Beyond Cold Water Bootcamp

Rescue & Treatment

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It is vital that you become familiar with the special skills required in the activities of Rescue and Treatment. Because Circum-rescue Collapse is a very real danger that may lead to death, this section will describe techniques that will minimize that risk, while keeping you safe at the same time.


The first key consideration in the performance of any rescue is to ensure your own safety to avoid worsening an already tense, dangerous situation. Make sure that you’re wearing the proper flotation and, where cold water is involved, appropriate thermal protection. Click here for more details on recommended Thermal Protection

After arriving on the scene, take enough time to assess whether the situation is an emergency (requiring assistance in the next minute or the victim will die) or whether it is urgent (a serious situation, but there is some time to make rational decisions and take deliberate actions). Remember: the victim has taken a long time to cool. They are unlikely to expire while a few valuable minutes are taken to ensure that the scene is safe, the equipment is readied and sufficient personnel are on-hand to carry out the rescue properly.


The two most critical components of the extraction are:

  1. Be as GENTLE as possible.Because of the stress on the heart, any jostling or rough handling can trigger ventricular fibrillation. Despite the urgency of the situation, take your time and move the victim carefully.

  2. Keep the victim’s body as HORIZONTAL as possible. Horizontal extraction keeps blood flowing more uniformly throughout the body. Extracting a victim vertically can cause blood to pool in the legs resulting in a drop in blood pressure which can cause ventricular fibrillation or cardiac arrest.

For specific Extraction techniques using various boat types and special equipment, click here.


Place the victim in a horizontal position and, if in a protected environment, remove wet clothing. Unless sure that the victim is only mildly hypothermic, cut their clothing off rather than jostling them to remove it. Mechanical stimulation and rough handling in a moderately or severely hypothermic victim can strain the heart and be extremely damaging.

Gently, blot the victim’s skin to remove moisture. Don’t pat or rub the skin since this, too, can bring on ventricular fibrillation.

Insulate the victim using dry blankets, dry clothing or other protective materials. If available, wrap a vapour barrier (plastic sheeting) around the insulated victim to prevent further evaporative and convective heat loss and to keep the insulating materials dry, protecting them from the environment.

If no dry clothing is available or you are in an unprotected environment, leave the victim’s clothing on. In this case, wrap the vapour barrier against the wet clothing to prevent evaporative heat loss, and to prevent the insulating material from getting wet and losing its effectiveness.

charcoal_heaterIf the victim is awake and alert (mildly hypothermic) it is all right to provide a drink with a high sugar content (like warm cocoa) to provide additional energy to fuel shivering (heat production). If the victim is not alert or passing in and out of consciousness, never give fluids or solid food.

Moderately or severely hypothermic victims are losing consciousness and aren't able to shiver, so apply external heat sources, if available, to the chest and armpit areas to aid rewarming.

The Decision Tree below is a guide to the treatment of hypothermic patients, either mild, moderate, or severe. 

decision_treeIMPORTANT NOTE: if the victim is unresponsive, check for a pulse for one minute. If no pulse can be found, ventilate the patient for 3 minutes in order to better oxygenate the heart and hopefully increase its function. Then check for a pulse for another one minute. It can be very difficult to find a pulse in a hypothermic victim as their heart rate may be slowed to only a few beats per minute and vasoconstriction has reduced the blood flow to their extremities. You must take the time to ensure that there is no pulse before beginning chest compressions, because doing so with even a minimal pulse can cause ventricular fibrillation.

Click the image to see Dr. Giesbrecht's video on Rescue and Treatment.
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Part 1
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Part 2