When a drowning incident occurs, the minutes immediately following the rescue are critical for survival. The primary cause of cardiac arrest in drowning victims is a lack of oxygen, requiring immediate and effective intervention before trained medical personnel arrive. This guide provides a sequential, step-by-step approach for bystanders to take life-saving action.
Prioritizing Safety and Removing the Victim
The initial response must prioritize the rescuer’s safety, as a drowning victim may panic and put the rescuer at risk. Before attempting a rescue, assess the environment for hazards like strong currents or dangerous water conditions. If conditions are unsafe, do not enter the water; call for professional help immediately.
A rescue attempt should follow the sequence of “Throw, Row, Go.” If the victim is close to shore, first throw a flotation device or reach with an object (like a pole) to pull them to safety without entering the water. If they are too far, row out using a boat or watercraft.
Only go into the water as a last resort, and ideally, only if trained and using a flotation device between yourself and the victim. Once the person is reached, focus on quick and safe removal to a stable surface, such as a dock or shore. This phase focuses solely on extrication, not assessment or treatment.
Remove the victim from the water quickly, ideally in a near-horizontal position with the head maintained at or above body level to keep the airway open. Avoid active measures to expel water from the lungs, such as the Heimlich maneuver or hanging them upside down, as these actions waste time and increase the risk of vomiting. If the victim is conscious, a more vertical position may minimize the risk of aspiration if they vomit.
Assessing the Victim and Initiating Emergency Services
Once the victim is safely on stable ground, assess their condition and activate the emergency response system. Check for responsiveness by tapping the shoulder and shouting, “Are you okay?” If the person is unresponsive, immediately call 911 or your local emergency number. If a bystander is present, direct them to make the call and retrieve an automated external defibrillator (AED) if available.
Next, check for breathing. Open the victim’s airway by tilting the head back and lifting the chin. Look, listen, and feel for normal breathing for no more than 10 seconds. Agonal gasps (isolated or infrequent noisy breaths) should not be counted as normal breathing.
If the victim is conscious and breathing normally, place them in the recovery position. This involves rolling the person onto their side, which helps keep the airway open and allows fluids (water or vomit) to drain from the mouth, preventing aspiration. Monitor the person continuously until emergency medical services (EMS) arrive.
Administering CPR and Rescue Breathing
If the victim is unresponsive and not breathing (or only gasping), immediate cardiopulmonary resuscitation (CPR) must begin, starting with rescue breaths. This differs from standard CPR protocols, where compressions start first, because drowning is primarily caused by a lack of oxygen (hypoxia). Initial steps involve opening the airway using the head-tilt, chin-lift method.
Deliver five initial rescue breaths. Pinch the victim’s nose shut, form a tight seal with your mouth over theirs, and blow until the chest rises (approximately one second per breath). If the chest does not rise, reposition the head and attempt the breaths again to ensure the airway is clear.
After the initial five breaths, begin chest compressions, following the adult ratio of 30 compressions to two breaths. Kneel beside the victim and place the heel of one hand on the center of the chest (between the nipples), placing the other hand on top and interlocking the fingers. Keep your arms straight and position your shoulders directly over your hands.
Push down hard and fast, compressing the chest to a depth of at least two inches, but no more than 2.4 inches, at a rate of 100 to 120 compressions per minute. Allowing the chest to fully recoil between compressions is important, as this permits blood to refill the heart chambers. Continue the cycle of 30 compressions and two rescue breaths until the victim shows signs of life, an AED becomes available, or professional help takes over.
If the rescuer is unwilling or unable to provide rescue breaths, perform continuous, high-quality chest compressions (compression-only CPR) until professional help arrives. However, the immediate delivery of oxygen via rescue breaths is recommended for drowning victims, as it directly addresses oxygen deprivation. If the victim vomits, quickly turn them onto their side to clear the mouth before resuming CPR.
Post-Rescue Monitoring and Medical Follow-up
Once the victim is breathing normally or is being treated by EMS, focus on preventing further complications and ensuring medical follow-up. Even if the person appears recovered, every individual involved in a drowning incident who required resuscitation must be transported to a hospital for evaluation, as the effects of water inhalation can be delayed.
Hypothermia is a major concern, particularly if the water was cold. To combat this, remove all wet clothing and cover the victim with warm blankets or towels to conserve body heat. Continuous monitoring is essential, watching for changes in consciousness, color, or breathing pattern.
There is a risk of delayed deterioration, sometimes referred to as “dry drowning” or “secondary drowning.” While these terms are misleading, they describe a rare phenomenon where pulmonary complications develop hours after the incident. This is caused by inhaled water irritating the lungs and leading to fluid leakage into the airways (pulmonary edema).
Signs requiring immediate medical attention include a persistent cough, difficulty breathing, chest pain, unusual lethargy, or behavioral changes. Since most significant complications occur within 4 to 8 hours of the submersion event, medical observation (often for several hours in an emergency department) is essential to ensure a full recovery.