3.6 — Drowning, Electrocution, Heat and Cold

Four situations linked by one rule: the first action is about protecting yourself, because in all four the hazard that got them is still there.

Drowning

What it actually looks like

Not like the films, and this is the most useful thing in this section.

Drowning is usually silent.

A drowning person cannot call for help, because the mouth is at water level and the breathing reflex takes priority over speech. They cannot wave, because their arms are instinctively pressing down on the water to lift the mouth clear. They are usually upright, head back, with no kicking, for a period of perhaps twenty to sixty seconds before going under.

Which means: people drown a few metres from other people, in silence, routinely.

The signs: head low in the water with mouth at water level; head tilted back; eyes glassy or closed; vertical in the water with no leg movement; appearing to climb an invisible ladder; hair over the face and not moved.

**And the reliable test: ask are you all right? If there is no answer, you have seconds.

Getting them out

Reach. Throw. Row. Go — and go last.

Reach with something: a pole, a branch, an oar, clothing. Lie down while you do it so you cannot be pulled in.

Throw something that floats, with a line if possible.

Row — use a boat if there is one.

Go — enter the water — only as a last resort and only if you are a strong swimmer trained in rescue. **A drowning person will climb on you. Double drownings are common and a very high proportion of them are would-be rescuers.

Once out

Check breathing (3.1).

If not breathing, this is the one exception to hands-only CPR (3.2). Drowning is an oxygen problem, so give 5 rescue breaths first, then standard CPR.

Do not attempt to press water out of the lungs or hold them upside down. It does not work and it delays compressions.

Get them warm and dry — hypothermia frequently accompanies drowning.

And everybody who has been rescued from drowning needs medical assessment, even if they seem fine, because breathing problems can develop over the following hours.

The encouraging part

Cold-water drowning has a genuinely remarkable survival record. The cold slows metabolism, and there are documented cases of full recovery after prolonged submersion in very cold water, particularly in children.

Which means: continue resuscitation in cold-water cases and let a hospital make the decision.

Electrocution

The rule

Do not touch the person until the power is off.

Every time, with no exception. A person in contact with a live source will conduct the current into you.

Low voltage — household

Switch it off at the main. Not just the appliance switch — the consumer unit or fuse box.

If you cannot, stand on something dry and insulating and push them away from the source with something non-conducting and dry — a wooden broom handle, a plastic chair.

Never anything metal, never anything wet, and not your hands.

High voltage — power lines, railways, substations

Do not approach.

Electricity at high voltage arcs across a gap, and the ground around a fallen line can be live for a considerable distance.

Stay well back — the standard guidance is a minimum of many metres — and call the emergency services and the utility.

And if you are in a vehicle that has contacted a line: stay in the vehicle. **The tyres insulate you. Get out only if there is fire, and then jump clear without touching the vehicle and the ground at once, and shuffle away with both feet together and never taking one foot far from the other.

Afterwards

Check breathing and start CPR if needed (3.2). Electrical injury commonly causes cardiac arrest and it is very responsive to defibrillation.

And everybody with an electrical injury needs hospital assessment, however minor it looks. The internal damage along the current path is invisible and the heart rhythm can be disturbed for hours.

Heat

Two conditions, and the difference between them is the difference between an inconvenience and an emergency.

Heat exhaustion

Heavy sweating, pale clammy skin, headache, nausea, dizziness, cramps, fast weak pulse, and feeling awful.

Crucially: still sweating, and still mentally normal.

What to do: move them somewhere cool, lie them down, raise their legs, remove excess clothing, cool them with wet cloths and airflow, and give water or an oral rehydration solution in small sips.

They should improve within about half an hour. If they do not, treat it as the next one.

Heat stroke

A medical emergency.

The distinguishing signs: confusion, disorientation, aggression, slurred speech, seizure or unconsciousness — and the skin may be hot and dry, because sweating has stopped, though it can still be moist in exertional cases.

Any altered mental state in a hot person is heat stroke until proven otherwise.

What to do: call an ambulance, and start cooling immediately — do not wait.

Cooling is the treatment and speed matters. Get them into shade or cold water, remove clothing, apply cold water over the whole body, use ice packs at the neck, armpits and groin, and keep air moving over them.

Immersion in cold water is the most effective method where it is possible.

And do not give anything to drink to a confused person.

Cold

Hypothermia

And the key fact: it does not require snow.

Wet and windy at ten to fifteen degrees is entirely sufficient, and this is how most cases actually happen — on hillsides, in boats, in flooded buildings, in unheated homes.

Signs, in order: shivering, cold pale skin, tiredness, then — as it worsens — shivering stops, speech slurs, coordination fails, and confusion and irrational behaviour appear.

The stopping of shivering is a bad sign, not a good one.

And the classic sign of moderate hypothermia is that the person insists they are fine, or begins removing clothing. Judgement goes early.

What to do

Get them out of the cold, out of the wind, and out of wet clothing.

Insulate — including from the ground, which takes heat faster than air.

Warm the core, gently. Blankets, dry clothing, another person's body heat, warm drinks if they are fully alert.

Handle gently. A severely hypothermic person's heart is unstable and rough handling can cause a dangerous rhythm.

Do not rub the limbs, do not put them in a hot bath, and do not give alcohol. All three move cold blood from the extremities into the core and can make things worse.

And in severe hypothermia — unconscious, no shivering — call for help and continue resuscitation efforts if needed.

The principle in cold-water and hypothermia cases is that a cold person is not dead until they are warm and dead, and there are documented recoveries from extraordinary levels of cooling.

Frostbite

Numb, white or waxy skin, usually fingers, toes, ears or nose.

Rewarm in warm — not hot — water, around body temperature.

Do not rub, do not use direct heat, and do not rewarm if there is any chance of it refreezing, because a freeze-thaw-freeze cycle causes far more damage than staying frozen until proper help.

What to do with this page

Drowning is silent and the person is vertical and quiet. Reach, throw, row — go last.

Drowning is the exception: 5 rescue breaths first.

Never touch an electrocuted person until the power is off, and stay in the vehicle if a line is down on it.

Confusion in a hot person is heat stroke. Cool immediately, do not wait for the ambulance.

And a cold person is not dead until they are warm and dead. Keep going.

Next: 3.7 — snake bite, where the first aid people know is mostly wrong and the correct version is simpler.