A vehicle is most easily exited during the initial Floating Phase. We suggest the following escape procedure: SEATBELT(s) unfastened; WINDOWS open; CHILDREN released from restraints and brought close to an adult; and OUT, children should exit first.

Prevention includes installing adequate guardrails, barriers, warning signs, and road markings, or placing roadways at a greater distance from water. Areas at high risk for flooding should have signs and public warning systems for flash flooding should be improved. Public education should also focus on the dangers of driving on flooded roads or bridges, and on ice roads.

Results suggest that a heavy vehicle will sink before surface exit is possible. Occupants would, therefore, be forced to breath-hold and make an underwater exit through a window, door, or roof hatch. Front-mounted external flotation devices on a light truck increased floating time and the possibility of exit while still on the surface.

This study compared head vs. torso warming using a similar source of heat donation. Six subjects were cooled in 8˚C water to either a core temperature of 35˚C or for 60 min. They were then rewarmed by either shivering only, or charcoal heater applied to the head, or torso. There were no significant differences in rewarming rate between the three conditions. Head warming did not inhibit average shivering heat production resulting in greater net heat gain during 35-60 min of rewarming compared to shivering. Head warming is as effective as torso warming for hypothermic victims.Head warming could be a preferred method in some cases: extreme conditions in which removal of the insulation and exposure of the torso to the cold is contraindicated; excessive movement is contraindicated (e.g., severe hypothermia which has a risk of ventricular fibrillation, or potential spinal injury); or if emergency personnel are working on the torso.iii ACKNOWLEDGEMENTS

The cold-shock response (increased minute ventilation and tidal volume) predominated over the dive response in the initial moments of immersion only. The order of emergence of these responses provides further recommendation to avoid head submersion upon cold water entry. It is important to protect the face, with a facemask, and the head dorsum, with an insulative hood, in cold water.

Fluidotherapy was not as effective as warm water for rewarming mildly hypothermic subjects. Although Fluidotherapy is more portable and technically simpler, it provides a lower rate of rewarming that is similar to shivering only. It does help decrease shivering heat production, lowering energy expenditure and cardiac work, and could be considered in a hospital setting, if convenient.

Introduction-To evaluate the rewarming effectiveness of a similar amount of heat (from a charcoal heater) applied to either the head or torso in a human model for severe hypothermia in which shivering is pharmacologically inhibited in mildly hypothermic subjects. Methods-Six male subjects were cooled on 3 different occasions, each in 8˚C water for 60 min, or to a lowest core temperature of 35˚C. Shivering was inhibited by intravenous meperidine (1.5 mg¢kg ¡1), administered during the last 10 min of the cold-water immersion. Subjects then exited from the cold water, were dried, and were placed in a 3-season sleeping bag for 120 min in one of the following conditions: spontaneous rewarming only, charcoal heater on the head, or charcoal heater on the torso. Supplemental meperidine (to a maximum cumulative dose of 3.3 mg¢kg ¡1) was administered as required during rewarming to suppress shivering. Results-No significant differences were found in the postcooling afterdrop amount or core rewarming rates among the 3 conditions (0.8˚C¢h ¡1). During the last 30 min of rewarming the net heat gain was significantly higher in the head (85.8 §25.3 W) and torso (81.5 §6.3 W) conditions compared with the spontaneous condition (56.9 §12 W) (P<0.05). Conclusions-In our study, head and torso warming had the same core rewarming rates when shivering was pharmacologically inhibited in mildly hypothermic subjects. Therefore, in nonshivering cold subjects, head warming is a viable alternative if torso warming is contraindicated (eg, when performing cardiopulmonary resuscitation or working on open chest wounds).

Results suggest that, compared to Control clothing, flotation Jackets and Overalls do not increase exit time or impede exit during egress from a submerged vehicle while providing thermoprotection and buoyancy in 20 degrees C and 8 degrees C water. The Inflated Vest created the most perceived exit impedance in comparison to Control.