Case Study 2

The Scenario: Falling Through the Ice

The Setting

You and three friends are on a ski trip in northern Minnesota. Today’s temperature is in the range only a Minnesotan could love. To shorten the route, the group decided this morning to cut across a lake, despite previously telling yourselves to avoid the lakes due to thin ice.

About 20 yards from shore you warn the others of “funny ice,” and suggest you turn around.  As you stop to talk it over with your companions, you break through the ice and sink up to your chest, gasping and struggling in the icy water. Fortunately your pack was partially wedged on the ice and keeps you from going completely through.

Remembering their scene size-up priority of rescuer safety (and scared they would also break through) your companions retreat to safety.  Once safe, they coach you to relax, which you find amusing considering you’re the person in the water. You are able to release your pack, but then slip into the water up to your chin. You struggle for a few minutes, gasping and hyperventilating, before realizing you are standing on the lake bottom.  After calming your breathing, you release the ski bindings and with the help of your companions using their extended skis you crawl out of the water, onto the ice, and away from danger.

The light is fading and the sun is ending its all too brief appearance of the day. It is 15°F (-9.4°C). Your clothing and hair quickly freeze. You are shivering. It dawns on you that the chest-deep water was not the only danger you will face today.

Your companions, all Wilderness First Responders, get to work. 

SOAP Report


The patient is a 26-year-old male who fell into a lake while skiing. The patient was able to self-extricate.  Patient is presently complaining of being very cold, is shivering violently, and is unable to help himself.


Patient Exam:

The patient was not submerged and has no apparent injuries.

Vital Signs:


1530 hrs.




110, strong, regular


28, shallow, regular


pale, cool, dry


strong radial pulse


not noted


not taken







Occasional non-prescription pain medication, none taken today.

Pertinent Hx:

None relevant.

Last in/out:

Breakfast & lunch today, 1 liter of warm tea at 0800hrs.


None relevant.

Stop ...

What is your Assessment and Plan?

DO NOT click/peek at the next page without answering this first.