Why the standard resuscitation sequence is wrong here
Adult cardiac arrest is usually a rhythm problem, which is why standard CPR leads with compressions. Drowning is a hypoxic arrest — the heart stopped because the oxygen ran out. So the priority inverts.
- Give five initial rescue breaths before compressions, in an adult as well as a child. Oxygen is the thing that is missing, and compressions circulating deoxygenated blood do not fix that.
- Then 30:2 as normal, continuing until help arrives.
- Do not attempt to remove water from the lungs. There is very little there, it cannot be drained, and trying wastes the only minutes that count. Water in the stomach is common; vomiting during resuscitation is common with it, so be ready to turn the head.
- Get them out of the water first if you can do so safely, and offer flotation rather than entering the water yourself. Rescuer drowning is a real and common outcome.
- Assume spinal injury only if the mechanism suggests it — diving, surfing, a fall. Routine immobilisation in every drowning delays the airway management that matters more.
Two things about drowning that surprise people
- Outcomes after cold-water drowning can be far better than they look, particularly in children, because hypothermia protects the brain. Prolonged resuscitation is justified — the decision to stop is a hospital decision, not a poolside one.
- Anyone rescued from drowning needs medical assessment even if they seem entirely well. Deterioration from lung injury can develop over the following hours. This is often called "secondary drowning" in the press, which overstates the drama but not the need to be checked.
- Real drowning is silent. It does not look like the thrashing and shouting people expect — someone drowning usually cannot call out, and is vertical, low in the water, and quiet. Lifeguards are trained to spot it precisely because it does not attract attention.