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Dr Gordon Giesbrecht coined the phrase 1-10-1 to describe the three critical phases of cold water immersion. Over many years, Gordon has researched the effects of cold water immersion on hundreds of subjects and has personally experienced those effects himself over 30 times.

1 - 10 - 1

1-10-1 is a simple way to remember the first three phases of cold water immersion 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 self 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.

This graph estimates times for fatal HYPOTHERMIA to occur depending on gender and body mass.

Prevention and Rescue


The best case scenario for Cold Water Immersion is to "reduce or prevent the risk". If you're boating in cold water, it's as simple as making sure not to overload your boat, avoiding situations where you may fall overboard and, of course, making sure that everyone is wearing a Coast Guard approved lifejacket to protect in the case of an unforeseeable emergency.


Without thermal protection you can lose body heat 25 times faster in water than in air with similar temperatures and that can be increased by a factor of up to 10 with movement like swimming or moving water.


The best choice in flotation equipment for Cold Water Immersion is a type that will offer the maximum thermal protection such as a floater jacket and pants or a one-piece survival suit. If you do find yourself in cold water, in addition to having proper flotation, there are some things you can do to delay the onset of Hypothermia. Drawing your legs up close to your chest and wrapping your arms around them in a tuck position will help conserve body heat. If you're in a group, huddling together as close as possible will also help conserve body heat.




Hypothermia can be divided into Mild, Moderate and Severe stages. These stages are defined by the "State of Alaska Cold Injuries Guidelines for Wilderness Emergency Care". The following chart lists the signs and symptoms used in the classification of these three stages.


Classifications of Hypothermia

Core Body Temperature

Patient's ability to rewarm without external heat source

Clinical presentation of Hypothermic Patient


Above 95ºF



Cold sensation shivering





Physical impairment

• Fine motor

• Gross motor

Mental impairment

• Complex

• Simple





Below 90ºF (32ºC) shivering stops

Below 86ºF (30ºC) consciousness is lost


Below 82ºF




Vital signs reduced or absent

Severe risk of mechanically stimulated ventricular fibrillation

(VF) (rough handling)

Below 77ºF



Spontaneous ventricular fibrillation (VF)

Cardiac arrest



  • If there is no way to get to a medical facility within 30 minutes, a mildly hypothermic person should be rewarmed as follows. 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.



  • 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 paramedics.

  • 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 n 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 shoud 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.



Dr. Giesbrecht has a really good site dedicated to this film at Cold Water Boot Camp