Tag Archives: water survival

Medical Problems in Sea Survival

PH1 David B. Loveall

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Seasickness is the nausea and vomiting caused by the bobbing motion created by the wave action of a flotation device. Seasickness can result in:

  • Dehydration and exhaustion.
  • A loss of the will to survive.
  • Others becoming seasick.
  • Unclean conditions.

To treat seasickness,wash yourself and the flotation device to remove the sight and odor of vomit, do not eat until the nausea is gone, rest if possible, medicate if available.

Saltwater Sores/Ulcers

Saltwater sores and ulceration occur when skin that has abrasions or is cut is exposed to saltwater. The sores  may form scabs and pus. Do not open or drain. Flush the sores with freshwater, if available, and allow to dry. Apply antiseptic, if available.


Irritants or the effects of the sun’s rays reflecting off the water can cause temporary blindness or headaches. If flames, smoke, or other irritants get in your eyes, flush the eyes immediately  with saltwater, then with freshwater, if available. Apply an ointment, if available. Bandage both eyes for 18 to 24 hours or longer if the damage is severe. If glare from the sky and water causes your eyes to become bloodshot and inflamed, bandage the eyes lightly. Try to prevent this problem by wearing sunglasses or goggles with a sunglass insert.

Osmotic Diarrhea

May develop following swallowing of large amounts of salt water.


This condition is a common problem associated with dehydration. For constipation, do not take a laxative if it is available; this causes further dehydration. Drink freshwater, if available

Heat exhaustion

Dehydrated survivors in a hot, humid environment are at risk. Prevention is good hydration.


The sun’s rays reflect at all angles off the waves of the water; therefore, sunburn and dehydration are serious problems in sea survival. Try to prevent sunburn by:

  • Erecting an improvised canopy, with available floating materials, to provide shade.
  • Wearing your soft cover or using a cloth, such as a handkerchief, to cover your head.
  • Covering your skin with sunscreen or lip balm from your first aid kit. Your lips, nostrils, eyelids, the backs of your ears, and the skin under your chin sunburns easily.
  • If enough sunscreen cream is available, all exposed skin should be covered.


Dehydration is caused by the loss of the body’s vital fluids. Dehydration in saltwater may result from a combination of factors such as a lack of water, the effects of saltwater on skin tissue, sunburn or vomiting from seasickness and other causes. Sleep and rest and reduced water and food intake are the best ways of enduring periods of exposure. The following measures will delay the effects of dehydration:

  • DO NOT drink saltwater.
  • DO NOT drink urine.
  • DO NOT drink alcohol.
  • DO NOT smoke.
  • DO NOT EAT unless water is available.

Information contained on this website is for general information and educational purposes only. Please refer to our Disclaimer and Terms and Conditions before attempting any technique described herein.


SEAL Qualification Training in Kodiak

Photo by PO2 Erika Manzano

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1-10-1 is a simple way to remember the first three phases of cold water immersion leading to hypothermia and the approximate time each phase takes:

1 – Cold Shock. An initial deep and sudden Gasp followed by hyperventilation that can be as much as 600-1000% greater than normal breathing. You must keep your airway clear or run the risk of drowning. Cold Shock will pass in about 1 minute. During that time concentrate on avoiding panic and getting control of your breathing. Wearing a lifejacket during this phase is critically important to keep you afloat and breathing.

10 – Cold Incapacitation. Over approximately the next 10 minutes you will lose the effective use of your fingers, arms and legs for any meaningful movement. Concentrate on self rescue initially, and if that isn’t possible, prepare to have a way to keep your airway clear to wait for rescue. Swim failure will occur within these critical minutes and if you are in the water without a lifejacket, drowning will likely occur.

1 – Hypothermia. Even in ice water it could take approximately 1 hour before becoming unconscious due to Hypothermia. If you understand the aspects of hypothermia, techniques of how to delay it, self rescue and calling for help, your chances of survival and rescue will be dramatically increased.


Without floatation, you will not die from hypothermia; you will drown first. The chilling effects of cold air and wind but water poses the greatest threat because it transfers heat 25 times faster than air. Depending on the water’s temperature, a victim can succumb to hypothermia within a few minutes.

The body’s sudden contact with cold water can also set off a body reaction known as the mammalian diving reflex. This reflex can greatly increase survival time (especially for women and children) in or under cold water. The mammalian diving reflex shuts off blood circulation, except for the flow between the heart, lungs, and brain. The small amount of oxygen left in the blood and lungs is saved for the body’s vital organs. This reflex has allowed people to survive being under cold water for an extended period of time. Therefore, a cold water drowning victim should be treated as if still alive even though the victim is not breathing, has no pulse, and may appear dead. WARNING: If the victim has no pulse and is not breathing, administer CPR immediately. If the victim does have a pulse but is not breathing, give rescue breathing only. If the victim has a pulse and is breathing, DO NOT give CPR—CPR could prove fatal. Continue first aid until medical help arrives. Check for a pulse for at least 45 seconds.


