News broke this morning that a worker at a Nevada spa, Chelsea Ake-Salvacion, was killed in an accident involving a cryotherapy* tank. According to reports, Ms. Ake-Salvacion decided to take a dip in the cryotherapy tank after work, unsupervised, and an accident occurred. Her body was discovered frozen solid the next day. Other reports, citing local sources, indicate that Ms. Ake Salvacion appears to have been killed a few seconds after stepping into the tank. It is always shocking when an unfamiliar technology results in someone's death, as illustrated by the media's fevered reaction, but hopefully we can sidestep the hysteria, place cryotherapy in a balanced context, and examine product liability concerns raised by this incident.
For those not familiar with cryotherapy (like me until this morning), the process involves pumping chilled air, usually between -160 and -319 degrees Fahrenheit, through a small chamber or sauna-like room. The main benefit of cyrotherapy is that it supposedly relieves muscle and joint pain, similar to an ice bath. Some of the wilder claims for the therapy include things like "it shocks the metabolism" and "detoxifying effects." Here is a sample of fairly typical cryotherapy promotional language:
"Seven sessions of Whole Body Cryotherapy is the optimal number of sessions and exposure to see your body's complete system rehabilitation and functional reset. Seven sessions will provide the ultimate cleanse and rehabilitation usually most beneficial for mommy postpartum, post-surgical recovery, begin skin rejuvenation (reduce cellulite) and jump start weight-loss<."
What's more surprising than the purported benefits of cryotherapy are the temperatures involved. It sounds shocking at first, but, so long as everything goes according to plan, the ludicrously sounding low temperatures are not as scary as they sound. Just think back to high school physics class. Since air has about one percent of the density of water, the transfer of heat between your body and air is much slower than the transfer of heat to an icy bath. Picture this: when your clothes get soaked, you feel warmer almost as soon as you take them off. The air can be just as cold as the wet clothes you were just wearing, the density is just lower, so heat transfer slows and your body feels warmer, basically because it is not losing heat as quickly as it was when it was in contact with cold water that wicked away body heat more effectively.
So even though these devices immerse you into a gas that is shockingly cold, as far as your body is concerned, the heat transfer isn't much different than if you were in a cold bath. The takeaway here is that A) the purported health benefits of "jump starting immune systems" et al are no more likely to occur with such treatments than they would be if one were to take a cold bath (and I mention this because phony health claims stick in my craw), and B) despite how crazy these temps sound, simply concluding, "Well, that's what happens when you get into a device that cold," is patently incorrect. Simply put, something had to have gone wrong.
It is natural to blame something unique to cryotherapy for Ms. Ake-Salvacion's death, but one could just as easily die from staying in an ice bath for too long. The same risks of frostbite or hypothermia apply to both processes. Of course, the huge difference between ice bath and cryotherapy is the potential for uncontrolled cooler of the cryotherapy tank. This appears to be what happened in the case of Ms. Ake-Salvacion.
When you dump ice into a bath tub, the water can only cool so much. There is no way to cool the ice bath quickly enough with simple water ice that whomever is taking an ice bath has ample time to escape of the temperatures become dangerous. However, when one is dealing with liquid nitrogen and the extreme temperatures required for cryotherapy, a sudden release of all of too much cooling agent could cause temperatures to drop quickly and catastrophically, preventing someone from being able to take action to save their own life. In essence, a person could be flash frozen.
Of course, one of the questions that goes unanswered in the news story is who manufactures these cryotherapy tanks? A quick look online shows that several companies produce them and their designs range from mini-sauna-like enclosures to barrel-looking things that look more suited for people trying to ride over Niagara Falls. In cases like Ms. Ake-Salvacion's in Nevada, the news story is fairly quick to point out that she was operating the machine without supervision, which the early new stories did. If you look at a lot of news coverage, there is a tendency to blame the victim of a tragedy.
It may seem pretty straight-forward to most readers, operators are told by the manufacturer not to use the tanks without supervision, they choose to do so, something bad happens, and it is the fault of the person who did not listen to the manufacturer. However, it is the responsibility of the manufacturer, to ensure that the product can be operated in a safe manner. If the latest details of the Nevada story are correct and the operator was frozen to death in a matter of seconds, it becomes harder to argue that the manufacturer is not strictly liable for making an inherently dangerous product. Had she stepped into the machine unsupervised and, say, fallen asleep resulting in a slow demise due to long-term exposure, that would be on thing. But news outlets have made it clear that she was frozen in a matter of second. In such a case, supervision, or the lack thereof, was not the problem here.
It is common sense that a product capable of achieving deadly temperatures needs to have some regulator to ensure that deadly temperatures are not reached too quickly, as appears to have happened in Nevada. If you look at other technologies that employ potentially deadly agents, for medicinal or diagnostic use, like x-rays, an abundance of precautions are used by the technicians to ensure the safety of both them and the patient. When you are getting an oral X-ray, you are required to wear a heavy flak jacket to shield your vital organs from unnecessary X-rays. Imagine that an X-ray technician decided to take their own X-ray and was immediately fried because the X-ray machine shot out a massive dose of X-rays. Certainly, the technician would bear some of the responsibility for operating the machine unsupervised, but common sense would point us back to the manufacturer of the X-ray machine, because it should not be able to spit out a lethal does of X-rays in an instant.
Similarly, if the cryotherapy tank permitted the air to be cooled to such a degree that a person could be flash frozen in a matter of seconds, then while the operator should have had supervision, it certainly seems that a deadly product was put out on the market. It would be the same as a sauna that malfunctioned and instantly heated up to a lethal temperature, we, as a community, would certainly look to hold the manufacturer accountable for putting out an unnecessarily dangerous product. Would anyone even be able to sell a hot tub that could go from room temperature to boiling in a matter of seconds? Of course, not.
We are not saying that there are no circumstances under which dangerous products can be placed into the market. There are plenty of dangerous tools and machinery that integral to resource extraction, manufacturing, and the treatment of disease. However, even the businesses who manufacture those products attempt to make sure that they can be used in the safest manner possible. That is what the law requires and what we as a community expect. Whatever the merits of cryotherapy, those who have undertaken to fill the market desire for cryotherapy tanks are under the same obligations as any other products manufacturer. While the facts of the case may show that the tragic events in Nevada were beyond the manufacturer's control, it is certainly worth taking a closer look at the machinery itself.
Shockingly, it has taken over a week to determine who will even conduct an investigation into the incident. Apparently, The Nevada Department of Health and Human Services does not consider cryotherapy to be a legitimate medical procedure, so they do not regulate the practice. Nevada OSHA lost interest in the accident when it was determined that Ms. Ake-Salvacion was supposedly not on the clock. The Las Vegas Police, initially declined to investigate, because the death was accidental, but appear to have taken on the case as a "courtesy" to other departments. In fact, the only agency to take any action so far has been the Nevada Board of Cosmetology, which shut down the spa Ms. Ake-Salvacion worked at, as well as another location owned by the same company.
In the end, Ms. Ake-Salvacion was killed, most likely because of an unnecessarily dangerous product; It took a week to get anyone to even investigate. No one is asking questions of the manufacturer; And no one seems too terribly concerned with holding accountable those responsible for the unnecessary death of a young woman. Thankfully, our civil courts offer a forum to seek answers and hold those responsible to account when none of the other institutions of society care.
*For the purposes of this article we are referring to cryotherapy as it is practice in spa and clinical settings, not the direct application of super-cooled liquids to cancerous cells, which is also called cryotherapy.