A 2-year-old boy was submerged for at least 20 min in a freshwater creek in Union County, FL. Cardiopulmonary resuscitation (CPR) was administered for approximately 1 h at the scene and during transport to the hospital. On arrival, his Glasgow coma scale score was 3 and rectal temperature was ≤ 26.7°C. He demonstrated respiratory failure, intense vasoconstriction, hemoglobinuria, anemia, hypercoagulability, thrombocytosis, leukopenia, and persistent coma. With intensive care, he began emerging from the coma after 72 h and progressively improved. Testing at the Developmental Evaluation Center and clinical observations showed him to be completely normal by 6 months after drowning. Thus, severe, rapid hypothermia can occur during drowning in cold water in any geographic location and at temperatures above those necessary for ice formation. Hypothermia provides cerebral protection from hypoxia, permitting total recovery with appropriate CPR and intensive care.