Treatment of people recovered from cold water
Check for vital signs. Is the casualty breathing? Are they unconscious (unresponsive) or conscious?
Begin appropriate First Aid as described below. See also the flow diagram in the appendix.
Always obtain medical advice as soon as possible, even if the casualty has not been in cold water for long, and is conscious. Free advice may be obtained from a Telemedical Assistance Service (TMAS), which can be contacted via a Rescue Coordination Centre (RCC).
Adopt standard First Aid procedures.
If not breathing:
- Check/clear airway; if still not breathing give two full rescue breaths.
- Commence cardiopulmonary resuscitation (CPR) in accordance with First Aid training.
- While awaiting medical advice continue CPR at a compression rate of 100 per minute, with two rescue breaths every 30 compressions.
- Continue until exhausted if acting alone. If assistance is available, interchange every two minutes to avoid exhaustion.
- If the cardiac arrest was not witnessed; if medical advice is still not available and none is imminent; and if there are still no signs of life after 30 minutes, stop CPR but treat the casualty in accordance with the advice in section 9 below.
- If the cardiac arrest was witnessed, maintain CPR until you are either exhausted or receive medical advice.
If breathing but unconscious:
- Transfer to a sheltered location.
- Check for other injuries.
- Place in the recovery position.
- Beware of vomiting which is very common in seawater drowning.
Short exposure (less than about 30 minutes): survivor is shivering
- Survivors who are fully alert, rational and capable of recounting their experiences, although shivering dramatically, will recover fully if they remove their wet clothing and are insulated with blankets, etc. If their exposure has been relatively short, 30 minutes or so, they can be re-warmed in a hot bath, or seated in a shower2 – but only if shivering and while being supervised for early signs of dizziness or collapse associated with overheating.
- Alternatively, for survivors who are shivering and alert, physical exercise will speed up re-warming.
- Seek medical advice.
Long exposure (more than 30 minutes) and/or survivor is not shivering
- Insulate to prevent further heat loss through evaporation and exposure to wind.
- Avoid unnecessary manhandling – enclose in blankets and/or plastic, including head (but not face), neck, hands and feet.
- Move to a warm, sheltered location.
- Lay down in a semi-horizontal or half-sitting position (unless dizziness develops, when a horizontal attitude would be best).
- Oxygen should be given if available.
- If water was inhaled, encourage deep breathing and coughing.
- Monitor and record breathing and heart rate (neck/carotid pulse) at 5-minute intervals for the first 15 minutes and then, if no change, at 15-minute intervals. (An increasing breathing and/or heart rate may indicate the onset of drowning complications – and remember that in a severely hypothermic person cardiac arrest can occur at any time.)