To be permissive or not to be, is it the question?

Sir, Resuscitation following submersion (head under) remains a matter of some debate and a stumbling block to achieving a common policy between rescue services. We have suggested that survival/resuscitation is extremely unlikely if submerged longer than 30 min in water warmer than 6 °C and, survival/resuscitation is extremely unlikely if submerged longer than 90 min in water 6 °C or below. 1 and 2 We have been criticised for being insufficiently permissive by suggesting limiting a search to 30 min in water warmer than 6 °C. Given this, I was encouraged to read the paper by Quan et al.4 and their support for our position for water warmer than 6 °C. However, Quan et al. also state that “this statement is also true for water temperatures of 6 °C or below”. This is in contrast to our conclusion, indeed Quan et al. state that “Tipton's statement that “survival/resuscitation is extremely unlikely if submerged longer than 90 minutes in 6 °C or below” isoverly permissive”.