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.