← Flooding
Mode
Single casualty in the water — toggle to Multi-Patient if more than one casualty is involved. ⚠ Multiple casualties — review the Triage Tool and Major Incident reference.

A person in the water may…

  • Be unconscious.
  • Present with an exacerbation of comorbidities — drowning should not be assumed as the primary cause of cardiac arrest.
  • Be distressed and displaying abnormal behaviour.
  • Present with exacerbation of mental health, substance misuse or withdrawal.
  • Present with cold-induced disabilities.
  • Have suffered trauma.
  • Be hypoglycaemic from physical exertion or prolonged shivering.
  • Be entrapped.

Risk Considerations — avoid becoming a second victim

  • Prioritise personal safety — do not put yourself at risk to attempt a rescue.
  • If you have access to a personal flotation device, wear it.
  • Encourage bystanders to stay away from the water's edge.
  • Water can be fast-flowing, deep, cold and contaminated.
  • Only attempt a rescue if it is safe to do so.
  • A person struggling in the water may make you a victim too.

National Risk Register (NRR) ⓘ

The National Risk Register (NRR) sets out the UK Government’s assessment of the most significant risks facing the United Kingdom. It provides an updated evaluation of the likelihood and potential impact of a wide range of threats and hazards that could affect the UK, its people, infrastructure, and national interests, including the risk of flooding.

Click to view the relevant risks ▸
Think — Prioritise your own safety Follow the actions below
999
Phone 999 — request specialist water rescue and advanced clinical care.
Tell them to stay calm and float on their back.
Throw rescue equipment — never enter the water.
Single casualty in the water — hypothermia with water in the lungs Multiple casualties in the water — one in focus with others around
Patient survivability depends on doing the essentials well,
team coordination and clear communication.
A

Clear the Airway

  • Prioritise postural drainage over suction where clinically appropriate.
  • Be prepared to take action for vomit.
  • Consider a supraglottic airway (SGA).
  • Request advanced clinicians for airway & resuscitation management.
  • Position the patient in the recovery position, if indicated.
B

Reverse Hypoxia

  • Critical importance — alleviate hypoxia.
  • Provide 5 effective rescue breaths with high-flow oxygen if available.
  • Deliver effective bag-mask ventilation — optimise mask seal.
  • Effective ventilation & oxygenation may restore cardiac activity.
C

Confirm Signs of Life

  • Check for a central pulse for up to 1 minute.
  • Initiate BLS where clinically appropriate.
  • Apply an AED as soon as available — do not delay rescue breaths & chest compressions.
  • Only a minority of patients present with a shockable rhythm.
D

Cervical Spine Immobilisation

  • Do not delay ventilations & chest compressions (BLS) to immobilise the cervical spine.
  • Immobilisation may complicate airway management.
E

Prevent Further Loss of Body Heat

  • Use the Swiss Staging System to guide treatment.
  • Provide shelter and remove wet clothing; actively dry the patient.
  • Improve thermal management — insulate and provide a vapour barrier.
  • Mild to moderate hypothermia may be suitable for assisted self-evacuation.
Open the full Casualty Management Model Immediate Care · Optimised Care · Transition of Care
Patient survivability depends on doing essentials well · team coordination · clear communication

Decision Tools & References

Click to open — also linked from the relevant keyword above

Submerged Person Tool — Rescue vs Recovery (JESIP JDM)

Submerged Person Tool — JESIP Joint Decision Model: Submerged vs Immersion, start clock, and the 0/30/60/90-minute rescue-vs-recovery decision cycle with DRA and ARA assessments
Official Submerged Person Tool (JESIP JDM). Summary flow below for quick reference.
0 min
Start clock
First responder on scene, submersion confirmed. Inform control of the start time; ensure safe system of work.
< 30 min
Rescue?
JDM DRA. If recovered → standard resuscitation pathway.
30–60 min
Icy Cold?
JDM ARA. Water ≤ 6 °C: extended rescue may be justified.
60–90 min
Safe to continue?
JDM ARA. Balance survival chance vs. risk of rescue.
> 90 min
Not for resus
JDM ARA. Recovery operations — withhold resuscitation, verify death.
Information required at each JDM node
  • Time person last seen.
  • Age & size of person under water (small / thin person?).
  • Water temperature — Icy Cold ≤ 6 °C.
  • Potential air pocket — Yes = person NOT submerged.
DRA — Dynamic Risk Assessment
  • "Start clock" = first responder on scene & submersion confirmed.
  • Inform control of the start time.
  • Ensure a safe system of work is in place.
ARA — Analytical Risk Assessment
  • If moving to recovery (< 90 min), clinical authorisation from Paramedic level (or equivalent) is required for withholding resuscitation or verification of death.
  • If a child is likely to be recovered after 30 minutes of continual submersion and starting resuscitation is considered futile — senior clinical advice should be sought to support decision-making.
  • Can extended rescue operations be justified? Balance chance of survival versus risk of rescue.
  • Review all available information.
  • Complete contemporary documentation of risk(s) and decision(s).

