Synopsis
Rescue and resuscitate drowning safely, recognise evolving aspiration-related lung injury and hypothermia, and avoid ineffective water-expulsion or prophylactic treatments.
- Use the terms fatal or non-fatal drowning; the older phrase near drowning does not describe severity or outcome reliably.
- Rescuers must not become additional casualties. Reach, throw or use a flotation device, and activate the ambulance service or Coastguard before a trained in-water rescue when possible.
- Drowning arrest is primarily hypoxic, so rescue breaths matter: current RCUK guidance gives five initial breaths before standard CPR on land or a rescue boat.
Key red flags
Unresponsiveness with absent or abnormal breathing after submersion indicates cardiac arrest or imminent arrest. Agonal gasps are not normal breathing; begin ventilations and compressions without waiting for a pulse oximeter.
Investigation priorities
Identify respiratory failure, shock, neurological impairment and trauma.
Management branches
A person is unresponsive and not breathing normally after submersion.
- Call 999 or the Coastguard, use safe rescue equipment and retrieve the person to land or a boat; trained rescuers may give five in-water breaths only with secure flotation.
- Once on a firm surface, open the airway, give five rescue breaths and then begin standard CPR with an AED as soon as available.
Key medicines
Supplemental oxygenUse high concentration during resuscitation, then titrate to 94-98% saturation or an individual 88-92% target when hypercapnic risk exists.
Antibiotic therapyDo not prescribe prophylactically; when pneumonia is established, follow local severe-pneumonia guidance modified by exposure history and microbiology advice.