Immediate Action: Your Guide to Emergency Drowning Steps

Drowning is a silent, swift killer. Unlike the dramatic thrashing often depicted in movies, a person drowning is frequently quiet, struggling to keep their mouth above water, unable to call for help. When every second counts, knowing the definitive emergency steps can be the difference between life and death. This guide provides a clear, actionable roadmap, focusing purely on what to do when faced with a drowning emergency.

Recognizing the Signs of Drowning: Beyond the Splash

Before you can act, you must recognize the problem. Drowning doesn’t always look like drowning. Forget the Hollywood version; real drowning is often subtle.

What to Look For:

• Head Low in the Water, Mouth at Water Level: They may be bobbing, struggling to keep their head up, with their mouth barely breaking the surface.

• Gasping or Hyperventilating: Rapid, shallow breaths, or an inability to breathe effectively.

• Hair Over Forehead or Eyes: Indicating their face is submerged.

• Eyes Glassy and Empty, or Closed: A sign of distress and potential oxygen deprivation.

• Vertical Position in the Water: Unlike active swimmers who are horizontal, a drowning person is often upright, as if treading water but making no forward progress.

• No Leg Kick: The person may be using their arms to push down on the water, but their legs are still, not cycling as in active swimming.

• Looks Like They’re Climbing an Invisible Ladder: A characteristic arm motion, pushing down on the water to try and get air.

• Cannot Call Out for Help: Their efforts are focused on breathing, leaving no breath to speak.

• Silent: This is crucial. A drowning person is typically silent.

• Agitated or Panicked Appearance: Before succumbing, there may be a brief period of intense struggle.

• Appears to Be Playing in the Water: Especially with children, their struggle can be mistaken for playful splashing. Always investigate unusual quietness or movements in the water.

Example: You’re at a pool party. You notice a child in the deep end. They aren’t splashing or yelling like the others. Their head is low, mouth occasionally dipping below the surface, and their arms are moving up and down as if pushing something invisible. Their eyes look vacant. This is a drowning in progress. Do not hesitate.

Immediate Rescue: Getting Them Out of the Water Safely

Once you’ve identified a drowning victim, immediate rescue is paramount. Your safety is also critical. Do not become a second victim.

Prioritizing Your Safety: Reach, Throw, Row, Go

Before entering the water, consider all safer options.

1. REACH: If the person is close enough, extend an object to them.
   • Action: Lie on your stomach or brace yourself to avoid being pulled in. Extend a pole, a branch, a towel, or even your arm if they are within a foot or two.

   • Concrete Example: A child is struggling near the edge of a pool. You lie down and extend a long pool noodle for them to grab.

2. THROW: If they are further away but you can’t reach, throw them a flotation device.

   • Action: Use a lifebuoy, a throwable cushion, a rescue tube, or anything that floats and they can hold onto. Aim for slightly beyond them so they can pull it towards themselves.

   • Concrete Example: Someone is struggling 10 feet from the dock. You throw a life ring with a rope attached, then pull them in.

3. ROW: If a boat is available and the person is further out, use it.

   • Action: If you have access to a rowboat, canoe, or paddleboard, use it to get to the victim without entering the water yourself.

   • Concrete Example: A swimmer is far from shore in a lake. You quickly launch a kayak and paddle out to them, extending an oar for them to grab onto.

4. GO (Enter the Water as a Last Resort): Only enter the water if the above methods are impossible and you are a strong, trained swimmer. If you do enter, bring a flotation device with you to offer the victim.

   • Action: If you must enter, do so with a flotation device (e.g., a rescue tube, a kickboard, even a plastic cooler). Approach the victim from behind if possible to avoid being grabbed in panic. Extend the flotation device to them.

   • Concrete Example: A friend has fallen off a boat in choppy water and is clearly in distress, 50 feet away. No other rescue aids are immediately available. You are a strong swimmer. You grab a life vest, put it on, and swim out to them, pushing the life vest towards them as you approach.

Bringing the Victim to Safety: The Tow

Once contact is made, the goal is to get them to shallow water or out of the water completely.

• Action (with Flotation Device): Position the flotation device between you and the victim. If they are conscious, instruct them to hold onto it. If unconscious, support their head and neck above water while towing them by holding the device.

• Action (without Flotation Device – only if necessary and trained): If no flotation device is available and you are a trained rescuer, approach from behind. Place one arm under their armpit, across their chest, and hold their other armpit or chin, keeping their head above water. Use your legs to propel yourself to safety. This is a difficult and risky maneuver for untrained individuals.

• Concrete Example: You’ve reached an unconscious person in the pool with a rescue tube. You position the tube under their armpits, cradle their head to keep their face out of the water, and kick strongly to pull them to the shallow end.

Assessing Responsiveness and Breathing: The Crucial First Look

Once the person is out of the water, every second counts for assessment and intervention.

