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Cold Water Survival, Rescue, and First Aid

Learn cold water survival, rescue, and first aid for common cold water illnesses

In this article, you will learn how to survive cold water.

It covers prevention and specific action steps for surviving cold water once immersed.

There is also information on cold water rescue and first aid for common cold water illnesses.

Although the focus is on cold water survival, a lot of this information applies to the cold in general.

IMPORTANT: This article is for reference only. Please never attempt cold water survival training without a professional instructor.


As always, prevention is the best form of survival. The obvious one would be to stay out of cold water. But if your job requires it, or you enjoy water sports, that may not be an option. And there is always the possibility of an accident. In these cases, knowledge is the next best thing, in which case, you have come to the right place.

C.O.L.D. is an acronym you can use to help you remember the prevention techniques for cold illnesses.

  • ​Cover your extremities, i.e., head, hands (mittens work better than gloves) and feet.
  • ​Overexertion will cause you to sweat. This will make your clothes wet, which will make you colder.
  • ​Layering. Layers of loose fitting, lightweight clothing is a good way to insulate your body. Wool and silk for inner layers are better than cotton.
  • ​Dry. Keep as dry as you can.

Other cold water immersion prevention tips include:

  • ​Enter cold water slowly, keeping the head above the water
  • ​Wear a PFD. They will help keep the head above water, and they also provide warmth. Look here for the best PFD's.

How to Dress for Cold Water Survival

If you know you will be in or around cold water, then dressing for the occasion can save your life in case of an accident. Also, being hot outside does not mean it will be warm in the water. It only takes a slight change in weather to take the situation from fun to dangerous.

  • ​Be prepared with the right clothing and use layering.
  • ​Choose fabrics that provide warmth even when wet. Not cotton or jeans.
  • ​In colder conditions, use a wetsuit.
  • ​Once out of the water, put on warm clothes. Use clothing that blocks the wind, such as a poncho.

If you know you will be entering cold water, use a cold water survival suit. Look here for the best cold water wetsuit.


Layering means using several items of thin clothing as opposed to one or two thick ones. If you get too warm you can strip one or two layers without losing all your protection.

There are three basic layers. Base, insulator, and outer.

Base Layer

The first layer, (base layer), will reduce water flowing past your skin and is also good for sun protection. You want a skin-tight, quick-drying material that will wick the water away. Rash vests are a good example. Polypropylene, polyester, and lycra are good materials for your base layer. Look here for the best base layers.

Insulating Layer

The insulating layer keeps you warm when it gets colder. It should fit snug. Not too tight or too loose. Use materials that dry fast. Unlined tracksuits work well, as does wool and fleece. Unlined is important, otherwise, it will hold air and water. A hooded top helps to prevent heat from escaping through your head. It also provides sun protection.

Adjust the number of insulating layers you use depending on the temperature. In warmer climates, you may not even need one.

Outer Layer

Your outer layer should be a water and windproof shell. Its purpose is to keep you warm and the elements (such as wind and rain) out. You will still get wet, either from perspiration or from being in the water.

A rain jacket, an anorak or a light nylon over-all works well. It should be large enough so you have good freedom of movement. This will also trap a warm layer of air inside it.

Being windproof is very important for the outer layer. Look here for the best outer layers.


Footwear is especially important in unknown waters where your feet may get injured. Simple canvas shoes with drain holes work well. Wear ones that are easy to remove in case you get caught in rocks.

Wearing socks provides insulation and also prevents chafing.

Swimming in footwear, as with any clothing, will create extra drag. Experiment with it during training.


Swimming goggles, or a mask, are not essential but are useful if you want to see underwater.

It is a good idea to always wear goggles in a chlorinated/chemical pool. Look here for the best swimming goggles.


A poncho is an excellent all-around piece of survival equipment. When it comes to water training, you will use ponchos for some self-rescue exercises. It can also become an improvised shelter or emergency blanket (extra warmth) when not in the water. Look here for the best ponchos.


Being visible in the water is for safety and survival. You want to be easy to spot by any water traffic. Also, if you get in trouble you will be easier to find by rescue services.


Always wash yourself and all your gear in fresh water after training in any type of water. This will keep everything in the best working condition for as long as possible.

Rinsing your gear under a tap is not enough. Most of the bad stuff (salt, chemicals, etc.) will not get washed out. It is best to wear it in the shower or put it in the washing machine.


