Cold water exposure rapidly causes the body to lose heat, leading to hypothermia when the core body temperature drops below 95°F (35°C). Water conducts heat away from the body significantly faster than air, making immersion a severe threat to temperature regulation. Prompt and careful intervention is necessary to prevent further heat loss and begin rewarming without harming the person’s compromised circulatory system. Providing the correct immediate care, including specific warming techniques and consumable items, is crucial for survival.
Immediate Actions to Stabilize the Victim
The first step after rescue is to gently move the person to a warm, sheltered location away from wind and cold surfaces. Gentle handling is paramount because rough or sudden movements can trigger life-threatening cardiac arrhythmias, such as ventricular fibrillation, in an already severely cooled heart. Wet clothing must be removed immediately, as evaporation accelerates heat depletion from the skin, even after the person is out of the water. If clothing is difficult to remove, cut it away to minimize unnecessary movement.
Once wet items are removed, insulate the person from the ground with a dry blanket or sleeping bag. Preventing heat loss requires covering the head and neck, as significant heat can escape from the head. Covering the core of the body, which contains the vital organs, is the priority while preparing for active rewarming measures.
Safe Internal Rewarming (Fluids and Energy)
For a person who is conscious and alert, the safest consumable item is a warm, sweetened, non-alcoholic, and non-caffeinated fluid. Warm broth or water with added sugar provides hydration and the necessary glucose to fuel shivering, the body’s natural heat production mechanism. The liquid should be warm, not hot, to prevent scalding and allow for gradual heat transfer to the core.
Avoid giving the person alcohol, as it is a peripheral vasodilator that causes blood vessels near the skin to widen. This vasodilation creates a temporary feeling of warmth but shunts warm blood from the core to the cold extremities, dramatically increasing heat loss and worsening hypothermia. Caffeine should also be strictly avoided because it acts as a mild diuretic, increasing the risk of dehydration, which impairs the body’s ability to rewarm.
If the person is conscious and can safely swallow, easily digestible, high-energy foods can replenish depleted calorie stores. Simple carbohydrates, such as a soft energy bar or dried fruit, provide quick fuel for the metabolic processes required to generate heat. Never give fluids or food by mouth if the person is confused, disoriented, vomiting, or has a decreased level of consciousness, as this presents a severe aspiration risk.
Techniques for External Warming
After stabilization, focus on controlled external warming using dry insulating materials to reduce radiant heat loss. Wrap the person in multiple layers of dry blankets, or add an emergency reflective blanket over the insulating layers to reflect heat back towards the body. Direct skin-to-skin contact with a warm, dry rescuer, placed around the torso, can be effective in transferring heat gradually and safely.
If additional heat sources are available, apply warm compresses or chemical heat packs only to the core areas of the body: the armpits, chest, and groin. These locations have large blood vessels close to the surface, allowing for efficient heat transfer to the central circulation. Never apply heat packs directly to the skin; they must be wrapped in a layer of cloth to prevent severe burns, as the person’s cold skin has reduced sensation.
Avoid direct and intense heat sources, such as hot water bottles, electric blankets, or hot baths, to prevent a phenomenon called “afterdrop.” Afterdrop occurs when rapid heating of the extremities causes peripheral blood vessels to dilate, sending cold blood from the limbs back to the core. This sudden influx of cold blood can cause a dangerous drop in the core body temperature and potentially trigger a fatal heart arrhythmia. The goal is always slow, steady rewarming, prioritizing the body’s core.
Recognizing Severe Hypothermia and Seeking Medical Help
All cases of cold water exposure resulting in hypothermia require professional medical evaluation, and emergency services should be contacted immediately. Signs that the person has progressed beyond mild hypothermia include slurred speech, confusion, drowsiness, and a lack of coordination, reflecting the brain’s impairment from low temperature.
As the condition worsens, shivering may cease entirely, signaling that the body’s compensatory mechanisms are failing, and muscles may become rigid. A weak or irregular pulse, slow or shallow breathing, and eventual loss of consciousness indicate severe hypothermia. While waiting for professional help, continue gentle rewarming and monitoring efforts without interruption.
If the person stops breathing or a pulse cannot be detected, a trained individual should begin cardiopulmonary resuscitation (CPR) immediately. Resuscitation efforts in severely hypothermic patients must continue until medical professionals arrive, as people can survive prolonged periods without a pulse when their body temperature is extremely low. Relay the victim’s symptoms and the estimated time of cold water exposure to the emergency operator.