HYPOTHERMIA from surfing in cold water should not be dismissed as something that kills the weak and niave. Hypothermia has the potential to catch us all off guard at some point, no matter how experienced we think we are.

It kills. How it kills depends on the situation.

Most of us can hopefully spot when we’re starting to ‘slow down’ from the effects of hypothermia, and ‘catch the next one in’. But then what? The risk isn’t necessarily over. There was a tragedy in Cornwall not so long ago of a few lads dying on their way home from a surf. They stayed in their wetties in their van, presumably to try and keep warm (only works for very short distances), and came off the road with horrific consequences. The accident was thought to be caused by hypothermia.

Wetsuits are so much better these days. No one is probably putting their lives at risk quite as much as we used to paddling out on a -20 wind chill winters day. Most of the people that pitch up to hospital with severe problems from hypothermia in the sea have usually not intended to be in the sea in the first place, or had been kept in it for a lot longer than they wanted (rip current etc).

Early Morning Stuff

Understanding the signs and symptoms of hypothermia is important if you’re a cold water (and warm for long sessions) surfer and value the safety of yourself and those around you. Taming your ego & arrogance that you know what you’re doing, and that it won’t happen to you, should be your first step to achieving this.

Everyone’s different right? I was amazed last year in the Maldives watching an American pulled on a long sleeve neoprene rashie on a cloudy day to ‘keep warm’. I thought he was on glue. I was basking! But then I live in the UK where we live in neoprene all year round. An Ode to Winter..

The diagram below shows how people are affected by the cold differently. It seems that people are born different, but can also aclimatise (to warm or hot) to some extent. Clearly age and the amount of fat (insulating) you carry makes a big difference.

Surfing hypothermia
Everyone ‘feels’ the cold differently. The better the wetsuit and it’s fit, the longer you have.


I’ve always tried to buy the best wetsuit I’ve been able to save up for. Apart from being super stretchy, & lined with organic cinnamon charcoal or whatever, a good one could save your life. It’s worth the investment. The warmer they keep you the longer you avoid getting hypothermia. I’m not going to go into what to look for in a good wetsuit. Others are more qualified to tell you that. Just make sure they fit.

Pissing into them used to keep you going for longer. Now they don’t flush water through them anywhere near as much this as the charming effect of making you, and your towel, and your suit, and your car stinking of piss. Not cool. Excuse the pun.

Frigid & Fun.


Think of it as a scale, not an endpoint. As your body cools the number of side-effects and their severity increases. Most cold water surfers put them selves on this scale each session.

If you read the books they will give you core body temperatures at which it occurs, but I find that pointless in practice. Who surfs with a thermometer?

The key is to be aware of the points on the ‘hypothermia scale’ and try and recognise when you (or others) are moving along it, so you can act to warm yourself.

This really is the key to surviving hypothermia.

Your feet feeling like ice blocks, your hands not responding and ice cream headaches aren’t signs of hypothermia. They’re just signs that your environment is cold, and perhaps you’re not as well covered in neoprene as you could be. These signs could be occuring however alongside more subtle signs of the killer.

Your body relies on a complex & dynamic array of chemical (metabolic) reactions that need to be constantly occuring to survive and function normally. Cooling slows these reactions and prevents the body from functioning normally. For every degree celsius drop of your core temperature your metabolic rate drops by 4%. Heart arrhythmias caused by hypothermia (and severely impaired chemical reactions) allegedly was responsible for more deaths than drownings during the Titanic disaster.

Basically with a body temperature drop of 1-2 degrees celsius you’ll shiver, have reduced dexterity (zips & keys), numb extremeties and find it a bit harder to concentrate & think about stuff. Temperatures lower than this mean that your decision making and endurance is seriously impaired & you’re at significant risk of drowning. Temperatures still lower and you’re at risk of death regardless of drowning prevention.

Effect on Breathing

Being suddenly immersed in cold water, after the initial gasp, usually leads to a significantly increased breathing rate. This isn’t a voluntary response and can be hard to control. The effect of this increased inbuilt drive to breath is that it can be harder to hold your breath for as long as you’re used to in warmer water. Increased breathing rates also make you more susceptible to developing a wheeze if you’re asthmatic. Cold air inhaled rapidly is a common trigger for asthma.

Effect on Paddling/swimming

A number of studies have been done looking at the performance of swimmers in different temperature water. It’s been shown that as the water gets colder (even in the most experienced swimmers) that a decrease in stroke length and a resultant increase in energy expenditure to travel the same distance was experienced. Combine that with the thicker neoprene that you’re used to and you realise why we’re not aquatic mammals.

Cold water surf
Winter Stoke. Eileens.


Ice (s)cream headache. The nemesis of all cold water surfers. Often the reason given by the older gents of the line up as to why they won’t surf through the coldest months of winter. It hurts. Makes you feel sick, see stars and can ruin an otherwise epic surf.