The more clothes you have on the harder it will be to swim. The best way to prepare is to simulate falling into the water while clothed and then swimming to safety.

Water-logged clothes will also make climbing out of the water harder.

How Long Can You Survive in Cold Water

Can cold water kill you? Yes it can, and in more ways than one.

Drowning and hypothermia are the obvious killers. Cold water and heart attacks happen due to vasoconstriction. Cold water and asthma is also a concern since cold in general can be a trigger. Treatments for some of these cold water illnesses are later on in this article.

Cold Water Survival 1 10 1 Rule

The cold water survival 1 10 1 rule states how long each stage of cold water immersion takes for the average human. Cold water immersion does not lead to immediate hypothermia. There are four phases:

Cold Shock Response

This is the most common cause of drowning in cold water. It can cause a few life-threatening conditions:

  • ​Gasp Reflex. When cold water is first entered it causes an automatic gasp reflex. This reflex usually lasts about 1 minute, but if the head is under water at the time, it will lead to drowning.
  • ​Hyperventilation. Panic can cause hyperventilation which can lead to fainting. This can lead to drowning.
  • ​Cardiac Arrest. Vasoconstriction (narrowing of the arteries) means the heart must work harder.

Cold Incapacitation

Prolonged vasoconstriction will cause the extremities to ‘shut down’. This means the limbs will not be able to help keep the body afloat. This happens after about 10 minutes in the water.


Hypothermia will set in after about 30 minutes in ice water for most adults. For the 1 - 10 - 1 rule the say being in cold water 1 hour is the onset of hypothermia.

Circum-rescue Collapse

This is not part of the 1 - 10 - 1 rule but is important to understand. When a patient knows they are being rescued, their mental state relaxes. Blood pressure drops, muscles fail and it may even cause cardiac arrest. It can happen before, during, or after the rescue.

Survival Time in Cold Water Chart

This cold water survival chart gives a bit more detail for cold water survival times.

Table representing how long you can survive in cold water depending on temperature.
How long you can survive in cold water.

Cold Water Drowning Survival Record

There have been a few cases where people have been underwater for long periods of time and survived. A quick google search revealed, amongst others, a story of a boy that was underwater for 42 minutes. Another was a child that was revived almost two hours after drowning.

In both cases, the experts said that their survival was most likely due to youth and that they fell in cold water. I won't go into the scientific details of why cold water helped them survive, but I do bring this up for a reason.

People may seem dead, but there is still hope. Never give up on a cold water drowning victim (or any drowning victim) until announced dead by a physician. In Norway, there is a recorded cold water drowning survival time of close to seven hours!

How to Survive in Cold Water

Being immersed in cold water will sap your breath and energy quicker than normal. Panicking will make things worse. You must relax and get out. Concentrate on deep breathing to calm your mind and body.

If you cannot get on dry land you have to do whatever you can to keep your body heat until help arrives.

  • ​Button or zip up your clothes and keep them on
  • ​Don’t use up energy swimming unless you have a dry place to swim to
  • ​Get as much of yourself out of the water as possible
  • ​Use the HELP or Huddle position

Once you get out of the water it is important to remove all your wet clothing, dry yourself off, and get warm. Watch yourself and others for signs of hypothermia and treat as necessary.

HELP Position in Swimming

HELP is an acronym for the Heat Escape Lessening Posture. It is the position to adopt when you are alone in the water and want to conserve your body heat.

The general idea of the HELP position is to protect your major areas of heat loss. These are your armpits, groin, head, neck, and rib cage.

When you are wearing a life-jacket, keep your head out of the water and lean back on it. Fold your arms and hug your jacket close to your body.

Cross your lower legs and bring your knees as high on your chest as you can.

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HELP Position

If you do not have a life jacket, do your best to get as close to the HELP position as possible.

Huddle Position in Swimming

The huddle position is the HELP position for groups of people (2+). Huddling together in a group has benefits such as:

  • ​Lessen loss of body heat
  • ​Increase morale
  • ​Be easier to spot for rescuers
  • ​Stronger swimmers can aid weaker ones

To adopt the huddle position form a ring and group together. Everyone groups together as close as possible. Use your arms and legs to wrap around each other. Place those in need (such as children) in the middle.


Huddle Position

How to Escape Ice Water

Escaping from a fall into ice water is not easy and the result can be deadly.

DO NOT PRACTICE THIS IN ICE WATER! Go through the motions in a pool instead.

