Drowning is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. This event is often silent and rapid, frequently occurring without the loud splashing and yelling commonly depicted in fiction. Rescuer safety must be the priority to prevent a second victim, so the primary goal is to recognize the danger quickly and initiate a safe intervention. This guide provides immediate, actionable steps to manage a drowning incident from initial recognition to post-rescue care.
Identifying the Signs of Distress
The perception that a person drowning will thrash and cry for help is a dangerous misconception; most drowning incidents are silent due to an involuntary physiological reaction called the Instinctive Drowning Response. A person struggling is unable to speak or call out because their respiratory system is focused entirely on breathing, and their mouth is not consistently above the water long enough to exhale, inhale, and vocalize.
Visual cues are the most reliable indicators of a true emergency. Look for a head low in the water, with the mouth at or slightly below water level, or the head tilted back with the mouth open. The eyes may appear empty, glassy, or closed, reflecting the person’s focus on the autonomic task of breathing rather than visual awareness.
The body typically remains upright and vertical in the water, without any supporting kick. Arms are extended laterally and pressed downward on the water’s surface in an attempt to leverage the mouth out of the water for air, which makes waving impossible. This lack of effective movement or noise means that if a child becomes quiet while playing in the water, or an adult appears to be treading water without making headway, intervention is immediately warranted.
Safe Rescue Steps Without Entering the Water
Call for help immediately by contacting emergency services, such as 911 or the local equivalent, while attempting a rescue from the safety of the shore or deck. The “Call, Reach, Throw, Go” mantra emphasizes that untrained individuals should not enter the water. A panicked victim will instinctively grab onto anything for support, which can unintentionally pull the rescuer under and turn a single emergency into a double drowning.
The safest initial method is the “Reach” assist, which involves extending an object to the victim. This object can be a pole, a branch, an oar, a fishing rod, a towel, or even an article of clothing. The rescuer should lie flat or keep their body low to the ground while extending the item to avoid being pulled into the water by the victim’s desperate grasp. Once the person grabs the object, pull them slowly and steadily toward the edge.
If the victim is too far away for a reaching assist, the next step is the “Throw” assist, which requires throwing a buoyant object to the person. Suitable items include a life jacket, a ring buoy, a throw bag with a line, or even a sealed cooler. Untrained persons should only consider entering the water as a last resort if the victim is unconscious and a floating device is kept between the rescuer and the person.
Essential Post-Rescue Care and Monitoring
Once the person is safely removed from the water, the immediate priority is assessment and emergency medical care. Check for responsiveness, breathing, and a pulse. If the victim is unresponsive and not breathing normally, CPR should begin immediately. Drowning is primarily a respiratory event resulting in a lack of oxygen, so the CPR protocol for a drowning victim prioritizes ventilation.
Start with five initial rescue breaths before beginning chest compressions, following the ratio of 30 compressions to two rescue breaths. Compressions should be delivered at a rate of 100 to 120 per minute. Unlike cardiac arrest from other causes, compression-only CPR is not recommended for drowning victims because they require oxygenation. If the person is breathing but unconscious, they should be placed in the recovery position—on their side with the head tilted back—to help prevent aspiration if they vomit.
All persons involved in a drowning incident require a medical evaluation, even if they appear to have recovered completely and quickly. Complications can arise hours later due to lung inflammation and fluid buildup. Symptoms like persistent coughing, difficulty breathing, or confusion after the incident indicate a serious risk and necessitate professional medical monitoring. The victim should also be kept warm with dry blankets after removing wet clothing to prevent hypothermia.