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.
- Seek medical advice.
- Monitor and record breathing and heart rate (neck/carotid pulse).
An increasing breathing and/or heart rate may indicate the onset of
drowning complications – and in a severely hypothermic person
cardiac arrest can occur at any time.
- Provide oxygen by mask, if available.
- Provide additional insulation to prevent continued cooling. To
provide protection against evaporative heat loss enclose in a large
waterproof bag or sheeting.
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 showerfootnote – 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.)
- Seek medical advice.
- When alert and warm it is no longer necessary to maintain a semi-horizontal
or horizontal position.
- Give warm sweet drinks – but no alcohol.
If the survivor's condition deteriorates, refer to the treatment
procedure for the unconscious patient, above.