Once the body’s core temperature drops, the victim will show one or more of the following symptoms:

  • Violent and uncontrollable shivering as the body tries to warm itself.
  • Slow or slurred speech.
  • Disorientation or poor coordination.
  • Loss of skin color.
  • Blue and pinched lips.
  • A slowing or stopping of shivering that progresses into a rigid torso and limbs.

Survival Time

A hypothermia victim’s survival depends on the water’s temperature and the time spent in the water. A small body build cools faster than a large build. Children cool faster than adults.

Cold Water ExposureTo increase your chance of survival in the water, utilize the HELP position, or huddle position in a group, shown below:

huddle-300x240Extra clothing and inactivity (remaining motionless in the water) can also increase your survival


A hypothermia victim must be warmed to prevent further heat loss; therefore, treatment should begin as soon as possible. Consciousness of the victim determines the treatment that should be pursued. The following general treatment procedures are recommended:

  • If the victim is conscious, give the victim warm fluids. Give candy or sweetened foods to a victim who is able to eat.
  • If the victim is unconscious, place him on his back with his head tilted back to ensure an open airway.
  • DO NOT massage the victim. Massage can break blood vessels and create swelling, internal pressure, and blocked blood circulation.
  • DO NOT give alcohol to the victim. Alcohol lowers the victim’s body temperature.
  • Shock is a possibility, treat accordingly.
  • Seek medical help immediately/as soon as possible.

If medical help is not immediately available and can be removed from the water:

  • Get the victim into shelter.
  • Remove the victim’s wet clothing.
  • Put the victim in dry clothing.
  • Place the victim in a sleeping bag if one is available. It may be necessary to place another person in the sleeping bag with the victim.
  • Place as much insulation as possible between the victim and the ground.
  • Use hot water bottles, electric blankets, or blankets heated in an oven or by a campfire to warm the victim’s neck, groin, and the sides of the chest. CAUTION: DO NOT apply heat to extremities.

Treatment for mild hypothermia

If there is no way to get to a medical facility within 30 minutes, a mildly hypothermic person should be rewarmed as soon as possible. Shivering is a very effective process especially when well insulated. Shivering should be fueled by calorie replacement with fluids containing sugars. The sugar content is actually more important than the heat in warm liquids. Make sure that the person is capable of ingesting liquids without aspirating. Alcohol and tobacco use should not be permitted because they constrict blood flow.

External heat can be applied to high heat transfer areas such as the underarms and sides of the chest. Active heating of the skin is beneficial as it increases comfort, preserves energy stores and reduces cardiovascular stress

Light exercise such as walking produces heat but should only be attempted after a mildly hypothermic person is dry, has had calorie replacement and has been stable for at least 30 minutes. A warm shower or bath may be tolerated by an individual that is alert and mobile. However, this could be fatal to a moderate to severely hypothermic person and should be avoided in this case.

Treatment for moderate to severe hypothermia

This is a serious medical emergency requiring proper handling and treatment and in severe cases, immediate transport to a medical facility. There are some specific things you can do to help stabilize the individual prior to the arrival of proper medical attention.

Great care must be taken in handling a moderate or severely hypothermic person. Extraction from the water must be as gentle as possible to avoid precipitating ventricular fibrillation. Arms, hands, feet and legs should not be rubbed or manipulated. The person should be placed in a horizontal position and wet clothing should be gently removed and the body insulated as best as possible using dry blankets, clothing or other protective materials. If shelter is available, keep the person protected from the elements and insulated from the cold ground or snow using sleeping bags, clothing, back packs or even evergreen boughs.

If vital signs are present, the person should be rewarmed as previously described but not allowed to sit or stand until rewarmed. Under no circumstances should the person be placed in a warm shower or bath, no oral fluids or food should be given and no attempts should be made to rewarm with exercise, including walking.

In any hypothermic individual, core body temperature continues to decrease after rescue. It is called ‘afterdrop’ and may last many hours in a moderate to severely hypothermic person when no shivering is present and metabolic heat production may be only 50 percent of normal. Even gradual warming of the heart will help avoid cardiac arrest and ventricular fibrillation.

Information contained on this website is for general information and educational purposes only. Please refer to our Disclaimer and Terms and Conditions before attempting any technique described herein.


Photo by PM3 John DeCoursey

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Drowning is suffocation by liquid. It can lead to death and ongoing health problems. A drowning victim inhales water into the lungs or the throat closes by reflex so that little or no water can enter the windpipe. In either case, a victim can no longer breathe.

