First aid procedures for people recovered from cold water

A previous IMO Circular [MSC.1/Circ.1185/Rev.1] provides guidance on cold water survival and comprehensive information which can help seafarers, trained as first-aid providers, to treat those rescued from cold conditions.

This guide briefly examines the hazards of exposure to the cold that may endanger life, and provides advice based on the latest medical and scientific opinion on how to prevent or minimize those dangers.

It is most important to realize that you are not helpless to affect your own survival in cold water. Understanding your body’s response and simple self-help techniques can extend your survival time, particularly if you are wearing a lifejacket.

However, if the casualty is unconscious, meaning that the individual is not responding after being recovered from cold water, the following standard first aid procedures should be followed:

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.

If the casualty is conscious, the following should be taken into consideration:

When there is a short exposure (less than about 30 minutes) and the 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 shower – 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

When there is a long exposure (more than about 30 minutes) and the 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

The guide highlights to 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).