The team share the logistical and clinical challenges of managing a trapped paddler for over 20 hours on the remote Tasmanian Franklin River. A 65-year-old male is trapped at the knee with water up to his chest on the Coruscades Rapid in the Great Ravine on the Franklin River wearing a 7mm wetsuit and buoyancy aid. The team explore the team composition, skill diversity, shared decision making, adaptive problem solving, and strengths-based role allocation that shaped patient survival. They discuss the strategies employed to slow worsening hypothermia while technical swift water rescue teams attempt to free him from the 14°C water. They discuss aspects of improvised surgical amputation, modified RSI, hypothermic cardiac arrest, hypothermic neuroprotection, complex winch extraction and mechanical CPR as a bridge to ECMO.