Initial Management of Drowning Patients

Immediate Rescue and Safety Considerations

Rescuer safety is paramount during any water rescue attempt, according to the American Heart Association 3, 4
Do NOT routinely immobilize the cervical spine unless there are specific circumstances suggesting spinal injury, as recommended by the American Heart Association 3, 4, 2, 5

For healthcare providers, use the A-B-C sequence (not C-A-B) for drowning victims because cardiac arrest from drowning is hypoxic in nature, not a primary cardiac event, as stated by the American Heart Association 3, 4
Begin rescue breathing as soon as the victim is removed from the water (or in shallow water if safe), as recommended by the American Heart Association 3, 4, 2, 5
If trained and safe to do so, in-water rescue breathing may prevent progression to cardiac arrest and should be initiated before removing the victim from water, according to the American Academy of Pediatrics and the American Heart Association 1, 2, 6, 5
Give 2 initial rescue breaths that make the chest rise before checking for pulse, as recommended by the American Heart Association 3, 4, 7

After delivering 2 effective breaths, if no pulse is definitely felt within 10 seconds, immediately begin chest compressions, as stated by the American Heart Association 3, 4, 7
Provide cycles of compressions and ventilations according to standard BLS guidelines, as recommended by the American Heart Association 3, 4
Attach an AED and attempt defibrillation if a shockable rhythm is identified once the victim is out of the water, as recommended by the American Heart Association 3, 4, 7

Administer high-concentration oxygen as soon as available, as cardiac arrest following drowning results from severe hypoxemia, according to the American Heart Association and the American Academy of Pediatrics 1, 6

ALL drowning victims who require ANY form of resuscitation (including rescue breathing alone) must be transported to the hospital for evaluation and monitoring, even if they appear alert with effective cardiorespiratory function at the scene, as recommended by the American Heart Association 2, 5
Minimum observation period is 4-6 hours for all patients requiring any resuscitation, as stated by the American Heart Association 2, 5

Never delay ventilation to perform cervical spine immobilization in the absence of trauma indicators, as recommended by the American Heart Association 3, 4, 2, 5
Never use abdominal thrusts or Heimlich maneuver as routine treatment, as stated by the American Heart Association 3, 4, 7
Never assume a patient is stable for discharge without appropriate hospital observation, even if they appear well initially, as recommended by the American Heart Association 2, 5