Drowning leads to cardiac arrest because the body is deprived of oxygen, a condition known as hypoxic arrest. The primary problem is the lack of air, which quickly depletes the oxygen supply in the blood and brain. This lack of oxygen causes the heart to stop beating, making immediate restoration of breathing and circulation the only chance for survival. This unique emergency requires specific, rapid actions by any bystander to maximize the victim’s outcome.
Prioritizing Safety and Victim Extraction
The first rule in any water rescue is to avoid becoming a second victim. Panicked people who are drowning can inadvertently pull a rescuer underwater, so a direct swimming rescue should be the last resort. Safe rescue methods prioritize reaching the victim with an object like a pole, throwing a line or a flotation device, or using a boat.
Once the victim is secured, a quick assessment should determine if they are unresponsive and not breathing normally. If the victim is unconscious, the priority shifts to moving them onto a firm, flat surface where effective cardiopulmonary resuscitation (CPR) can be performed. Chest compressions are not possible in the water due to buoyancy, so resuscitation must be delayed until the person is safely out.
Victims should be removed from the water quickly. If a spinal injury is suspected, such as from a dive or fall, stabilize the neck before extraction. The process of moving the person must be swift because every moment without effective CPR reduces the chance of a positive outcome.
Immediate CPR Steps for Drowning Victims
Cardiac arrest following drowning is primarily a respiratory event, meaning the body is starved of oxygen. This dictates a change in the standard CPR protocol, shifting the sequence from the standard “C-A-B” to a ventilation-focused approach. Bystanders should immediately open the airway and deliver a series of rescue breaths before initiating chest compressions.
The resuscitation process begins by ensuring the airway is open using the head-tilt-chin-lift maneuver. The responder must then deliver five initial rescue breaths. Each breath should last about one second and be sufficient to make the chest visibly rise. If the chest does not rise, the airway should be repositioned before attempting the second breath.
After the initial five breaths, the responder should begin chest compressions immediately, alternating with rescue breaths. The compression-to-breath ratio is 30 compressions followed by two breaths, performed at a rate of 100 to 120 compressions per minute. Compressions should be hard and fast, pressing the sternum down about two inches for an adult.
Time should not be wasted attempting to drain water from the lungs or stomach. The focus must remain on providing ventilations and compressions. Vomiting is common during CPR due to water ingestion; if it occurs, the victim should be quickly rolled onto their side to clear the airway before immediately resuming the CPR sequence.
Monitoring and Transitioning Care
Once the victim shows signs of life, such as coughing or breathing normally, CPR should be stopped, and they should be moved to the recovery position. This position involves turning the person onto their side with the head supported and the upper leg bent to stabilize the body. The recovery position helps keep the airway open and allows fluids to drain safely from the mouth, preventing aspiration.
Many drowning victims, especially those rescued from cold water, may be suffering from hypothermia (a dangerously low body temperature). The responder should remove any wet clothing and cover the victim with warm, dry blankets or clothing to prevent further heat loss. Resuscitation efforts must continue for victims who are cold, as severe hypothermia can mimic death, and the person is not considered dead until they are warm and dead.
Even if a person appears to have fully recovered and is breathing without assistance, they must be transported to a hospital for professional medical assessment. Water aspiration can lead to post-immersion syndrome, where fluid in the lungs causes inflammation and difficulty breathing hours after the incident. Symptoms like persistent coughing, difficulty breathing, lethargy, or confusion can develop up to 24 hours later, making mandatory transport and observation necessary for all non-fatal drowning events.