The Symptoms of Hypothermia
The most typical symptoms of hypothermia are listed below in the general order of onset.

Treatment of Hypothermia

• Mild hypothermia (victim shivering but coherent): Move victim to place of warmth. Remove wet clothes, give warm, sweet drinks; no alcohol or caffeine. Keep victim warm for several hours.
• Moderate hypothermia (shivering may decrease or stop): Victim may seem irrational with deteriorating coordination. Same as above but no drinks. Victim should be kept lying down with torso, thighs, head and neck covered with dry clothes, coats or blankets to stop further heat loss. Seek medical attention immediately.
• Severe hypothermia (shivering may have stopped): Victim may resist help or be semiconscious or unconscious). Removed from water, victim must be kept prone, on back and immobile. Victim must be handled gently. Cover torso, thighs, head and neck with dry covers to stop further heat loss. Arms and legs must not be stimulated in any manner. Cold blood in extremities that suddenly returns to the core may induce cardiac arrest. Seek medical attention immediately.
• Victim appears dead (little or no breathing or pulse, body rigid): Assume victim can still be revived. Look for faint pulse or breathing for 2 minutes. If any trace is found, do not give CPR. It can cause cardiac arrest. Medical help is imperative. If pulse and breathing are totally absent, trained medical personnel should start CPR.

Cold Shock is a dangerous, sometimes fatal, condition that can result when a person is suddenly immersed in cold water, such as would occur in a capsize. The sudden exposure of the head and chest to cold water typically causes an involuntary gasp for air, sudden increases in heart rate and blood pressure, disorientation and can possibly cause cardiac arrest.

Hypothermia is a dangerous and often-fatal condition that results when exposure to cold temperatures causes the body to no longer be able to maintain its normal temperature in the core region (heart, lungs, etc.). While this condition can occur through exposure to cold air alone, its onset is much faster when the body is wet or immersed in water. Paddlers must take special care to protect themselves from this danger any time they paddle in cold water, rainy conditions, or cool air temperatures.

To reduce the exposure to these hazards:

• Dress in layers using synthetic fabrics such as polyester fleece to prevent getting overheated or chilled from perspiration. Avoid wearing cotton clothing when paddling in cool or cold temperatures.
• Carry a waterproof jacket designed for splash and/or rain protection.
• Any time the water temperature is less than 60 degrees Fahrenheit, wear specialized insulating clothing capable of protecting you while in the water.
• You should always wear a wet suit or dry suit 1) if both the air temperature and water temperature are below 60 degrees Fahrenheit, 2) if you will be far from shore on cold water, or 3) anytime in cool or mild weather when you expect be repeatedly exposed to cold water. Keep in mind that the best type of wetsuit for paddling is the "Farmer john" style, and that the warmth and comfort range of a dry suit can be flexible based on the clothing worn underneath it.
• Wear a warm hat that will stay on your head in the water. A fleece-lined skullcap is ideal.
• Have spare dry clothing and store in a sealed dry bag while on the water and, if wet, change into dry clothing at first signs of shivering.
• Test your protective clothing in a controlled cold water environment to understand the level of protection provided.
• Know the water temperature before you set out. Please recognize that dam released water can be significantly colder than expected.
• Always wear your lifejacket (PFD).
• Paddle near to shore and/or near others who can help you in the event of capsize.
• Keep your body well fueled with high carbohydrate foods and lots of water.

In the event of a capsize in cold water:

• Get out of the water and dry off as quickly as possible.
• Once you are out of the water, put on dry clothes.
• If you are unable to exit the water quickly, keep calm, remain with your boat, conserve energy and get in the H.E.L.P. (heat escape lessening posture) position - fold your arms against your chest, cross legs, and keep still until help arrives.
• If 2 or more people are in the water, get into the "Huddle" posture - put your arms around one another, stay close together, and keep still.
   
• Only attempt to swim to shore if 1) the is little or no chance of rescue 2) you are in danger of floating into dangerous rapids or other hazards, 3) you are absolutely certain you can make it.

Note: Any decision to swim for shore should not be entered into lightly. Physical activity such as swimming, or other struggling in the water increases heat loss. Survival time can be reduced to minutes. Strong swimmers have died before swimming 100 yards in cold water. In water under 40 degrees farenheit, victims have died before swimming 100 feet. Also keep in mind that judging distance accurately on the water is difficult.

Acknowledgments: This article was adapted from information in the ACA video Cold, Wet and Alive, and from the article Off-Season Boating, Cold Shock, and Hypothermia by Charles A. Sutherland, Ph.D.