Drowning is a major cause of accidental death globally, and the resulting cardiac arrest is fundamentally different from one caused by a sudden heart event. Cardiac arrest in a drowning victim is typically an asphyxial event, meaning it is caused by a severe lack of oxygen in the blood rather than a primary electrical problem with the heart. This distinction necessitates a specialized cardiopulmonary resuscitation (CPR) protocol that prioritizes immediate oxygen delivery to maximize the chance of survival.
Immediate Response: Safety and Activation
The first step in any water rescue scenario is to ensure the safety of the rescuer, as a second victim only complicates the situation. Before attempting to remove the person from the water, assess for potential hazards like strong currents, ice, or electrical dangers. Once the scene is safe, the victim must be quickly removed from the water and placed on a firm, flat surface to allow for effective CPR.
After removal, the rescuer should immediately check for responsiveness and breathing. If the victim is unresponsive and not breathing, or only gasping, emergency medical services (EMS) must be activated immediately by calling 911 or the local emergency number. If a second person is available, they should retrieve an Automated External Defibrillator (AED) while the initial rescuer begins the specialized resuscitation protocol.
The Critical Difference: Initial Rescue Breathing
The specialized CPR protocol for drowning victims addresses severe oxygen deprivation, or hypoxia. Unlike typical adult cardiac arrest where chest compressions are performed first (the C-A-B sequence), a drowning victim requires immediate oxygen, following the A-B-C (Airway, Breathing, Compressions) sequence.
Because the lack of oxygen is the underlying cause of the arrest, the protocol calls for five initial rescue breaths immediately after opening the airway. To deliver these breaths effectively, the rescuer must use the head-tilt/chin-lift technique to open the airway and then seal the person’s nose and mouth to create an airtight seal. Each breath should last about one second and be just enough to make the chest visibly rise.
If the first breath does not make the chest rise, the rescuer should quickly reposition the head and attempt the second breath. Delivering these five breaths without delay is the most important intervention, as the goal is to quickly oxygenate the remaining blood supply. Only after these five breaths are delivered does the rescuer transition to the ongoing cycle of chest compressions and ventilations.
Continuing Resuscitation: Compression and Ventilation Cycles
Following the five initial rescue breaths, the rescuer immediately starts the continuous cycle of chest compressions and rescue breaths. For adults, children, and infants with a single rescuer, the standard ratio of 30 chest compressions followed by two rescue breaths (30:2) is used. This combination ensures that the newly oxygenated blood is circulated throughout the body, particularly to the brain and heart.
Chest compressions must be performed at a rate of 100 to 120 compressions per minute, pushing hard and fast in the center of the chest. The depth should be at least two inches for an adult, ensuring that the chest fully recoils between each compression to allow the heart to refill with blood. Minimizing interruptions to chest compressions is paramount for maintaining blood flow.
The two rescue breaths should be delivered quickly after every 30 compressions, maintaining the one-second duration for each breath. If an AED arrives, it should be applied immediately after drying the victim’s chest, and the rescuer should follow the device’s voice prompts while continuing CPR between AED analyses and shocks. Resuscitation must continue without stopping until EMS personnel take over, the victim shows clear signs of life, or the rescuer is too exhausted to continue.