a special liquid nitrogen storage room where all the full tanks are stored. A special nitrogen hose connects the Cryosauna with a full tank via a very small opening in the wall by the floor.
My storage room has specially insulated walls with a special and very expensive oxygen sensor connected by a relay switch to a 1000 CFM ceiling exhaust fan. The oxygen sensor activates when the percentage of oxygen in the room falls below 19.4%, an audible alarm goes off and the fan automatically goes on and the nitrogen gas is expelled outside on the roof.
I am very grateful to our Tequesta Fire Chief, James Weinand, who made me and my architect, James Stergas, jump through hoops to ensure my Cryo office was completely safe and secure.
The Tequesta Fire Department also had me post two signs, one over my front door and the other over the door to the liquid nitrogen storage room indicating that I have liquid nitrogen on the premises. The sign is in the photo shown here and the “3” indicates it is liquid nitrogen and the “SA” means it is a simple asphyxiate.
Cryosauna therapy is a wonderful modality used by millions around the world. It can be very safe as long as the Cryo operators know what is going on.
On my Client Consent Form, there is a page dedicated to who should not use Cryotherapy. I know many clients loath to read the fine print, but I stress they review it.
I check everyone’s blood pressure on their first visit to ensure their BP is below 160/100. Cryotherapy can increase the systolic pressure from 10 to 30 points and if a client is sitting at a systolic of 160 or above and they get frozen it could go up to 190 systolic and that could very well cause a brain aneurysm causing a stroke. Depending on the severity of the hemorrhage, brain damage or death may result.
I also check the client’s skin temperature as soon as they emerge from the Cryosauna. At room temperature, your skin temperature is around 88 degrees. Cryotherapy can reduce skin temperature on the leg down to 40 degrees. Since your blood is your body’s radiator, people who have circulatory problems like diabetics will have a much lower skin temperature after Cryo. If their skin temperature comes anywhere near 40 degrees, the next session will be fewer seconds…simple math. Since we do double sessions here at iceland Cryo, this is vital information to ensure everything is done safely.
In my office, there are security cameras throughout the public spaces to safeguard myself and my client. And if an incident or accident happens it is captured on digital video. If the office where Chelsea Ake worked had security cameras, we may know what exactly happened to her and why she died.
In my office, my Certificate of Training is prominently displayed. When we had the Cryosauna installed five of us received extensive training from the distributor, Mr. Robin Kuehne of Cryo Healthcare.
Many of my clients have tried Cryo in other parts of the States and the world. I am dismayed to hear that some of these operators do not check blood pressure or skin temperatures, and some are storing their liquid nitrogen tanks out in a public room.
I am hoping that by providing this information, Cryosauna operators, and building and fire department officials will take notice of the right way to do things so that we avert a tragic accident.
To summarize, if you are visiting another Cryosauna office look for these elements to make sure your visit will be a safe and happy one:
1) Liquid nitrogen tanks. Are full tanks stored in a separate room equipped with an oxygen sensor tied to an exhaust fan?
2) Contraindications. Does the operator remind you to read who should not use Cryotherapy?
3) Blood pressure. Does the operator takes your blood pressure and shows it to you, puts it in your chart, and explains why the need for measuring blood pressure?
4) Skin temperature. Does the operator take your skin temperature immediately after you emerge from the Cryosauna and puts it on your chart?
5) Security cameras. Ask if they are on and working…even ask to see the security monitor.
6) Does the operator freezing you have a Certificate of Training to operate the Cryosauna machine?
If any of these 6 critical elements are missing from your Cryo operator’s office, kindly inform them and seek a better and safer Cryo office.