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.
- Trained rescuers may give five in-water rescue breaths only when it is feasible and safe with effective flotation; retrieval must otherwise take priority.
- Do not use abdominal thrusts or prolonged positioning to expel water. These delay ventilation and increase regurgitation and aspiration.
- Suspect cervical injury only when the mechanism supports trauma, such as diving into shallow water, collision or a fall; routine immobilisation can obstruct airway care.
- Fresh water and salt water do not require different initial resuscitation. Hypoxaemia, ventilation, temperature, trauma and complications drive treatment.
- Cough, tachypnoea, crackles, hypoxaemia or reduced consciousness after rescue may progress to non-cardiogenic pulmonary oedema and acute respiratory distress over hours.
- Prophylactic antibiotics and corticosteroids are not routine after water aspiration; treat established infection or exceptional gross contamination with microbiology advice.
- Any persistent respiratory, neurological or temperature abnormality warrants monitored hospital care and serial reassessment, even after apparent early improvement.
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.
Persistent cough, tachypnoea, increased effort, crackles, frothy sputum, cyanosis or an oxygen requirement after rescue suggests alveolar injury. Deterioration may occur despite an initially clear radiograph.
Confusion, agitation, seizure, coma or focal signs may reflect hypoxia, head or cervical trauma, hypoglycaemia, intoxication or stroke. Do not ascribe altered consciousness solely to cold exposure.
Cold skin, shivering followed by reduced shivering, bradycardia, confusion, impaired consciousness or rigidity suggests falling core temperature. In an unconscious hypothermic person, RCUK advises checking vital signs for up to one minute.
Scalp injury, neck pain, neurological deficit, chest-wall injury or a diving, boating or high-energy mechanism warrants trauma assessment alongside resuscitation. Airway and ventilation still take priority.
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.
- Do not spend time expelling water or performing abdominal thrusts; clear visible vomit, use suction when available and resume effective ventilation promptly.
- Continue advanced resuscitation, treat hypothermia and reversible causes, and transfer to an appropriate emergency department even when circulation returns.