Laying the Victim Down

• Action: Carefully lay the victim flat on their back on a firm surface. If there’s a risk of spinal injury (e.g., diving accident), try to move them as a single unit, supporting the head and neck.

• Concrete Example: You’ve pulled an unconscious teenager from the lake onto the grassy bank. Gently lay them flat on their back, making sure their airway is clear.

Checking for Responsiveness

• Action: Gently tap their shoulders and shout loudly, “Are you okay? Can you hear me?” Do not shake them vigorously, especially if a spinal injury is suspected.

• Concrete Example: You tap the child’s shoulder and say loudly, “Hey! Can you hear me?” There is no response.

Opening the Airway

• Action: This is critical. Use the head-tilt/chin-lift maneuver. Place one hand on their forehead and gently tilt their head back. With the fingers of your other hand, gently lift their chin forward. This moves the tongue away from the back of the throat, opening the airway.

• Exception: If you suspect a spinal injury (e.g., they hit their head), use the jaw-thrust maneuver. Place your fingers under the angles of the jaw and lift the jaw forward without tilting the head. This is harder and should only be used if a head injury is likely.

• Concrete Example: After determining unresponsiveness, you place your hand on their forehead, tilt their head back gently, and lift their chin, immediately noticing their breathing seems less obstructed.

Checking for Breathing

• Action: LOOK, LISTEN, and FEEL for breathing for no more than 10 seconds.

  • LOOK: Watch for chest rise and fall.

  • LISTEN: Place your ear near their mouth and nose to listen for breath sounds.

  • FEEL: Feel for air movement on your cheek.

• Important Note: Agonal gasps (infrequent, noisy gasps) are NOT normal breathing. Treat them as not breathing.

• Concrete Example: After opening the airway, you lean your ear close to their mouth and nose. You see no chest movement, hear no sounds, and feel no air for 8 seconds. This confirms they are not breathing.

Initiating CPR: The Lifeline

If the victim is unresponsive and not breathing (or only gasping), immediate Cardiopulmonary Resuscitation (CPR) is essential. Drowning victims often suffer from a lack of oxygen, making immediate ventilations (rescue breaths) particularly important.

Calling for Help: Activate Emergency Services

• Action: Designate someone to call emergency services (e.g., 911 in the US, 115 in Vietnam, 999 in UK). Tell them to state clearly: “Someone has drowned and is not breathing. We are starting CPR.” Provide your exact location. If alone, put your phone on speaker and call while starting CPR.

• Concrete Example: “You! Call 911! Tell them we have an unresponsive drowning victim and are starting CPR at the public pool near Oak Street.”

Starting CPR: Compressions First, Then Breaths

The current standard for lay rescuers typically recommends starting with chest compressions, followed by rescue breaths. For drowning victims, however, the primary problem is lack of oxygen, so starting with rescue breaths can be beneficial if you are comfortable and trained. If not, follow the standard C-A-B (Compressions-Airway-Breathing) sequence.

For Drowning Victims (if trained in rescue breathing):

1. Give 2 Initial Rescue Breaths:
   • Action: Pinch the victim’s nose shut. Make a complete seal over their mouth with yours. Give a breath over 1 second, watching for chest rise. Give a second breath. If the chest doesn’t rise, re-tilt the head and try again.

   • Concrete Example: After opening the airway, you pinch their nose, form a tight seal with your mouth, and give a full breath, watching their chest rise. You then repeat for a second breath.

2. Begin Chest Compressions:

   • Action: Place the heel of one hand in the center of the victim’s chest, on the lower half of the breastbone. Place your other hand on top, interlacing your fingers.

   • Positioning: Lock your elbows, keep your arms straight, and position your shoulders directly over your hands.

   • Depth: Push hard, push fast. Compress the chest at least 2 inches (5 cm) for adults, and approximately 1.5 inches (4 cm) for infants, at a rate of 100-120 compressions per minute. Allow the chest to fully recoil after each compression.

   • Concrete Example: You place your hands correctly, lock your elbows, and begin pushing down firmly and quickly, counting “one and two and three…”

3. Continue Cycles of 30 Compressions to 2 Breaths:

   • Action: After 30 compressions, quickly give 2 rescue breaths. Continue this 30:2 cycle without interruption.

   • Concrete Example: You complete 30 compressions, then immediately pinch the nose and give two quick breaths, then resume compressions.

For Victims of All Ages (General CPR):

• Adults and Children (Puberty and Older): Use two hands for compressions.

• Children (1 Year to Puberty): Use one or two hands for compressions, depending on the child’s size, aiming for about 2 inches (5 cm) depth.

• Infants (Under 1 Year): Use two fingers (index and middle) on the breastbone just below the nipple line. Compress about 1.5 inches (4 cm) depth.

  • Rescue Breaths for Infants/Children: Maintain head-tilt/chin-lift. Pinch nose (children) or cover mouth and nose (infants) and give two gentle puffs of air, watching for chest rise.

