Drowning Rescue: First Aid, CPR & Emergency Response

What Should You Do First in a Drowning Emergency?

In a drowning emergency, immediately call for help and dial emergency services. Try to rescue the person using reaching or throwing techniques before entering the water yourself. A drowning person can panic and pull rescuers under, so always prioritize safe rescue methods first.

When you witness someone drowning, every second counts. The brain can only survive 4-6 minutes without oxygen before permanent damage begins. However, acting quickly doesn't mean acting recklessly - failed rescue attempts often result in multiple victims. The first priority is always to call for professional help while beginning rescue efforts.

According to the World Health Organization, drowning is the third leading cause of unintentional injury death worldwide, claiming approximately 236,000 lives annually. This makes understanding proper rescue techniques critically important. The International Life Saving Federation emphasizes that most successful rescues occur without the rescuer ever entering the water - using reaching aids, throwing flotation devices, or directing victims to safety.

The physiological response to drowning happens rapidly. When water enters the airways, the body's initial response is laryngospasm - an involuntary closing of the airway that prevents water from reaching the lungs. This protective mechanism only lasts for about 30-60 seconds before it relaxes, allowing water to enter the lungs and causing rapid oxygen depletion throughout the body.

Call Emergency Services Immediately

The moment you recognize a drowning emergency, shout for help to alert others nearby. If someone is with you, direct them to call emergency services while you focus on the rescue. If you're alone, make the emergency call first before attempting rescue for adult victims, as professional help with advanced equipment significantly improves survival rates.

When calling emergency services, provide clear information: your exact location (including landmarks or GPS coordinates if possible), the number of people involved, whether the victim is still in the water, and their current condition. Stay on the line if possible - dispatchers can provide real-time guidance for CPR and rescue techniques while help is on the way.

How Do You Safely Rescue a Drowning Person?

To safely rescue a drowning person, use the "reach, throw, row, go" sequence. First, try to reach them with your arm or an object. If that fails, throw a flotation device. Only enter the water as a last resort, and always bring something for the victim to hold onto between you and them.

Rescuing someone from the water is extremely dangerous, even for strong swimmers. A panicking drowning victim will instinctively grab anything nearby, including potential rescuers, and can easily pull them underwater. The victim's survival instinct is so strong that they may climb on top of a rescuer to stay above water, putting both lives at risk. This is why professional lifeguards are trained to approach drowning victims from behind and use specific techniques to prevent being grabbed.

The safest rescue method is always one that doesn't require you to enter the water at all. Studies of drowning rescues show that the majority of successful interventions involve reaching or throwing aids rather than swimming rescues. When these methods aren't possible, always bring a flotation device or improvised float between yourself and the victim.

Reach or Throw First

Look around quickly for anything that can extend your reach - a branch, pole, towel, rope, or even clothing. Lie flat on the ground or dock to lower your center of gravity, preventing the victim from pulling you in. If the person is too far to reach, throw a flotation device like a life ring, life jacket, or any buoyant object. Even empty plastic bottles or coolers can provide enough buoyancy to help someone stay afloat.

When throwing a flotation device, aim slightly beyond the victim and pull it back toward them. If no flotation device is available, throw anything that floats - beach balls, foam noodles, kickboards, or tied-together empty bottles. The key is giving the drowning person something to hold onto that keeps them at the surface while help arrives or while you prepare a safer rescue approach.

Entering the Water

If you must enter the water, never swim directly to a panicking victim empty-handed. Grab a flotation device, kickboard, or any buoyant object to place between yourself and the victim. This creates a barrier that prevents them from grabbing you directly. Approach from behind if possible, speaking calmly to alert them to your presence.

When towing someone to shore, swimming on your back while holding the victim's head above water is often the most effective technique. This keeps the victim's airway clear and puts you in a position where they cannot grab your arms or push you under. If the victim grabs you and pulls you under, escape by ducking and pushing away - a drowning person will typically release their grip when they feel you going deeper rather than keeping them afloat.

For unconscious victims in the water, begin rescue breathing immediately if safely possible. Position yourself behind the victim, support their head above water, pinch their nose, and give rescue breaths. This can be performed while moving toward shore and significantly improves outcomes by delivering oxygen even before the victim is fully out of the water.