When you first fall into ice water you will start to hyperventilate. Try to stay calm and keep your head above the water. Taking deep breathes may help but do not breathe in the water.

After 1 to 3 minutes the shock response will begin to wear off. Now you have about 10 minutes to get out before you fall unconscious.

Once you have got your hyperventilation under control, find where you first fell in. You want to get out where you know it was strong enough to support your weight. Going to where you came from is your best bet.

Place your hands on the surface and pull yourself up while staying as horizontal as possible. Pulling yourself straight up will be far less effective and a waste of energy.

Kick your legs as your creep yourself out of the water. It will be very slippery.


Stay as horizontal as possible and kick your legs to get out of the water

Once you are out of the water, lie flat on the ice and roll away.

Rolling away keeps your weight distributed. It has less of a chance of creating further cracks in the ice.


Lie flat on the ice and roll away

If you know you will be crossing ice country it is very wise to get some ice picks. They will make it far easier to pull yourself out of the water, although it will still be difficult.

If you cannot get out, then you need to conserve your heat and energy. Put your arms on the ice and keep them there so they freeze to the surface. This way, when you become unconscious you will have a better chance of not falling into the water.


Freeze your arms to the surface of the ice

Never go out to someone who has fallen into ice. Coach them on what to do from a safe distance and reach something out for them to hold onto such as a stick or rope.


Use a reach rescue to save someone

Once out of the water get out of the wet clothes and get warm as soon as possible.

Escaping Ice Water Video

Cold Water Rescue

If rescuing someone from cold water immersion:

  • ​Only enter water to rescue if no other option
  • ​Extract from water slowly
  • ​Use in-water rescue breathing if needed
  • ​Treat critical systems as needed, e.g., CPR, hypothermia
  • ​Start with five rescue breaths, and then continue as normal
  • ​If patient is breathing but unconscious, put on his/her side

If you think you may need to rescue someone from cold water, invest in a cold water rescue suit. The Stearns cold water rescue suit is a good choice. Look here for the best prices.

Cold Water First Aid

In this section, we will cover the first aid procedures in the case of cold water immersion.

Most of what is here is not only for cold water cases. You can use the same steps for general treatment also.


Hypothermia occurs when the cold overwhelms the body’s ability to produce and keep heat. It usually occurs when exposed to the cold.

Symptoms of Hypothermia

Hypothermia can be mild or severe and it progresses through very definite symptoms. The patient will have mild hypothermia and, if untreated, it will become severe.

Symptoms of Mild Hypothermia:

The first symptoms of hypothermia are:

  • ​Body temperature between 35.5 °C (96 °F) to 32 °C (90 °F)
  • ​Difficulty speaking
  • ​Intense shivering
  • ​Irritable
  • ​Lethargic
  • ​Loss of fine motor coordination
  • ​Sluggish thinking
  • ​Violent shivering
  • ​Withdrawn

Symptoms of Severe Hypothermia:

  • ​Body temperature below 32 °C (90 °F)
  • ​Blue, puffy skin
  • ​Coma
  • ​Decreased vital signs (pulse, respiratory, B/P)
  • ​Jerky movements
  • ​Muscular rigidity, i.e., no more shivering
  • ​Respiratory and cardiac failure

Hypothermia Treatment

  • ​The treatment whether mild or severe is basically the same. The earlier you treat it the better
  • ​Cover the top of the head
  • ​Do not rub or massage extremities (in case of frostbite)
  • ​Heat packs on armpits, chest, groin and neck
  • ​Insulate from below and above, starting from the ground up
  • ​Increase heat production, i.e., exercise

Note: Only exercise after the patient has an improved mental status. Ensure he has had enough food and fluids.

  • ​Remove causes, e.g., exit cold water, block the wind, remove wet layers
  • ​Warm, non-alcoholic and non-caffeinated liquid (only if patient is capable)
  • ​Immersion heating, e.g., a warm bath. Only if in a controlled environment; the possibility of after-chill may make it worse

Skin-to-skin rewarming inside of a sleeping bag (or similar) is a survival technique. The problem is that it may cause the body-temperatures of all involved to drop.

Hypothermia Packaging

Hypothermia packaging is useful when you need to transport the patient. Even if you don't need to move the patient, it is a great way to keep him/her warm.

