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.the first step in rescuing a drowning victim is to bring the victim's mouth and nose above the water surface. for further treatment it is advisable to remove the victim from the water. conscious victims may panic and thus hinder rescue efforts. often, a victim will cling to the rescuer and try to pull themselves out of the water, submerging the rescuer in the process. to avoid this, it is recommended that the rescuer approach the panicking victim with a buoyant object, or from behind, twisting the victim's arm on the back to restrict movement. if the victim pushes the rescuer under water, the rescuer should dive downwards to escape the victim. .drowning victims should be treated even if they have been submerged for a long time. the rule "no patient should be pronounced dead until warm and dead" applies. children in particular have a good chance of survival in water for up to three minutes, or ten minutes in cold water. submersion in cold water can slow the metabolism drastically. there are rare but documented cases of survivable submersion for extreme lengths of time. in one case a child survived drowning after being submerged in cold water for seventy minutes. in another, an eighteen-year-old man survived thirty-eight minutes under water. this is known as cold water drowning.