National Risk Register (NRR) — Relevant Risks

Natural and environmental hazards include:

Open the full National Risk Register 2025 (PDF) ↗

Lexicon — Using the Correct Terminology

Precise language saves lives. Using the wrong term — for example saying “body in the water” when the person may still be viable — can lead a control room to treat the incident as a recovery in slow time and miss a life-saving opportunity.

Patient — a person(s) at an incident who receives healthcare, agnostic of whom.
Casualty — any person at the scene of an incident who is identified by responding personnel as having been injured or made unwell as a direct result of that incident.
Person — a casualty for whom there remains a reasonable possibility of life and successful resuscitation.
A body — a casualty for whom there is no reasonable expectation of life or successful resuscitation.
Immersed person — a casualty in the water with the airway (nose and mouth) above the surface and therefore able to breathe.
Submerged person — a casualty with the airway (nose and mouth) below the water surface and therefore unable to breathe.

Terminology to be confirmed against the national lexicon work (NCA / Hour-and-a-Life).

Multiple Casualties in Water — Triage Tool

Multiple Casualties in Water Triage Tool flowchart — W1/W2/W3 priority decision flow with footnotes
Official Multiple Casualties in Water Triage Tool. Summary flow below for quick reference.
Hazards causing immediate danger to life?
YES →
W1
Purposeful swimming or floating and external source of flotation within reach? (1)
YES →
W3
Airway above surface and wearing effective sustainable flotation? (2)
YES →
W2
Purposeful signs of movement OR airway observed to submerge → Rescue the Airway
YES →
W1
Not Breathing — rescue as resources allow.*
—
Rescue
as able
* Rescues must be attempted once resources are able to do so.
Footnotes
(1) Within reach:
Casualty is able to move towards and utilise an external source of flotation. Caution — the ability to hold onto external flotation will become impaired with time, particularly in colder waters.
(2) Effective flotation:
Airway maintained clear of the water without effort. This may involve a lifejacket and/or immersion suit.
(3) Re-triage:
Casualties may deteriorate — remain vigilant; re-triage required.
W1 — Highest priority for rescue W2 — 2nd highest priority for rescue W3 — 3rd highest priority for rescue

Swiss Staging Tool — Hypothermia

CategoryCategoryEstimated Core TemperatureClinical Findings
Stage 1Mild35 – 32 °C Conscious with shivering. Normal mental status, but not functioning normally and unable to care for self.
Stage 2Moderate32 – 28 °C Impaired consciousness. Abnormal mental status with shivering, or abnormal mental status without shivering, but conscious.
Stage 3Severe28 – 24 °C Unconsciousness. Vital signs (breathing, palpable carotid or femoral pulse) are present.
Stage 4DeepBelow 24 °C Vital signs are absent.
 Stage 1Stage 2Stage 3Stage 4
Clinical Findings Alert from AVPU Verbal from AVPU Painful or Unconscious from AVPU
AND
Vital Signs Present		 Unconscious from AVPU
AND
No Vital Signs
Risk of cardiac arrest Low Moderate High Cardiac Arrest

Gather & Share Information

🚨 Major Incident Reference

Escalation triggers

Major incident thresholds vary by region and clinical specialty. Common triggers include:

Declaration & coordination

Once declared, JESIP principles apply across all responding agencies. Use the METHANE report to communicate scene status:

Local plan

Each region maintains its own Major Incident Plan covering thresholds, command structure, casualty receiving hospitals, and surge capacity.

Placeholder — host integration to follow.
This area will display the locally-loaded Major Incident plan for the presenter's region. Each deploying organisation can plug in their own document, URL or contact details.