How Do You Assess a Drowning Victim?

Once out of the water, place the person on their back on a firm surface. Check for responsiveness by tapping their shoulders and asking loudly if they're okay. Then check for normal breathing by looking at the chest, listening for breath sounds, and feeling for air from the nose and mouth for no more than 10 seconds.

Rapid assessment of a drowning victim is crucial because their condition determines what actions you need to take immediately. The assessment should take no more than 10 seconds - every moment of delay reduces the victim's chances of survival and recovery. The primary goals are determining whether the person is conscious and whether they are breathing normally.

Understanding what normal breathing looks like is essential. Normal breathing is regular, effortless, and results in visible chest movement. Abnormal breathing includes gasping (also called agonal breathing), which consists of occasional gasps that may sound like snoring or gurgling. Agonal breathing is a sign of cardiac arrest and should be treated the same as no breathing - begin CPR immediately.

Checking Responsiveness

Lay the person flat on their back on a firm surface - the ground, a dock, or the deck of a boat. Gently tap or shake their shoulders and speak loudly: "Can you hear me? Are you okay?" Watch for any response - eye opening, movement, groaning, or attempts to speak. If there's no response, the person is unconscious and requires immediate action.

For infants and small children, gently tap the bottom of the foot and call their name. Never shake an infant vigorously as this can cause brain injury. If the child doesn't respond to gentle stimulation, assume they are unconscious and proceed with the assessment.

Checking Breathing

Position yourself beside the victim's head. Tilt their head back by lifting the chin - this opens the airway by moving the tongue away from the back of the throat. Place your ear close to their mouth and nose while looking at their chest. Look, listen, and feel for normal breathing for no more than 10 seconds:

• Look: Watch for the chest and abdomen rising and falling regularly
• Listen: Put your ear near their mouth and nose to hear breathing sounds
• Feel: Feel for breath on your cheek

If you see anything in the mouth that could block the airway - vomit, debris, or dentures - turn the head to the side and carefully remove it with your finger. However, do not spend time trying to drain water from the lungs. Research shows that most drowning victims do not aspirate large amounts of water, and any water present is absorbed into the circulation. Attempts to drain the lungs waste critical time and can cause vomiting, which increases aspiration risk.

How Do You Perform CPR on a Drowning Victim?

For drowning victims, start CPR with 5 rescue breaths before beginning chest compressions. This differs from standard CPR because drowning is primarily a respiratory emergency. After the initial 5 breaths, continue with the standard 30 compressions to 2 breaths cycle. Push hard (5cm deep) and fast (100-120 per minute).

Cardiopulmonary resuscitation (CPR) for drowning victims follows modified guidelines established by the International Liaison Committee on Resuscitation (ILCOR), the American Heart Association (AHA), and the European Resuscitation Council (ERC). The key difference from standard CPR is the emphasis on early ventilation, reflecting the fact that drowning is primarily a respiratory rather than cardiac emergency. The heart stops because of oxygen deprivation, so restoring oxygen supply is the priority.

The 2020 ILCOR guidelines recommend that rescuers trained in CPR should provide rescue breaths for drowning victims, beginning with 5 initial rescue breaths. This approach delivers oxygen to the brain as quickly as possible, which is critical since the brain's oxygen stores are depleted during submersion. Studies show that early ventilation significantly improves neurological outcomes in drowning victims.

Step 1: Give 5 Initial Rescue Breaths

With the victim lying flat on their back, tilt their head back and lift their chin to open the airway. Pinch the nose closed with your thumb and forefinger. Take a normal breath, seal your mouth over theirs completely, and blow steadily for about 1 second. Watch for the chest to rise - this confirms the breath is reaching the lungs. Release and allow the chest to fall before giving the next breath.

Give 5 rescue breaths, checking that each one produces visible chest rise. If the chest doesn't rise, reposition the head (tilt back further) and try again. If breaths still don't go in after repositioning, there may be an obstruction. Check the mouth again for visible debris, but do not perform blind finger sweeps as this can push objects deeper.

Step 2: Begin Chest Compressions

After the 5 initial rescue breaths, immediately begin chest compressions. Place the heel of one hand on the center of the chest, on the lower half of the breastbone (sternum). Place your other hand on top, interlocking your fingers. Position yourself directly over the victim's chest with your arms straight and shoulders above your hands.

