Drowning is a rapid and silent emergency requiring an immediate, yet carefully considered, response. Unlike dramatic struggles, a person drowning often shows little outward distress, typically positioned vertically and unable to call for help. Since brain damage can begin within four to six minutes without oxygen, fast action is paramount. However, the fundamental rule in any rescue scenario is the safety of the rescuer, making a systematic, low-risk approach the most effective way to save a life.
Scene Assessment and Prioritizing Rescuer Safety
The first action upon recognizing a water emergency is to immediately call for emergency medical services (911 or your local equivalent) and keep the line open. While calling, the rescuer must conduct a rapid scene assessment to identify any hazards that could compromise their own safety, such as strong river currents, submerged debris, sudden drop-offs, or the risk of hypothermia.
A crucial part of this initial assessment is distinguishing between an active and a passive victim, as this dictates the rescue approach. An active victim is conscious but instinctively struggling, pressing down on the water’s surface to keep their mouth above the waterline. A passive victim is motionless, floating face-down or submerged, which may indicate unconsciousness due to exhaustion or a medical event. The rescuer should also quickly locate any available rescue aids, such as flotation devices, long poles, or rope, to prepare for a non-contact rescue attempt.
The Sequence of Non-Contact Rescue Methods
The safest and most preferred methods of rescue adhere to the “Reach, Throw, Row, Go” sequence, which prioritizes keeping the rescuer out of the water entirely.
Reach
The first step, “Reach,” is appropriate if the victim is close to the edge of a pool, dock, or shore. The rescuer should extend a long, rigid object, such as a pole, branch, or towel, toward the victim. The rescuer must lie flat or anchor their body securely on the ground to prevent being pulled in. This method is the quickest and carries the least risk.
Throw
If the victim is too far away to reach, the next step is to “Throw” a buoyant object that the victim can grab onto. This involves using a ring buoy, a throw bag with a line, a life jacket, or a buoyant object like a cooler. The object should be thrown past the victim so they can retrieve it, and the line can then be used to pull them back to safety. This action provides immediate flotation and helps keep the victim’s airway clear.
Row
The third option, “Row,” is used when the victim is farther from the shore or dock and a boat or watercraft is available. The rescuer should use the boat to approach the victim, always wearing a personal flotation device, and then extend a paddle, oar, or rope for the victim to grasp. If stable footing is guaranteed in very shallow water, a supervised “Wade” can be performed, but the rescuer must still carry a flotation device for support and maintain a distance from the panicking victim.
Entering the Water: Contact Rescue as a Last Resort
Entering the water for a “Go” rescue is the final, most hazardous option and should only be attempted when non-contact methods have failed and the rescuer is a strong swimmer with specific water rescue training. The single most significant danger is the instinctive, panic-driven grasp of a conscious victim, whose strength can inadvertently pull the rescuer under the water. Therefore, the rescuer should always enter the water with a flotation device, such as a rescue tube or life jacket, to place between themselves and the person in distress.
The safest approach is to swim toward the victim from behind, avoiding their line of sight to prevent them from grabbing the rescuer. If the victim is active and panicking, the rescuer should stay just out of reach and only make contact after placing the flotation device between them. For an unconscious or passive victim, the approach is still from behind, securing them using a specific carry, such as the cross-chest carry, while taking care to keep their head and airway above the water. If a victim grabs the rescuer, the trained response is to immediately take a deep breath and submerge, as a drowning person will often release their grip in an attempt to push off and return to the surface.
Immediate Care After Extraction
Once the person is safely out of the water, immediate care shifts from rescue to stabilization, starting with an assessment of their responsiveness and breathing. If the victim is conscious and breathing normally, they should be covered with blankets to help prevent hypothermia, which is a common and potentially severe complication of cold water immersion. Even if they appear fine, all victims of a drowning incident require immediate medical evaluation, as pulmonary complications like chemical pneumonitis can develop hours later.
If the victim is unresponsive and not breathing, the rescuer must immediately begin cardiopulmonary resuscitation (CPR). Unlike cardiac arrests from other causes, drowning-related cardiac arrest is primarily due to a lack of oxygen, making rescue breaths a particularly important component of initial resuscitation. CPR starts with five initial rescue breaths before alternating with chest compressions. If the victim is unresponsive but has a pulse and is breathing, they should be placed into the recovery position, which is on their side with the head supported, to allow any water or vomit to drain and maintain a clear airway while awaiting the arrival of emergency medical services.