CPR + Cardiac Emergencies

Performing CPR in WaterThis protocol applies only to normothermic patients (core temperature > 90° F, 32° C) in cardiac arrest. Chest compressions are to be initiated for patients in cardiac arrest as evidenced by pulselessness. To be effective, CPR must be started promptly and be provided in a consistent and quality manner. Even then, its benefits in a wilderness or remote setting are limited.

CPR should NOT be started, or may be discontinued
after initiated for the following reasons:

  1. Cardiorespiratory arrest after submersion in water for more than sixty minutes in the absence of a source of air such as SCUBA equipment or an air pocket.
  2. Obvious lethal injury such as decapitation, exsanguination, or massive head injury.
  3. Where cardiac arrest persists continuously for over 30 minutes of sustained CPR.
  4. Where rescuers are at risk of injury or death.


Special Circumstances


Chest compressions should NOT be performed on any individual suspected of being hypothermic. Regardless of whether or not a pulse is found, ONLY positive pressure ventilations (mouth-to-mask or rescue breathing) should be administered due to the possible fragile electrical state of the heart.

Ensure that ABCs are checked for a full 60 seconds on any patient considered to be hypothermic (core temperature <90°F; 32°C). Evacuate to definitive care slowly and carefully and rewarm the patient’s core, continually checking the warming mechanisms to ensure they remain effective.


CPR should be administered immediately, when safe to do so, to all lightning strike victims who appear breathless and/or pulseless. Respiratory paralysis may continue long after cardiac activity returns.

Cold Water Submersion

CPR should be administered immediately to any unconscious (and not breathing and/or pulseless) patient who has been submerged in cold water (70°F; 21.1°C) for less than one hour.



The above mentioned Wilderness Medical Field Protocol has been authorized by Center for Wilderness Safety Inc. for those who hold current WEMT, WFR, WAFA, WFAA or WFA certification issued by CWS, provided they meet the requirements of the authorization criteria listed under the overall Protocols.

Download the Wilderness Medical Protocols (PDF)

Download • Wilderness Medical Field Protocols

These protocols were written by Jeffrey Isaac, PA-C of WMA, and have been edited and authorized by the executive medical and curriculum directors Kathryn Vaughn, M.D., William Incatasciato, M.D. and Jennifer Kay, RN, BSN for use by Center for Wilderness Safety, Inc.Last Revised: February 2021