Drowning is an emergency where respiratory impairment results from submersion or immersion in liquid, causing a rapid lack of oxygen in the body. This sudden oxygen deprivation, known as hypoxia, is the primary threat to life, distinguishing a drowning incident from a typical cardiac arrest. Immediate cardiopulmonary resuscitation (CPR) requires a modified protocol to address this unique respiratory failure, maximizing the victim’s chances for survival.
Immediate Assessment and Scene Safety
The first consideration for any rescuer must be scene safety; never enter the water unless it is safe, potentially using a reach or throw assist to avoid becoming a second victim. Once a safe environment is established, quickly remove the victim from the water and place them on a firm, flat surface for assessment. Check for responsiveness by tapping the victim and shouting a verbal prompt, such as “Are you okay?”
If the victim remains unresponsive, immediately direct a bystander to call the local emergency medical services (EMS). If the rescuer is alone, they should quickly provide five initial rescue breaths before taking the time to call for help. Activating EMS should not delay the immediate start of resuscitation efforts for an unresponsive, non-breathing victim.
The Protocol Shift for Drowning Victims
The primary difference between CPR for a drowning victim and CPR for a typical collapse is the order of intervention, shifting the focus to rescue breaths first. Drowning is almost always an asphyxial event, meaning the heart stops beating due to a lack of oxygen rather than a primary cardiac issue. Therefore, supplying oxygen to the lungs is the priority action a rescuer can take.
If the victim is unresponsive and not breathing normally—including only gasping—the airway must be opened using the head-tilt, chin-lift maneuver. After ensuring the airway is clear, the rescuer must immediately deliver five initial rescue breaths. This series of breaths rapidly re-oxygenates the victim’s blood before circulation efforts begin.
To administer each breath, the rescuer pinches the victim’s nose shut, forms a tight seal over the mouth, and gently blows until the chest visibly rises. Each breath should last approximately one second. If the chest does not rise after the first attempt, the rescuer should quickly reposition the head and try the breath again.
Performing the Sustained CPR Cycle
After the five initial rescue breaths, the rescuer immediately transitions to the sustained cardiopulmonary resuscitation cycle. This cycle involves alternating between chest compressions and rescue breaths at the standard ratio of 30 compressions followed by two breaths (30:2).
To begin compressions, the rescuer kneels beside the victim and places the heel of one hand in the center of the chest, on the lower half of the breastbone. The heel of the second hand is placed directly on top of the first, with fingers interlaced and lifted off the chest wall. The rescuer’s arms must be straight, with shoulders positioned directly over the hands, using body weight to assist the compressions.
Compressions must be delivered hard and fast, pushing down at least 2 inches (5 to 6 centimeters) into the chest. The compression rate must be maintained at 100 to 120 compressions per minute. Allow the chest to fully recoil after each compression to permit the heart to refill with blood.
The rescuer must continue the 30:2 cycle without interruption, minimizing the time spent between compressions and breaths. If an automated external defibrillator (AED) becomes available, apply it and follow its prompts; however, CPR should not be delayed while waiting for the device. CPR should only be stopped if the victim shows definitive signs of life, such as normal breathing or movement, or if professional medical help takes over.
Post-Resuscitation Care and Monitoring
If the victim regains normal breathing but remains unconscious, immediately place them in the recovery position. This involves gently rolling the victim onto their side, which helps keep the airway clear and reduces the risk of aspiration if vomiting occurs. Support the victim’s head and neck carefully during the roll to prevent further injury.
Continuous monitoring of the victim’s breathing and responsiveness is required until EMS arrives, and the rescuer must be prepared to resume CPR if normal breathing stops. Drowning victims are at risk for hypothermia, especially if the water was cold, so cover them with blankets or dry clothing to conserve body heat.
All individuals involved in a drowning incident, even those who appear fully recovered, require immediate medical evaluation by a healthcare professional. Delayed complications, such as chemical pneumonitis or secondary drowning, necessitate a clinical assessment. Emergency personnel must be informed about the details of the drowning event and the resuscitation efforts performed.