Drowning occurs when a person experiences respiratory impairment from immersion in liquid. This respiratory impairment interrupts the supply of oxygen to organs of the body and most importantly the brain.

The administration of oxygen during resuscitation is particularly beneficial for casualties who have experienced  drowning; however resuscitation efforts should not be delayed while waiting for oxygen equipment to arrive.

Any person who displays signs of distress in the water including flailing of arms, head only showing above the water with mouth open, uneven swimming motions or lying face down in the water you should consider to be in trouble and requiring immediate and urgent assistance.

Children and infants can drown very quickly if they are left unattended in or around water of any kind. However, by receiving CPR they have a better then 50% chance of survival, especially in the early stages where only a respiratory failure has occurred. After the two initial rescue breaths are given they may display Signs of Life.

Important Considerations for Rescue and Resuscitation

Swimming ability of the rescuer:
You should not attempt to rescue a casualty from the water if it is beyond your swimming ability. Rescuers frequently become drowning victims when attempting water rescues.

In-water resuscitation

You should always remove the casualty from the water before attempting resuscitation. Only appropriately trained rescuers should attempt in-water resuscitation.

Vomiting and regurgitation

Vomiting and regurgitation is a common symptom of drowning. To minimise the risk of inhalation the casualty should be rolled onto their side for initial assessment of airway and breathing. If vomiting or regurgitation occurs during resuscitation the casualty should be immediately rolled onto their side again.

Suspected Spinal Injury in Water

Conscious casualty

If the casualty complains of neck pain, tingling in fingers or toes or paralysis, support the head and neck to maintain spinal alignment until medical assistance arrives. If this is not possible due to surf or fast running water remove the casualty from the water gently while maintaining spinal alignment as much as possible.

Unconscious casualty

The casualty should be rolled onto their back and immediately removed from the water. The management of an unconscious casualty with suspected spinal injury in water should never be delayed while waiting for a spinal board or cervical collar to arrive. They are not essential for effective management and should only be used by trained personnel.

Fall in body temperature

Hypothermia sustained during immersion may have protected the brain from the effects of a lack of oxygen. Hypothermia makes assessment of the circulation difficult due to a discolouration of the casualty’s skin and coolness of the body. Therefore, resuscitation should be attempted even after prolonged immersion.

Pale, cool skin.

Absent, rapid or shallow breathing.

Pulse may be rapid, weak, slow or absent.

Cyanosis (bluish tinge to skin).

Loss or altered level of consciousness.

Coughing, spluttering of water.

Follow the DRSABCD emergency action plan : Call First, Call Fast

Turn casualty onto their side to check airway and breathing, clear if needed.

Give 2 initial rescue breaths to get Oxygen to the brain.

Commence CPR if not breathing normally or there is no response after the 2 rescue breaths.

If normal breathing or responsiveness returns position casualty on their side in the recovery position.

Treat for hypothermia.

Monitor airway, breathing and circulation while waiting for the ambulance to arrive.

Suspect spinal damage and immobilise if possible.

The casualty must be assessed in hospital immediately!
All casualties who have had a drowning experience must be carefully observed in hospital
even following a successful rescue.
Complications following immersion are common, even if the casualty appears well.