BACKGROUND: Hypothermia is frequently observed in near-downing victims, and rewarming is difficult to control. We describe the use of an automatic heating system (Arctic Sun Temperature Management System). The device consists of hydrogel coated pads that adhere to the patient's abdomen, back and thighs, and react to patient temperature by automatically adjusting the circulating pad water temperature to achieve a preset patient target temperature. Temperature is measured by a bladder temperature probe. The process of warming can be adjusted to allow the body temperature to increase at a rate from 0.5 to 1.0 degree C h(-1). CASE REPORT: A 62-yr-old woman was rescued from the Vistula river after a suicide attempt. The temperature of the river water was 150C and it was not possible to estimate the time she was submerged. On admission she was conscious and maintaining partially logical communication. She was hypothermic (temperature measured in the bladder was 32.7 degrees C), and dyspnoeic (SaO2