Drowning causes respiratory impairment from submersion in water, leading to a severe lack of oxygen (hypoxia) in the body’s tissues. This oxygen deprivation rapidly causes the heart to stop beating, resulting in cardiac arrest. Immediate and effective intervention is necessary to prevent irreversible brain damage or death. The actions taken by a bystander significantly influence the victim’s survival and neurological outcome. This guide provides instructions for performing cardiopulmonary resuscitation (CPR) specifically tailored for a person who has experienced a drowning incident.
Essential Steps Prior to Starting CPR
The first priority in any rescue situation is the safety of the rescuer, as entering the water if you are untrained can lead to becoming a second victim. Use any available reaching or throwing aids to bring the person to safety without entering the water if possible. Once the person is safely out of the water and on a firm surface, immediately check for responsiveness by shouting and gently tapping the person.
If the person does not respond, activate the emergency medical services (EMS) system by calling the local emergency number. If another person is present, send them to make the call and, if available, retrieve an automated external defibrillator (AED). Most jurisdictions have Good Samaritan laws designed to offer liability protection to individuals who provide reasonable emergency care in good faith, encouraging bystanders to intervene without fear of unwarranted prosecution.
The Importance of Initial Rescue Breaths
Resuscitation for a drowning victim differs fundamentally from the protocol used for a sudden cardiac arrest caused by a heart problem. In typical cardiac arrest, the heart stops suddenly, but the blood remains oxygenated for a short period. For a drowning victim, the root problem is a severe lack of oxygen because breathing has stopped, which then causes the heart to fail. This condition is known as asphyxial cardiac arrest.
The immediate priority is to deliver oxygen to the lungs before trying to circulate the existing, deoxygenated blood. Starting with rescue breaths offers a better chance of survival for people whose cardiac arrest is caused by respiratory failure, such as in drowning. Therefore, after confirming the person is unresponsive and not breathing normally, the rescuer should immediately provide rescue breaths first, before beginning chest compressions.
Performing Chest Compressions and Rescue Cycles
After safely moving the victim onto a flat, firm surface, the rescuer must deliver five initial rescue breaths to quickly introduce oxygen into the bloodstream. Open the airway using the head-tilt/chin-lift maneuver, pinch the nose closed, and form a tight seal over the mouth. Each breath should be delivered over approximately one second and be just enough to cause a visible rise of the chest.
Following these five initial breaths, the rescuer must begin cycles of chest compressions and breaths. The recommended cycle for a single rescuer, regardless of the victim’s age, is 30 chest compressions followed by two rescue breaths (the 30:2 ratio). Compressions should be delivered rapidly at a rate between 100 and 120 compressions per minute. In all cases, it is important to allow the chest to fully recoil after each compression to permit the heart to refill with blood.
Adult Compression Technique
For an adult, the compression depth should be between 2 and 2.4 inches. Use the heel of one hand with the other hand interlaced on the center of the breastbone.
Child and Infant Compression Technique
Resuscitation techniques vary slightly for smaller victims, though the overall ratio remains the same for a single rescuer.
For a child, the compression depth is about 2 inches, or approximately one-third the depth of the chest. The rescuer may use one or two hands as appropriate for the child’s size.
For an infant, the compression depth should be about 1.5 inches, or one-third the chest depth. Compressions are administered using only two fingers placed in the center of the chest just below the nipple line.
If a second trained rescuer is present for a child or infant, the compression-to-ventilation ratio changes to 15 compressions followed by two breaths.
Monitoring and Transitioning to Post-Resuscitation Care
The rescuer must continue the 30:2 compression and breath cycles without interruption until one of three events occurs: the person begins to move or breathe normally, an AED becomes available and is ready to use, or trained emergency medical personnel arrive to take over. Brief pauses, not exceeding ten seconds, are permissible only to deliver the two rescue breaths. Rescuers should not stop CPR to check for a pulse or breathing unless the person shows obvious signs of recovery.
If the person regains consciousness or begins breathing effectively, they should be immediately moved into the recovery position by gently rolling them onto their side. This position helps keep the airway open and allows any water or vomit to drain out of the mouth, preventing aspiration into the lungs.
Even if the person appears to have recovered completely and seems fine, they must be transported to a hospital for immediate medical evaluation. Drowning can cause delayed complications, such as pulmonary edema from fluid accumulation in the lungs, which can worsen hours after the incident. A medical professional must assess for these potential issues to ensure a full and safe recovery.