Drowning itself is quick and silent, although it may be preceded by distress which is more visible. A person drowning is unable to shout or call for help, or seek attention, as they cannot obtain enough air. The “instinctive drowning response” is the final set of autonomic reactions in the 20 – 60 seconds before sinking underwater, and to the untrained eye can look similar to calm or safe behavior. Persons trained in rescue learn to recognize drowning people by watching for instinctive movements in two categories:

Distress: People in trouble, but who still have the ability to keep afloat, signal for help and take actions.

Drowning: People suffocating and in imminent danger of death within seconds. This includes:

    • Passive drowning: People who suddenly sink or have sunk due to a change in their circumstances. Examples include people who drown in an accident, or due to sudden loss of consciousness or sudden medical condition.
    • Active drowning: People such as non-swimmers and the exhausted or hypothermic at the surface, who are unable to hold their mouth above water and are suffocating due to lack of air. Instinctively, people in such cases perform well known behaviors in the last 20–60 seconds before being submerged, representing the body’s last efforts to obtain air. Notably such people are unable to call for help, talk, reach for rescue equipment, or alert swimmers even feet away, and they may drown quickly and silently close to other swimmers or safety.

Drowning begins at the point a person is unable to keep their mouth above water; inhalation of water takes place at a later stage. As mentioned, drowning can be quick and unspectacular and media depictions as a loud, violent struggle have much more in common with distressed non-swimmers who may well drown but have not yet begun. In particular, an asphyxiating person is seldom able to call for help. The Instinctive Drowning Response covers many signs or behaviors associated with drowning or near-drowning:

  • Head low in the water, mouth at water level
  • Head tilted back with mouth open
  • Eyes glassy and empty, unable to focus
  • Eyes open, with fear evident on the face
  • Hyperventilating or gasping
  • Trying to swim in a particular direction but not making headway
  • Trying to roll over on the back to float
  • Uncontrollable movement of arms and legs, rarely out of the water.

Other warning signs drowning is that the victim may call for help and has an expression of dread or panic. But typically a victim that is active and drowning may not call for help because he is trying to conserve his air and will not speak. Another symptom of drowning is when the victim thrashes at the water’s surface. If the victim stops or grows calmer, he has likely been overcome by fatigue, hypothermia, or a lack of air. At this stage, the victim usually has 20 to 60 seconds before going under the water’s surface.

Drowning can also happen in ways that are less well known:

  • Deep Water Blackout. Caused by latent hypoxia upon ascent from depth, where the partial pressure of oxygen in the lungs under pressure at the bottom of a deep free-dive is adequate to support consciousness but drops below the blackout threshold as the water pressure decreases on the ascent. It usually strikes upon arriving near the surface as the pressure approaches normal atmospheric pressure.
  • Shallow Water Blackout. Caused by hyperventilation prior to swimming or diving. The primary urge to breathe (more precisely: to exhale) is triggered by rising carbon dioxide (CO2) levels in the bloodstream. The body detects CO2 levels very accurately and relies on this to control breathing. Hyperventilation artificially depletes this, but leaves the diver susceptible to sudden loss of consciousness without warning from hypoxia. There is no bodily sensation that warns a diver of an impending blackout, and victims (often capable swimmers swimming under the surface in shallow water) become unconscious and drown quietly without alerting anyone to the fact that there is a problem; they are typically found on the bottom.
  • Secondary drowning. Inhaled fluid can act as an irritant inside the lungs. Physiological responses to even small quantities include the extrusion of liquid into the lungs (pulmonary edema) over the following hours, but this reduces the ability to exchange air and can lead to a person “drowning in their own body fluid.” Certain poisonous vapors or gases (i.e., burning fuel, toxic materials, or chemical vapor on/near the water surface), or vomit can have a similar effect. The reaction can take place up to 72 hours after a near drowning incident, and may lead to a serious condition or death.


If the victim is not breathing, begin rescue breathing. Place the victim on his back, tilt head back to open airway, pinch the nose, and give two full breaths. If the victim does not inhale during the first two breaths, reposition his head and attempt two more breaths. Check for a pulse. If a pulse is present, but the victim is still not breathing, continue rescue breathing. If a pulse is not present, begin CPR. WARNING: If the victim has no pulse and is not breathing, administer CPR immediately. If the victim does have a pulse but is not breathing, give rescue breathing only. If the victim has a pulse and is breathing, DO NOT give CPR—CPR could prove fatal. Continue first aid until medical help arrives. A victim who is not breathing and has no pulse may appear dead. DO NOT decide that death has occurred. Continue with the prescribed treatment.


Information contained on this website is for general information and educational purposes only. Please refer to our Disclaimer and Terms and Conditions before attempting any technique described herein.