Push hard and fast - compress the chest at least 5cm (2 inches) deep at a rate of 100-120 compressions per minute. The rhythm is similar to the beat of the song "Stayin' Alive" by the Bee Gees. Allow the chest to fully recoil between compressions - lifting your hands slightly helps ensure full recoil, which is essential for blood to refill the heart.

Step 3: Continue the CPR Cycle

After 30 compressions, give 2 rescue breaths, then continue the cycle: 30 compressions, 2 breaths. This 30:2 ratio should continue without interruption until emergency services arrive and take over, the victim starts breathing normally, or you become too exhausted to continue. If multiple rescuers are available, switch every 2 minutes to prevent fatigue and maintain compression quality.

What Should You Do If the Person Is Breathing?

If the drowning victim is breathing but unconscious, place them in the recovery position (stable side position) to keep their airway clear. Protect them from hypothermia with dry blankets or clothing. Stay with them until emergency services arrive - even if they seem fine, they need hospital evaluation for potential delayed complications.

When a drowning victim is breathing on their own, the immediate threat to life has passed, but significant dangers remain. An unconscious person lying on their back can choke on vomit, blood, or secretions. The tongue can also fall back and block the airway in an unconscious person. The recovery position addresses these risks by using gravity to keep the airway clear and allow any fluids to drain from the mouth.

Hypothermia is a serious concern for any drowning victim. Immersion in water causes heat loss 25 times faster than exposure to air at the same temperature. Even in relatively warm water, prolonged immersion leads to dangerous cooling of the body's core temperature. Hypothermia below 35°C (95°F) impairs judgment and muscle function, while severe hypothermia below 28°C (82°F) can cause cardiac arrhythmias and death.

The Recovery Position

To place someone in the recovery position, kneel beside them. Straighten their legs if they aren't already. Place the arm nearest to you at a right angle to their body, with the palm facing upward. Bring their far arm across their chest and hold the back of their hand against their near cheek. With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground.

While holding their hand against their cheek, pull on the leg to roll them toward you onto their side. Adjust the upper leg so both the hip and knee are bent at right angles for stability. Tilt the head back to keep the airway open. If necessary, adjust the hand under the cheek to maintain head position. Check breathing regularly while waiting for help.

Preventing Hypothermia

Remove wet clothing as soon as possible and replace it with dry clothing, blankets, or towels. If nothing dry is available, use body heat - lie close to the victim or have other rescuers form a "human blanket." Cover the head, as significant heat is lost through the scalp. If the person is conscious, warm sweet drinks can help, but never give anything to drink to an unconscious person.

Do not rub or massage cold extremities, as this can cause cold blood from the limbs to rush to the core and further lower body temperature (a phenomenon called "afterdrop"). External warming should focus on the core - the chest, neck, head, and groin - rather than the arms and legs. In severe hypothermia cases, rough handling can trigger fatal cardiac arrhythmias.

What Is Secondary Drowning and Why Is Hospital Care Necessary?

Secondary drowning (delayed drowning) occurs when water in the lungs causes pulmonary edema hours after the initial incident. Symptoms include persistent coughing, difficulty breathing, extreme fatigue, chest pain, and fever. This is why ALL drowning victims need hospital evaluation, even if they initially appear completely recovered.

One of the most dangerous aspects of drowning is that life-threatening complications can develop hours after the victim appears to have fully recovered. Water in the lungs - even small amounts - can trigger inflammatory responses that cause fluid accumulation (pulmonary edema), impair gas exchange, and lead to respiratory failure. This delayed deterioration, sometimes called "secondary drowning" or "dry drowning," can be fatal if not recognized and treated promptly.

The mechanism behind secondary drowning involves damage to the surfactant lining of the alveoli (air sacs in the lungs). Surfactant normally reduces surface tension and keeps the alveoli open. When water washes away or damages this surfactant, the alveoli collapse, reducing the lung's ability to transfer oxygen to the blood. Additionally, the body's inflammatory response to lung irritation causes fluid to leak into the air spaces, further impairing breathing.

