GENERAL PREVENTION

- Respect the power of moving water and debilitating effects of cold water on the body.1-3 The effects of fast-moving water can be devastating for swimmers of all skill levels.
- Wear a personal flotation device (PFD) and have a PFD available for every person.1-2,4
- Huddle – if in a group, everyone faces inward and huddle with arms interlocked.
- Get as much of body out of the water as possible (e.g., climb onto submerged boat) to reduce detrimental hypothermic effects of cold-water exposure.1-2,5
- Learn to swim, tread water, or float (not a substitute for PFD) and always swim with others.
- Have a well-developed safety and rescue plan that is exercised and practiced routinely.1-2
- Be aware of the behavior of submerging vehicles.
- Average vehicle takes 30 seconds to 2 minutes to sink.
- Once even partially submerged, windows and doors can be nearly impossible to open or kick out.
- Vehicle escape procedure SWOC: 6
  - Seatbelts off
  - Windows open
  - Out immediately
  - Children first

COLD WATER IMMERSION/SELF AID

- Sudden immersion in cold water ( < 91.4°F/33 °C) causes panic and reflexive gasp for air and rapid breathing which results in increased risk of aspiration, dysrhythmias.
- Prolonged exposure to cold water rapidly leads to incapacitation with diminished strength and coordination.1,15,7,2,3,5,8,9
- Follow the above instructions for escaping a vehicle (if warranted).
- Limiting time of exposure is critical. A general timeline is provided for guidance below with expected survival times listed in Table 1 at the beginning of CPG.
- Control breathing in order to survive shock of exposure during the initial one minute.
- Within 10 minutes, exposed individuals will become incapacitated and thus must move judiciously during this time. If able to reach and maintain control of the ice, the victim should hold on to the edge of the ice, kick his/her feet to become horizontal and pull. See ice rescue training images (Figure 4).
- Incapacitated individuals will generally become unresponsive due to hypothermia within the first hour.
- Onset of lethal dysrhythmia can occur within the first 2 hours.
- If a flotation device is available, exposed individuals should assume the “HELP” position (heat escape lessening posture) (Figure 5.) by bringing the knees to the chest and crossing the arms over them. Alternatively, in a group, the "huddle” position (Figure 5.) should be used.1-2