You’re leading a canoe trip on the Rio Grande River in Big Bend. It’s been hot, with temperatures of 97°F (36°C) day after day and evening lows 70°F (21°C). Today you paddled for a few hours after a long morning hike up a side canyon and now are floating lazily watching a bird. Your observations are interrupted by yells for help downstream. You paddle to a beached canoe and several people on shore. One of your participants shouts that George is having a seizure.
George is on his back in obvious pain with his legs quivering. His arms seem to be moving appropriately. The other participant is insisting this is a seizure. You’re not so sure. Your scene size-up tells you George is wet, no one is in the water, and there are no obvious hazards. You learn that these “seizures” started when George was kneeling in the canoe. He fell into the water near shore when he tried to exit the canoe and was not submerged. You don your gloves and do your initial assessment.