Cardiopulmonary Resuscitation, or CPR, is a technique used to manually maintain oxygen flow to the brain and other organs when a person’s breathing or heart has stopped. In the context of a water emergency, where drowning has occurred, the need for immediate intervention is urgent because the body is suffering from severe oxygen deprivation, known as hypoxia. The water environment introduces unique challenges that modify the standard procedure. Understanding the correct steps for a water-related resuscitation is important, as the priority for a drowning victim differs significantly from a typical cardiac arrest situation.
The Critical Distinction: Why CPR Cannot Be Done Underwater
The physical mechanics of standard CPR make it impossible to perform effectively while submerged in water. Chest compressions require a firm, stable surface beneath the victim to generate the necessary force and depth to circulate blood. Attempting to press down on a floating body would only push the victim away from the rescuer, failing to compress the chest by the required two inches for an adult.
Delivering rescue breaths underwater is also ineffective and poses a significant risk. It is nearly impossible to maintain a secure, sealed airway while submerged, and attempting to ventilate can force water deeper into the victim’s lungs. Furthermore, the rescuer is put in danger by having to hold their breath and manage the victim’s airway simultaneously. A rescuer’s primary objective must be to get the victim’s head above the water to manage the airway and initiate rescue breathing, as hypoxia is the primary cause of death in drowning cases.
Immediate Care While Still in the Water
For a drowning victim, time spent without oxygen is the most destructive factor, meaning resuscitation efforts must prioritize getting air into the lungs. This contrasts with the standard CPR protocol for a non-drowning adult, which prioritizes chest compressions first. For a person pulled from the water who is unresponsive and not breathing, the correct sequence begins with managing the airway and breathing, following the “Airway, Breathing, Compressions” (ABC) approach.
If a trained rescuer can safely stabilize the victim at the surface or in shallow water, five initial rescue breaths should be started immediately. This is done by tilting the victim’s head back, lifting the chin to open the airway, pinching the nose, and creating a seal over the mouth to deliver a breath lasting about one second. Observing the chest rise confirms a successful ventilation, and this immediate oxygenation is the most important step while the victim is still in the water.
The rescuer should continue providing rescue breaths while carefully moving the victim toward a stable surface. The delivery of these ventilations while towing the victim is a demanding task. If the rescuer is alone and unable to perform in-water ventilations without compromising safety, the priority shifts to the fastest safe removal from the water to begin full CPR.
Transferring the Victim and Initiating Full CPR
Once the victim is being moved out of the water, it is important to minimize unnecessary movement, especially if the drowning incident involved a fall or dive where a spinal injury is possible. While airway and breathing remain the highest priority, the rescuer should attempt to keep the head and neck stabilized during the transfer. The transition to a firm, flat surface, such as the ground, a dock, or a boat, is necessary because effective chest compressions cannot be performed on a floating body.
Upon reaching a stable surface, the rescuer should immediately transition to the full CPR cycle of chest compressions and rescue breaths. The current standard for adults is to alternate 30 chest compressions with two rescue breaths. Compressions should be delivered hard and fast in the center of the chest, aiming for a depth of at least two inches at a rate of 100 to 120 compressions per minute.
The focus on rescue breaths remains paramount for drowning victims, as their cardiac arrest is usually a result of prolonged oxygen deprivation. If the victim vomits, which is common due to water in the stomach, the rescuer must quickly turn the victim to the side to clear the airway before resuming the CPR cycle without delay. Compressions combined with effective ventilations must continue until emergency medical services arrive or the victim shows definitive signs of life.
Essential Safety Guidelines for the Rescuer
The first rule of any water rescue is to ensure the scene is safe, as a panicking victim can inadvertently endanger a rescuer, leading to a second victim. Before entering the water, rescuers should attempt safer methods like “Reach, Throw, Row,” using a pole, rope, or flotation device.
If entering the water is necessary, the rescuer should always use a personal flotation device (PFD) to ensure buoyancy and avoid exhaustion. Untrained individuals should avoid direct contact with a struggling person and instead extend something for them to grab. Self-preservation is the highest priority, and a rescuer should never attempt a rescue that exceeds their swimming ability or training.