When to Stop CPR

Continue CPR until:

• An AED (Automated External Defibrillator) arrives and is ready to use.

• Emergency medical services (EMS) take over.

• The victim shows clear signs of life (e.g., breathing normally, moving).

• You are too exhausted to continue.

Managing the Victim Post-Rescue: Beyond CPR

Even after successful resuscitation or if the victim is breathing on their own, immediate care and observation are crucial.

Recovery Position (If Breathing Spontaneously)

• Action: If the victim is breathing normally and has a pulse but is still unconscious, roll them onto their side into the recovery position. This prevents them from choking on vomit or fluids.

• How to: Extend the arm closest to you straight out. Bring the other arm across their chest and place the back of their hand against their cheek. Bend the leg furthest from you at the knee. Gently roll them towards you onto their side. Keep their hand supporting their head.

• Concrete Example: The child starts coughing and breathing on their own, but is still unresponsive. You carefully roll them onto their side, supporting their head with their hand, to ensure their airway remains clear.

Maintaining Body Temperature: Preventing Hypothermia

Drowning victims, even in warm water, can rapidly become hypothermic.

• Action: Remove wet clothing and cover them with dry blankets, towels, or even spare coats. If available, use an emergency thermal blanket.

• Concrete Example: After the child is breathing, you quickly get a dry towel from your bag and wrap them in it, then find a small blanket to cover them completely.

Continuous Monitoring

• Action: Stay with the victim and continuously monitor their breathing and responsiveness until EMS arrives. Watch for any changes in their condition, such as difficulty breathing, vomiting, or a decrease in consciousness.

• Concrete Example: You sit beside the child, gently holding their hand, constantly watching their chest rise and fall, and checking if they respond to your voice.

Addressing Secondary Drowning (Dry Drowning/Secondary Drowning)

Be aware of the risks of secondary drowning, which can occur hours after an incident. This is when a small amount of water inhaled into the lungs irritates them, leading to inflammation and fluid buildup.

• Symptoms to watch for over the next 24-48 hours: Persistent coughing, difficulty breathing, chest pain, extreme fatigue, irritability, changes in consciousness.

• Action: Even if the person appears fully recovered, always seek medical evaluation after any near-drowning incident. Inform the medical professionals about the drowning event.

• Concrete Example: The child seems fine after being pulled out, but a few hours later, they start coughing intermittently and seem unusually tired. You immediately take them to the emergency room, explaining the near-drowning incident.

What to Do After the Emergency: Emotional and Practical Steps

The immediate crisis may be over, but the aftermath of a drowning incident requires careful attention, both for the victim and the rescuer.

Seeking Professional Medical Attention (Always!)

• Action: Regardless of how well the victim appears after resuscitation, always transport them to the nearest hospital for a thorough medical evaluation. Drowning can cause delayed complications like secondary drowning, acute respiratory distress syndrome (ARDS), and neurological damage.

• Concrete Example: Even though the child is now awake and crying, you insist on taking them to the hospital via ambulance (or immediately driving them if EMS isn’t available) to ensure they receive a full check-up for any hidden injuries or complications.

Emotional Support for the Victim and Witnesses

• Action: Drowning is a traumatic event. Provide comfort and reassurance to the victim. For witnesses, especially children, the experience can be deeply disturbing. Encourage them to talk about their feelings.

• Concrete Example: After the ambulance departs with the child, you gather the other children present, explaining what happened in an age-appropriate way, and reassure them that the child is now safe with doctors. You also offer to talk privately to any adults who witnessed the event.

Self-Care for the Rescuer

• Action: Rescuing a drowning victim is incredibly stressful. You may experience shock, anxiety, or even symptoms of PTSD later. Talk to someone about your experience – a friend, family member, or mental health professional. Do not bottle up your emotions.

• Concrete Example: A few days after the incident, you find yourself replaying the events in your mind and having trouble sleeping. You decide to schedule an appointment with a therapist to process the trauma.

Reviewing and Improving Safety Protocols

• Action: After the incident, critically review the circumstances that led to the drowning. Were there insufficient barriers? Lack of supervision? Faulty equipment? Use the experience to implement stricter safety measures to prevent future incidents.

• Concrete Example: The drowning occurred because a pool gate was left ajar. You immediately ensure the gate is repaired and implement a strict “check the gate” policy every time someone enters or leaves the pool area.

Conclusion: Empowering Action

The moments following a drowning incident are critical. Your ability to act swiftly and correctly can be the sole determinant of survival. This guide, stripped of unnecessary detail and focused solely on actionable steps, is designed to empower you with the knowledge to be a lifesaver. From recognizing the subtle signs of distress to performing CPR and ensuring post-rescue care, each step is a vital link in the chain of survival. Practice these steps, remain calm under pressure, and be prepared to act. Your readiness can save a life.