Have you ever noticed why the headache is worse (and gets worse) as you’re paddling out after a wave? Rather than being under water getting nailed. Wind chill on a freshly submerged skull is agony. Why? This is my ice cream theory..

Everyone know that you’re tissues contain blood vessels, and that these vessels expand and collapse in response to your bodies temperature ASWELL as the environmental temperature. You’re head may be exposed to the elements, but if your body is wrapped up in state of the art neoprene, and you’re busting a gut to get through the winter groundswell peeling off your local sand bank, the you’re getting HOT. Your head will be used as a way of helping prevent your body getting too hot. The vessels under your scalp will be nice and expanded helping your body lose heat.

Then comes the duck dive. It’s cold water. Say 14 degrees. But the pains not there. It’s just really cold. Then as your head breaks back to the surface and the wind hits you the pain begins. Evaporation is a really efficient source of heat loss. All of a sudden your head (tissue) thinks been thrown into a sub-artic environment and quickly tries to constrict all your blood vessels. This causes ‘vasospasm’ which is painful.

Cold water suddenly entering your ear canal can cause a reflex called the calorific reflex. This can stimulate the vomit centre in your brain and make you want to throw.

Just a theory.

cold water bodyboarding
Seriously cold.


Apply common sense to this! If you jump in the North Atlantic in February naked, the signs are going to come on thick and fast (dead in 10-15 minutes). They would be less rapid if you’re wearing a well-fitting good quality wetsuit and accessories.

Having said that, your body will try and keep your body at normal temperature (normothermic) for as long as possible (by shivering and burning off easily accessible energy stores). It can’t do this indefinately (everyone is different), and the decline after this initial compensation can be rapid, even in a decent wetsuit.

The following are signs that you are starting to develop mild hypothermia and should be looking to catch a wave in:

  • Shivering. Your body is trying to generate more heat to keep your core (not your toes) warm. A good test is to see if you can stop yourself shivering. If you can you only have mild hypothermia. Having said that, if your hypothermia is getting severe, your body gives up on trying to shiver.
  • Purple extremities. Your body is no longer wanting blood to go to the cold bits
  • Pissing loads. As you get colder your blood vessels to your extremities close, your heart rate increases and your blood pressure rises. This can cause you to urinate more than usual and get dehydrated. This can make you feel horrible and be at risk of fainting when you re-warm.

The following are signs that you need to urgently get out, get dry and get warm:

  • Tiredness. This is subtle at first and gets more and more severe. Don’t just put it down to the pumping surf and the fact you got up at 5am.
  • Delayed thoughts. You know what I mean. When you are maybe aware that you’re slowing down, maybe, but the very act of thinking about your thoughts slowing down isn’t that easy, maybe. This is called dazed consciousness. Don’t be an idiot. Paddle in, get dry & get warm.
  • Slurred speech. Don’t think your mouth isn’t working because it’s cold. Your brain is not working properly (not an insult) and it can’t give your mouth clear instructions.
  • Bad surfing! You start to loose your fine motor control. Don’t just think you’re having a bad day or that your wettie is too thick. Get out, get dry & get warm.
  • Irrational behavior. If your mate starts doing more weird things than usual, be suspicious!
  • When the shivers begin to get more severe, then start having pauses between them things are getting serious.

Have a look at the following table to see the different signs of hypothermia. You can read it better if you click on it.

hypothermia symptoms
Know the signs. Click to enlarge.

Surf Canada
Surfing Lake Ontario in Canada. As core as it gets.



  • Make sure you’ve eaten (at least an hour before) and are well hydrated
  • Some of my mates swear by driving to the surf in a dry wetsuit to save losing heat by changing outside. Don’t drive home in a wet one.
  • Have plenty of dry layers to put on when you get out.
  • Thermos of a hot sweet drink or soup for when you get in.
  • There is no role for a ‘warming spirit’ or tot of whiskey before a surf. This is actually really dangerous for added reasons than perhaps surfing smashed!
  • Piss in your suit. I can’t find any evidence that this actually makes any difference in keeping you warm in the long run. That’s not going to stop me doing it! There is evidence that too much caffine makes you loose lots of heat through your urine!
  • Never surf after drinking booze. Alcohol makes you lose heat quicker. Beware the morning after.
  • Read these top ten tips by the editor of UK Carve magazine.
Wax or de-icer?


  • Get emergency medical help
  • As a general rule, if the hypothermia came on slowly (not sudden emersion) then it should be reversed slowly. No dunking surfers that have had a 5 hour session and are struggling from hypothermia in a hot bath.
  • keep them horizontal during and following removal from water. This prevents a sudden fall in blood pressure.

I’ll never complain of being cold again (maybe) after watching this movie. Its a different gravy!


Inhaling & swallowing cold water drops your body temperature. This can cause your heart to have problems beating properly. Having said that, the cold could be a blessing in disguise in the longterm, so don’t be put off attempts at resuscitation.

We are planning to write a detailed article on drowning and basic life support soon.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.

This website is designed to provide general practical information not specific medical advice.

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