Drowning is medically defined as experiencing respiratory impairment due to submersion or immersion in a liquid. This leads to a lack of oxygen, which rapidly affects the brain and other organs, making it a time-critical medical emergency. The outcome of a drowning incident depends entirely on the speed and effectiveness of the immediate response. Understanding the precise steps for rescue and life support is paramount to preventing severe, long-term consequences.
Immediate Response and Safe Rescue
The primary rule in any water rescue is ensuring the safety of the rescuer. Before attempting any rescue, immediately activate Emergency Medical Services (EMS) by calling 911 or the local emergency number, providing your exact location. Untrained rescuers should adhere to the “Reach, Throw, Row, Go” sequence, prioritizing methods that keep them out of the water.
If the victim is close, reach out with a long object like a pole or branch, or throw a flotation device. Only trained professionals should enter the water for a direct contact rescue, as a panicking victim can inadvertently pull a rescuer under the surface. If the person may have sustained trauma, stabilize their head and neck while supporting them on a buoyant object until trained help arrives.
Administering Emergency Life Support
Once the victim is safely removed from the water and placed on a firm, flat surface, assess their responsiveness and check for normal breathing. Since drowning causes a lack of oxygen, resuscitation guidelines prioritize ventilation immediately. Anyone removed from the water who is unresponsive and not breathing normally should be assumed to be in cardiac arrest due to hypoxia.
The first action is to open the airway and deliver five initial rescue breaths before beginning chest compressions. This approach ensures oxygen is delivered to the lungs first, which is the primary need in a drowning event. After these initial breaths, begin Cardiopulmonary Resuscitation (CPR) with a cycle of 30 chest compressions followed by two rescue breaths.
Compressions should be delivered hard and fast, at a rate of 100 to 120 per minute, allowing the chest to fully recoil between each push. For an adult, compress the chest to a depth of at least two inches. For a small child, a one-handed technique may be used to reach a depth of about two inches. In the case of an infant, use two fingers or two thumbs to compress the chest by about one and a half inches.
Be prepared for the victim to vomit, as water and air may have entered the stomach. If the victim vomits, quickly turn their head to the side to clear the airway before resuming compressions and breaths. Continue the 30-to-2 cycle of CPR until professional medical personnel take over or the victim begins to show clear signs of life, such as purposeful movement or normal breathing.
Post-Rescue Care and Stabilization
Once the victim is breathing effectively on their own, the focus shifts to maintaining stability while awaiting the arrival of EMS. If the person is conscious or breathing normally, place them in the recovery position—on their side with the top knee bent—to keep the airway open and reduce the risk of aspiration if they vomit. Continuously monitor their breathing and level of consciousness, as their condition can deteriorate quickly.
Drowning victims often experience hypothermia, especially if the water was cold. Remove any wet clothing and cover them with blankets or warm towels to conserve body heat. Rescuers should never attempt to drain water from the victim’s lungs using techniques like the Heimlich maneuver, which is ineffective and risks injury or aspiration. Prompt rewarming and observation are the primary concerns until advanced medical help arrives.
Understanding the Risk of Delayed Complications
Even if a person appears to recover quickly after a drowning incident, they must be transported to a hospital for immediate medical evaluation. The term “drowning” is now used regardless of the outcome, and terms like “secondary drowning” or “dry drowning” are discouraged in clinical settings. The underlying risk is a delayed respiratory complication caused by inhaled water irritating the lungs.
A small amount of aspirated water can wash away surfactant, a substance that keeps the tiny air sacs in the lungs open. This damage can lead to inflammation and a buildup of fluid in the lungs, known as pulmonary edema, which impairs oxygen exchange hours after the event. This delayed respiratory distress can be serious and life-threatening.
Warning signs of these delayed complications typically appear within the first 24 hours after the incident. These symptoms include persistent coughing, difficulty or rapid breathing, chest pain, and unusual fatigue or lethargy. Any individual who has struggled in the water and exhibits these signs needs immediate professional medical attention. Hospitalization allows doctors to monitor oxygen levels and intervene quickly if the delayed lung injury progresses.