Drowning causes respiratory impairment from submersion or immersion in liquid, leading to a lack of oxygen in the body’s tissues. Unlike standard CPR for a sudden cardiac event, where the heart stops first, a drowning victim’s heart often stops after the oxygen supply has been completely depleted. Immediate action focused on restoring oxygen is therefore paramount for survival in this water-related emergency.
Immediate Steps: Safety and Emergency Activation
Before attempting to provide care, the rescuer’s safety must be the first concern. Never enter the water unless you are trained in water rescue and possess appropriate flotation devices. Once the victim is safely removed from the water and placed on a firm, flat surface, check for responsiveness by tapping their shoulder and shouting to them.
If the victim does not respond, immediately call 911 or direct a bystander to do so. Instruct them to specify that the emergency is a drowning and to locate an automated external defibrillator (AED) if one is available nearby. The victim should be positioned face-up on a hard surface to ensure that chest compressions can be delivered effectively. Do not waste time attempting to remove clothing or perform any other non-CPR actions.
The Drowning Protocol: Initial Rescue Breaths
Because a drowning victim suffers from a severe lack of oxygen, the resuscitation protocol prioritizes getting air into their lungs immediately. The rescuer must start with five initial rescue breaths before moving to chest compressions. These initial ventilations are designed to overcome hypoxia and deliver oxygen to the body’s systems.
To deliver the breaths, open the victim’s airway using the head-tilt/chin-lift maneuver, which involves gently tilting the head back while lifting the chin. Pinch the victim’s nose shut to prevent air leakage, then create a complete seal over their mouth with your own. Deliver a breath lasting about one second, watching for a visible rise of the chest to confirm success.
Repeat this process four more times, ensuring the chest falls after each successful breath. Do not attempt to drain water from the victim’s lungs or stomach by pressing on their abdomen or performing the Heimlich maneuver. These actions are dangerous, delay oxygen delivery, and can cause the victim to vomit, increasing the risk of aspiration. The minimal water present will not significantly impede the rescue breaths.
Sustained Resuscitation: Compressions and Ratios
If the victim remains unresponsive and is not breathing normally after the five initial rescue breaths, the rescuer must immediately transition to the combined cycle of chest compressions and breaths. The ratio is 30 compressions followed by two breaths (30:2). This cycle must be maintained with minimal interruption to ensure continuous blood flow and oxygen delivery.
To perform chest compressions, place the heel of one hand on the center of the victim’s chest, on the lower half of the breastbone. Place your second hand on top of the first, interlocking your fingers. Ensure your shoulders are directly over your hands with your elbows locked straight. Push down hard and fast, compressing the chest by about two inches (five centimeters) at a rate between 100 and 120 compressions per minute.
After delivering the set of 30 compressions, return to the head-tilt/chin-lift position and deliver two rescue breaths, each lasting one second and causing a visible chest rise. The two breaths should take no longer than ten seconds to complete. If a second rescuer is present, the switch between them should occur every two minutes to prevent fatigue, which can compromise the quality and depth of the compressions.
Transitioning Care and Post-Resuscitation Monitoring
CPR should be continued without pause until professional emergency medical services (EMS) arrive and take over care or the victim begins to show signs of life. Signs of life include normal breathing, coughing, or any purposeful movement. Rescuer exhaustion is the only other acceptable reason for a single rescuer to stop CPR before professional help arrives.
If the victim begins breathing normally but remains unconscious, they should be immediately placed into the recovery position. This involves gently turning them onto their side, which helps keep the airway open and allows fluids, such as vomit, to drain out of the mouth. Even if the victim appears to recover fully, they must receive professional medical follow-up, as complications like “secondary drowning” or acute respiratory distress syndrome can occur hours later.
Drowning victims are susceptible to hypothermia, so their body temperature must be monitored and managed immediately. Remove wet clothing if possible and cover the victim with blankets or towels to provide warmth. Providing care is generally protected by Good Samaritan laws, but formal CPR and first aid training remains the best way to prepare for such situations.