Cardiopulmonary Resuscitation (CPR) is an emergency life-saving procedure that combines chest compressions with artificial ventilation to preserve brain function. It is a critical intervention during cardiac or respiratory arrest. However, CPR cannot be effectively performed underwater due to physical and physiological limitations of the aquatic environment.
Why CPR Requires a Dry, Stable Surface
Effective chest compressions necessitate a firm, stable surface beneath the person receiving aid. Compressions work by rhythmically pressing the sternum downward to circulate blood. This action requires significant resistance from the surface underneath, allowing the rescuer’s force to displace the sternum towards the spine. In water, buoyancy and the lack of a solid base prevent the necessary counter-pressure, making compressions ineffective.
Maintaining an open airway and delivering rescue breaths are also impossible when submerged. Water resistance makes it difficult to establish a tight seal around the person’s mouth and nose. Any attempt at ventilation underwater would force water into the lungs. The water’s instability also compromises rescuer positioning and efficiency, making it challenging to perform effective resuscitation.
Immediate Steps in a Drowning Emergency
The immediate priority in any drowning emergency is rescuer safety. Never enter the water to attempt a rescue if untrained, if conditions are unsafe, or without appropriate equipment. Instead, the “Reach or Throw, Don’t Go” principle advises using a reaching aid or throwing a flotation device to the person in distress. If safe entry is possible, remove the person from the water as quickly as possible.
Once removed, place the person on a firm, flat, and dry surface. Check for responsiveness by gently tapping and shouting. Simultaneously, assess for normal breathing by looking for chest rise and fall for no more than 10 seconds. If unresponsive and not breathing normally, call emergency services immediately.
Performing CPR After Water Rescue
After a person is safely removed from the water and placed on a firm surface, immediate Cardiopulmonary Resuscitation (CPR) is crucial. Unlike cardiac arrests from other causes, drowning incidents primarily involve a lack of oxygen (hypoxia). Therefore, for drowning victims, CPR guidelines emphasize starting with rescue breaths to rapidly re-oxygenate the person.
If trained, begin by giving five initial rescue breaths to deliver oxygen to the lungs. Tilt the head back and lift the chin to open the airway, pinch the nose, and give slow breaths, ensuring the chest rises. Following these breaths, immediately start chest compressions at a rate of 100 to 120 compressions per minute. Compress the center of the chest to a depth of at least two inches for adults, allowing the chest to fully recoil.
The standard CPR cycle involves 30 chest compressions followed by two rescue breaths, continuing this ratio. If an automated external defibrillator (AED) is available, use it as soon as possible after the person is out of the water, though CPR should not be delayed to retrieve it. Continuous, high-quality CPR should be maintained until professional medical help arrives, the person shows signs of life, or the rescuer is too exhausted to continue.
Key Drowning Prevention Strategies
Preventing drowning incidents is the most effective way to avoid the need for emergency CPR. Consistent supervision is paramount, especially for children around any body of water. Drowning can occur silently and quickly. Designating a “water watcher” solely focused on supervising those in the water can reduce risk.
Install proper barriers around water bodies, such as four-sided fences with self-closing and self-latching gates around pools, to prevent unsupervised access. Enrolling children and adults in formal swimming lessons can equip individuals with essential water safety skills. The use of U.S. Coast Guard-approved life jackets is important for non-swimmers and weak swimmers, particularly in open water or during boating activities. Learning CPR and basic water rescue skills provides valuable preparedness for unexpected aquatic emergencies.