  • ​Ensure the patient is dry
  • ​Keep patient horizontal
  • ​Stabilize any injuries, including covering any open wounds
  • ​Sandwich the patient between layers of insulation and waterproof layers

Suggested Hypothermia Packaging

  • ​The face should be partially covered, but allow for breathing, monitoring etc.
  • ​Place a large plastic sheet on the ground
  • ​Next, place an insulated sleeping pad
  • ​On the pad place a sleeping bag (or blankets or whatever you have)
  • ​The patient goes on top of this, along with heating bottles, IV’s etc.
  • ​Fold tops and bottom over the patient, then fold the corners over
  • ​Fold the sides over, keeping wrinkles to a minimum
  • ​Strap in place

Suggested hypothermia packaging

Drowning First Aid Treatment

There are three basic classifications of drowning: Asymptomatic, symptomatic, and respiratory or cardiopulmonary arrest.

Symptoms of Asymptomatic Drowning

  • ​The is out of the water
  • ​Alert
  • ​No respiratory distress
  • ​With or without coughing

Treatment for Asymptomatic Drowning

  • ​Watch for respiratory symptoms
  • ​If respiratory symptoms develop seek advanced medical care ASAP
  • ​Protect against and assess for hypothermia
  • ​Patients that do not worsen after 15 minutes are not likely to diminish but should still be monitored

Symptoms of Symptomatic Drowning

  • ​Patient requires resuscitation or shows signs of distress

Treatment for Symptomatic Drowning

  • ​Seek advanced medical care

Symptoms of and Treatment for Respiratory or Cardiopulmonary Arrest

  • ​DRABC
  • ​If patient is still in the water, only use rescue breathing

First Aid for Frostbite

Frostbite is the freezing of the water in the cells. The most commonly affected areas are the earlobes, nose, fingers, and toes.

Frostnip is a very mild form of frostbite. Frostnip does not do any permanent damage to the skin.

Exposure to the cold is the main cause. Constriction, dehydration, exhaustion, prior cold injuries and vasoconstrictors (coffee) are also contributing factors.

Symptoms of Frostbite

There are three levels of frostbite severity: Superficial, partial and severe.

Superficial Frostbite Symptoms

  • ​Cold and uncomfortable
  • ​Pink or pale complexion

Partial Thickness Frostbite Symptoms

  • ​Reduced perfusion (blood flow)
  • ​Numbness
  • ​Pale and soft

Treatment for Frostnip, Superficial and Partial Frostbite

Note: Thawing tissue and refreezing it will create more damage. Unless a stable environment is more than 24 hours away, it is best to wait.

  • ​Do not drink alcohol or smoke
  • ​Do not massage or rub affected area
  • ​Elevate extremity
  • ​General re-warming of whole body
  • ​Loosen constrictive clothing
  • ​Maintain food and water intake
  • ​Re-warm the affected body part with heat packs, skin to skin (do not rub or massage), warm water etc
  • ​When re-warming, be careful not to burn the patient as he/she may not feel it
  • ​Analgesics before re-warming

Symptoms of Full Thickness Frostbite

  • ​Numbness
  • ​Pale and hard body part
  • ​Possible ice crystals
  • ​Perfusion absent

Note: If the skin turns black it has died from a loss of circulation. It is gangrene. Amputation is usually necessary.

First Aid Treatment for Frostbite

  • ​Immersion of frozen area into 37 to 39 °C (98 to 102 °F) water
  • ​Dry dressings. Separate digits when bandaging
  • ​Analgesics before re-warming
  • ​NSAIDs for circulation

Cold Water Survival Conclusion

Surviving in cold water is not easy. Once you get in panic can set in fast which impairs your thinking. Stay calm and get out as fast as possible.

Once on dry land, you can concentrate on surviving cold water illnesses.

If you can't get out of the water, using the HELP or Huddle position. This will give you the best chance to survive in cold water until rescue arrives.

Did you find this article on survival in cold water useful? If so, please share it with your friends.

Article by Sam Fury

Sam Fury 3 png
Sam Fury 3 png

Sam Fury is the creator and owner of the Survival Fitness Plan.

He has had a passion for martial arts and outdoor pursuits since he was a young boy growing up in Australia.

As a young adult he joined the military and studied outdoor leadership in college. After that, to further his skills, Sam started traveling to learn from the best in the world in various fields related to the Survival Fitness Plan including various martial arts in China, SE Asia and Brazil, Parkour in Singapore, Surf Life Saving in Australia, and others. 

These days, he still enjoys learning new things, traveling and sharing what he has learned via the Survival Fitness Plan. 

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