MFA-L3.2

Hypothermia, drowning and the rescued casualty

MFA-M3 · Toxic and environmental emergencies · MFA-M3-A Poisons and toxic hazards aboard, drowning, hypothermia and the rescued casualty.

Cold water is the yacht crew's commonest environmental hazard, even in the Mediterranean in spring. The drowning casualty needs **five rescue breaths first**, and the hypothermic one needs handling gently.

Environmental: cold and water

Governing: Table A-VI/4-1 'medical care of rescued persons' and 'cardiac arrest, drowning and asphyxia'; RCUK First Aid Guidelines 2025 (drowning, prevention of hypothermia); RCUK Special Circumstances 2025 (accidental hypothermia).

Drowning

For the trained first aider or boat crew (RCUK 2025):

  1. Call for help before entering the water; use the rescue boat, lifebuoy or rescue tube rather than swimming if you can.
  2. Keep the casualty's head out of the water.
  3. If unresponsive and not breathing, and it is safe with effective flotation, five rescue breaths in the water.
  4. Get them aboard or ashore as soon as possible.
  5. If still not breathing: five rescue breaths, then standard CPR (30:2).
  6. Dry the chest and apply the AED.

RCUK 2025 special circumstances adds that spinal immobilisation in the water must not delay removal when resuscitation is needed, and that 100% oxygen should be used for ventilation if available. Anyone who has inhaled water, even if they seem to recover, needs medical advice because breathing problems can develop later.

Hypothermia staging

Swiss stage Picture Estimated core
I, mild Conscious, shivering 35-32 C
II, moderate Impaired consciousness; shivering reduced or absent 32-28 C
III, severe Unconscious, vital signs present 28-24 C
IV, deep Vital signs absent Below 24 C

Shivering that stops while the casualty gets more confused is getting worse, not better. RCUK 2025 says a low-reading thermometer is needed to measure core temperature; otherwise estimate the stage from the clinical picture.

Handling the cold casualty

  • Gently and horizontally. Lift from the water horizontally where possible and avoid rough handling, which can trigger a fatal heart rhythm in a very cold casualty.
  • Insulate: dry blankets or clothing, including a hat.
  • Shield from wind and move to shelter.
  • Remove wet clothing gently, cutting it off if necessary, and replace with dry.
  • Ground isolation: blankets or pads underneath.
  • Warm sweet drinks only if fully conscious and able to swallow. No alcohol, no rubbing of limbs.
  • Check for signs of life for up to 1 minute in an unconscious casualty before starting CPR.

Survival bags and thermal protective aids from the liferaft or rescue boat equipment are useful. Moderate or worse hypothermia needs TMAS advice and usually evacuation.

Cold injury

Frostbite and non-freezing cold injury (immersion foot) are rarer on yachts but occur on high-latitude expedition charters. Protect the part, do not rub it, and do not thaw it if it may refreeze.

WARNING — Man overboard from the swim platform Night-time falls from the stern by crew returning from ashore are a recurring yacht accident pattern. Water in the western Mediterranean in spring is cold enough to incapacitate a swimmer. Recovery and first aid should be part of the same drill.

TIP — Link to other courses Rescue boat recovery technique is in PSCRB and FRB; survival and cold shock are in PST.

Practice questions

5 questions

recall · core

How many initial rescue breaths does RCUK 2025 give a non-breathing drowning casualty before starting CPR? (a) None (b) Ten (c) Two (d) Five

recall · core

What core temperature range defines Swiss stage I (mild) hypothermia? (a) 35-32 C (b) Below 24 C (c) 32-28 C (d) 37-35 C

recall · core

For how long should you check for signs of life in an unconscious hypothermic casualty? (a) 10 seconds (b) 5 minutes (c) Up to 1 minute (d) 5 seconds

recall · core

Which of these is recommended to prevent further cooling? (a) Give alcohol (b) Immerse in hot water at once (c) Rub the limbs vigorously (d) Insulate, shield from wind, remove wet clothing and insulate from the ground

scenario · core

A crew member falls from the swim platform at night in April off Mallorca and is recovered by the rescue boat after 20 minutes. She is conscious, shivering violently and confused. What is the right approach? (a) Keep her horizontal and handle gently, remove wet clothing, insulate and shelter her, monitor and call TMAS (b) Walk her to a hot shower immediately (c) Give her a large brandy (d) Start CPR

Independent study. xplor is not an accredited training provider and awards no certificate or Certificate of Competency. The Medical First Aid certificate of proficiency is issued only on completion of an MCA-approved course with practical assessment on manikins and simulated casualties, and nothing here replaces hands-on training. AI-drafted content pending subject-matter-expert review.