What is the proper first aid procedure for drowning?

First Aid for Drowning

Immediately begin rescue breathing as soon as the unresponsive drowning victim is removed from the water—this is the single most critical intervention because hypoxia is the primary cause of death and brain injury. 1

Rescue and Removal from Water

• Prioritize rescuer safety first—do not become a secondary victim. Use flotation devices, throw ropes, or wait for professional rescue if entering the water poses danger. 2
• Remove the victim from water by the fastest means available, preferably in a near-horizontal position with the head maintained above body level if the patient appears to be in shock. 2
• Do NOT routinely immobilize the cervical spine unless there are obvious signs of trauma, diving into shallow water, or alcohol intoxication—unnecessary spine precautions delay life-saving ventilation and the incidence of spinal injury in drowning is extremely low (0.009%). 1

Immediate Resuscitation Sequence (A-B-C Approach)

For drowning victims, use the traditional Airway-Breathing-Circulation sequence rather than the standard C-A-B approach, because this is a hypoxic arrest. 1

Step 1: Airway

• Open the airway using head tilt-chin lift maneuver. 2
• Do NOT perform abdominal thrusts or the Heimlich maneuver—water is rapidly absorbed and does not obstruct the airway; these maneuvers are dangerous, cause vomiting and aspiration, and critically delay ventilation. 1, 3

Step 2: Breathing

• Give 2 rescue breaths immediately that make the chest rise. 1
• If the victim responds to rescue breaths alone (begins breathing), continue monitoring closely. 1
• For trained rescuers, mouth-to-mouth ventilation may be attempted in shallow water if it does not compromise safety, though this is of uncertain benefit. 1

Step 3: Circulation

• Check for a pulse for no more than 10 seconds. 1
• If no pulse is felt, immediately begin chest compressions and continue cycles of 30 compressions to 2 ventilations. 1
• For a lone rescuer, provide 5 cycles (approximately 2 minutes) of CPR before leaving to activate EMS. 1

Advanced Interventions

• Attach an AED as soon as available and attempt defibrillation if a shockable rhythm is identified. 1
• Administer 100% high-flow oxygen via non-rebreather mask at 15 L/min to all victims with respiratory symptoms or unknown oxygen saturation. 2
• Remove wet clothing and insulate the victim to prevent further heat loss; if available, ventilate with warm, humidified oxygen. 1
• Do NOT delay CPR to check temperature or wait for rewarming—begin resuscitation immediately even in hypothermic victims. 1

Managing Vomiting During Resuscitation

• Vomiting is extremely common—occurs in two-thirds of victims receiving rescue breathing and 86% of those requiring full CPR. 1
• If vomiting occurs, turn the victim to the side and remove vomitus using your finger, cloth, or suction. 1
• If spinal injury is suspected, logroll the victim as a unit to protect the cervical spine. 1

Transport and Hospital Evaluation

All drowning victims who require ANY form of resuscitation—even rescue breathing alone—must be transported to the hospital for evaluation and monitoring, even if they appear completely alert and recovered at the scene. 1, 2

• Decompensation can occur 4-6 hours after the drowning event, particularly in pediatric patients. 1
• Continue resuscitative efforts during transport until evaluated by advanced care providers, especially in hypothermic victims. 2
• The duration and severity of hypoxia is the single most important determinant of outcome—early, aggressive prehospital care is where survival is determined, not in the ED or ICU. 1, 3

Critical Pitfalls to Avoid

• Never delay ventilation to perform abdominal thrusts, check for water in the airway, or attempt drainage maneuvers. 1
• Never assume the victim is "fine" because they are conscious—transport all victims who required any resuscitation for observation. 1
• Never routinely immobilize the spine unless specific trauma indicators are present—this delays airway management. 1
• Never use the standard C-A-B sequence—drowning requires the A-B-C approach because respiratory arrest precedes cardiac arrest. 1