Symptoms of secondary drowning typically appear within 1-24 hours of the drowning incident. Watch for persistent coughing that doesn't improve, increasing difficulty breathing, unusual fatigue or lethargy, changes in behavior or confusion, chest pain or discomfort, and fever. In children, excessive sleepiness, vomiting, or a bluish discoloration of the lips may indicate developing complications.

Why Everyone Needs Hospital Evaluation

Even victims who appear to have made a complete recovery should be evaluated at a hospital emergency department. Medical professionals can assess lung function, check oxygen levels, and monitor for developing complications. Chest X-rays may reveal fluid or inflammation not apparent from physical examination. Some victims require observation for 24-48 hours before being safely discharged.

Hospital treatment for drowning complications may include supplemental oxygen, positive pressure ventilation, antibiotics for developing infections (aspiration pneumonia), and supportive care for any other organs affected by oxygen deprivation. Early intervention dramatically improves outcomes, which is why prompt medical evaluation is essential for all drowning victims.

What Happens to the Body During Drowning?

During drowning, water enters the nose and mouth, triggering laryngospasm (airway closure). When this protective reflex relaxes after 30-60 seconds, water enters the lungs. Oxygen deprivation causes unconsciousness within 2-3 minutes and can cause brain damage within 4-6 minutes. The heart slows and may stop due to lack of oxygen.

Understanding the pathophysiology of drowning helps explain why rapid response and proper CPR technique are so critical. The drowning process follows a predictable sequence of events, beginning with the initial submersion and potentially progressing to cardiac arrest and death if not interrupted. However, this process can be reversed at any stage with appropriate intervention.

When the face is submerged and water begins to enter the upper airways, the body initiates several protective reflexes. The laryngospasm reflex causes the vocal cords to close tightly, preventing water from entering the lungs. Simultaneously, the "diving reflex" slows the heart rate and redirects blood flow to vital organs (brain and heart), helping conserve oxygen. These reflexes are stronger in children, which partly explains why children sometimes survive prolonged submersion better than adults.

The laryngospasm reflex cannot be maintained indefinitely. As carbon dioxide builds up in the blood and oxygen levels drop, the involuntary drive to breathe eventually overcomes the protective reflex. The laryngospasm relaxes, and the victim inhales water into the lungs. The presence of water in the alveoli prevents oxygen transfer to the blood, rapidly worsening hypoxia (oxygen deficiency).

Effects on the Brain and Heart

The brain is exquisitely sensitive to oxygen deprivation. Brain cells begin to die within 4-6 minutes without oxygen, leading to permanent neurological damage. The severity of brain injury depends on the duration of hypoxia and the victim's core body temperature (cold slows metabolism and provides some protection). This is why drowning in cold water sometimes has better outcomes than warm water drowning - the cold protects the brain.

As hypoxia worsens, the heart's electrical system becomes unstable. The heart rate slows dramatically (bradycardia) and may develop dangerous arrhythmias. Eventually, without intervention, the heart stops beating altogether. However, because the primary problem is respiratory rather than cardiac, restoring oxygen supply through rescue breathing can often restart normal cardiac function.

Potential Complications

Survivors of drowning may experience various complications depending on the severity and duration of oxygen deprivation. Pulmonary complications include acute respiratory distress syndrome (ARDS), aspiration pneumonia, and pulmonary edema. Neurological complications range from mild memory problems to severe hypoxic brain injury with permanent cognitive and motor deficits. Cardiac arrhythmias, kidney damage from reduced blood flow, and infections are also possible.

The prognosis for drowning victims depends primarily on the duration of submersion and the time until effective CPR begins. Victims who receive immediate rescue breathing have significantly better outcomes than those who experience delays. Cold water submersion provides some protection, with documented cases of full neurological recovery after submersions exceeding 40 minutes in very cold water.

How Do You Cope Emotionally After a Drowning Incident?

Witnessing or being involved in a drowning incident is a traumatic experience. It's normal to experience shock, guilt, nightmares, anxiety, or flashbacks afterward. Talking about the experience with supportive people, seeking professional counseling if needed, and allowing time to process emotions are important for psychological recovery.

A drowning incident is traumatic for everyone involved - the victim, the rescuers, and witnesses. The sudden, life-threatening nature of the emergency creates intense stress that can have lasting psychological effects. Understanding that emotional reactions are normal and seeking appropriate support is an important part of recovery for all those affected.

