Open water swimming (OWS), either ‘wild’ such as river swimming or competitive, is a fast growing pastime as well as a part of events such as triathlons. Little evidence is available on which to base high and low water temperature limits. Also, due to factors such as acclimatisation, which disassociates thermal sensation and comfort from thermal state, individuals cannot be left to monitor their own physical condition during swims. Deaths have occurred during OWS; these have been due to not only thermal responses but also cardiac problems. This paper, which is part of a series on ‘Moving in Extreme Environments’, briefly reviews current understanding in pertinent topics associated with OWS. Guidelines are presented for the organisation of open water events to minimise risk, and it is concluded that more information on the responses to immersion in cold and warm water, the causes of the individual variation in these responses and the precursors to the cardiac events that appear to be the primary cause of death in OWS events will help make this enjoyable sport even safer.