An unresponsive individual in the water is a severe medical emergency requiring immediate and organized action. Drowning is defined as respiratory impairment from submersion or immersion in a liquid medium. The primary danger is hypoxia, a lack of oxygen, which rapidly leads to cardiac arrest and brain injury. Acting quickly and sequentially is paramount for a positive outcome.
Prioritizing Safety and Activating Emergency Services
Before attempting any rescue, a lay rescuer must first ensure their own safety to avoid becoming a second victim. The established hierarchy of water rescue techniques should be followed: Reach, Throw, and only then Go (swimming) if trained and necessary.
Once the situation is safe, or if another person is present, emergency medical services (EMS) must be activated by calling 911 or the local emergency number. Provide the dispatcher with the precise location and state that a drowning event has occurred. Early notification ensures advanced medical aid arrives quickly.
Water Removal and Primary Victim Assessment
The person must be removed from the water quickly and placed onto a firm, flat surface to begin assessment and resuscitation. While there is concern for potential spinal injury, the immediate need for oxygen takes precedence over spinal precautions, which can delay life-saving CPR. The victim should be brought to shore in a near-horizontal position to maintain the airway.
Upon removal, check for responsiveness using the “shout-tap-shout” method, gently tapping the person and speaking loudly. If there is no response, assess their breathing for no more than 10 seconds. Look for chest movement, listen for air movement, and feel for breath.
It is necessary to differentiate between normal breathing and abnormal patterns, such as agonal gasps. Agonal breathing sounds like snorting, gurgling, or labored, shallow breaths, occurring when the brain is deprived of oxygen. If the person is unresponsive and exhibiting these gasps, they are considered not breathing normally, and immediate intervention is required.
Responding to Lack of Normal Breathing
Because the primary cause of cardiac arrest in drowning is hypoxia, the resuscitation protocol prioritizes getting air into the victim’s lungs. Rescuers should follow the Airway, Breathing, Compressions (A-B-C) sequence, which differs from the standard Compressions-first approach. The first intervention is to open the airway using the head-tilt/chin-lift technique and deliver five initial rescue breaths.
If the victim remains unresponsive after the initial breaths, chest compressions must begin immediately. The compression rate should be 100 to 120 compressions per minute, pushing hard and fast in the center of the chest. Compressions are cycled with rescue breaths at a ratio of 30 compressions followed by two breaths (30:2).
An Automated External Defibrillator (AED) should be applied as soon as one is available, but retrieval must not delay the start of CPR. The chest should be dried quickly before the pads are attached to ensure effective shock delivery. If vomiting occurs, quickly turn the victim onto their side to clear the airway before immediately resuming the compression-breath cycle.
Ongoing Care While Awaiting Medical Personnel
If the victim regains consciousness or starts breathing normally but remains unresponsive, immediately place them in the recovery position. This involves rolling them onto their side, which helps maintain an open airway and allows fluids, such as water or vomit, to drain from the mouth, preventing aspiration.
Continuous monitoring of the person’s breathing and responsiveness is necessary, as their condition can change suddenly. Address the risk of hypothermia by removing wet clothing and covering the victim with blankets or towels to retain body heat. All drowning victims who required resuscitation must be transported to a hospital for evaluation due to the risk of delayed complications.
When EMS arrives, provide a concise handover, relaying what happened, the estimated time submerged, and the specific interventions performed. Accurate information assists the medical team in determining the next steps of advanced care.