Acute stress reactions immediately following the incident are normal and expected. These may include feeling detached or "in a fog," difficulty sleeping, intrusive memories of the event, heightened alertness or jumpiness, and emotional numbness or overwhelming emotions. For most people, these reactions gradually decrease over the following days to weeks as the brain processes the traumatic experience.

If intense symptoms persist beyond a few weeks, or if they significantly interfere with daily functioning, professional help may be needed. Post-traumatic stress disorder (PTSD) can develop following traumatic events and is characterized by persistent re-experiencing of the event, avoidance of reminders, negative changes in thoughts and mood, and heightened arousal. Effective treatments for PTSD include trauma-focused cognitive-behavioral therapy and EMDR (Eye Movement Desensitization and Reprocessing).

Supporting Children After Traumatic Events

Children may express trauma differently than adults. Watch for changes in behavior, regression to younger behaviors (bedwetting, thumb-sucking), new fears, clinginess, changes in sleep or appetite, or withdrawal from activities they previously enjoyed. Children often need reassurance of their safety, honest age-appropriate explanations of what happened, and the opportunity to express their feelings through play or drawing as well as talking.

Parents and caregivers should also attend to their own emotional needs, as children are sensitive to the stress of the adults around them. Modeling healthy coping strategies - talking about feelings, seeking support, and gradually returning to normal routines - helps children learn to process difficult experiences.

How Can You Prevent Drowning Accidents?

Prevent drowning by learning to swim, always supervising children around water, installing pool barriers, never swimming alone, avoiding alcohol near water, and learning CPR. Children under 5 are at highest risk - they can drown in as little as 2 inches of water and should never be left unsupervised near any water source.

Drowning is almost always preventable. Understanding risk factors and implementing proven prevention strategies can dramatically reduce the likelihood of drowning incidents. The World Health Organization identifies several evidence-based interventions that have been shown to reduce drowning deaths: barriers controlling access to water, supervised childcare, teaching swimming and water safety, safe rescue and resuscitation training, and management of flood risks.

Supervision is the single most important factor in preventing childhood drowning. Young children can drown quickly and silently - drowning often doesn't look like what people expect from movies. A drowning child is typically unable to call for help because they're focused entirely on getting air. They rarely splash or wave their arms; instead, they bob vertically with their mouth barely above the surface, making drowning easy to miss unless caregivers are specifically watching.

Water Safety for Children

Children under 5 years are at the highest risk for drowning and require constant, undistracted supervision around any water - not just pools and beaches, but also bathtubs, buckets, and any container holding water. "Touch supervision" means a caregiver should be within arm's reach of young children at all times when near water. Flotation devices are not substitutes for supervision - they can give a false sense of security and can fail or slip off.

Swimming lessons are recommended from around age 1, though they do not "drown-proof" children and should never replace supervision. Formal swimming instruction has been shown to reduce drowning risk in children aged 1-4 years. As children grow older, teaching them water safety rules - swimming with a buddy, understanding currents and water conditions, never diving into unknown water - becomes equally important.

Pool Safety Measures

Four-sided isolation fencing around pools (separating the pool from the house and yard) reduces drowning deaths by 83% according to research. Fences should be at least 1.2 meters (4 feet) high with self-closing, self-latching gates that open outward. Pool covers and alarms provide additional layers of protection but should not be relied upon as the sole safeguard.

Adult Water Safety

Alcohol is involved in up to 70% of adult drowning deaths. Alcohol impairs judgment, coordination, and swimming ability while increasing risk-taking behavior. Never swim, boat, or supervise children around water while under the influence of alcohol or drugs. Swimming alone is also dangerous - always use the buddy system and swim in areas with lifeguard supervision when possible.

• Learn to swim: Formal swimming lessons significantly reduce drowning risk at all ages
• Learn CPR: Bystander CPR dramatically improves survival and neurological outcomes
• Supervise actively: Watch children constantly around water - drowning is silent and fast
• Install barriers: Four-sided pool fencing with self-closing gates prevents unsupervised access
• Avoid alcohol: Never swim or supervise children after drinking
• Respect water conditions: Check currents, weather, and water depth before entering
• Wear life jackets: Use properly fitted life jackets when boating or in open water