If someone has been rescued from the water and is unresponsive and not breathing normally, drowning-specific resuscitation should begin immediately. Current European Resuscitation Council guidance recommends five initial rescue breaths, when feasible and safe, followed by standard CPR. Use an AED as soon as one is available.
Drowning is a time-critical emergency caused by respiratory impairment after submersion or immersion in liquid. Because lack of oxygen is central to the drowning process, rescue breaths are particularly important during resuscitation.
This guide explains how to respond to a drowning emergency, from protecting yourself during the rescue to checking breathing, giving rescue breaths, performing CPR and caring for the person until professional help arrives.
What to Do in a Drowning Emergency
If you encounter a drowning emergency, the priorities are:
- Protect yourself and avoid becoming another casualty.
- Call for professional help.
- Remove the person from the water as safely and quickly as possible.
- Check whether they are responsive and breathing normally.
- If they are unresponsive and not breathing normally, give five initial rescue breaths when feasible and safe.
- Begin standard CPR if they remain unresponsive and are not breathing normally.
- Use an AED as soon as one is available.
- Continue until professional help takes over or the person begins breathing normally.
Always follow the instructions of the emergency dispatcher and the current resuscitation guidance used in your location.
Why Drowning Requires Rescue Breaths
Drowning differs from many sudden cardiac arrests because the emergency begins with respiratory impairment and a falling oxygen level.
If this continues, severe oxygen deprivation can eventually lead to cardiac arrest. Restoring ventilation is therefore a critical part of drowning resuscitation.
This is why rescue breaths are particularly important after drowning and why CPR including rescue breaths is preferred when effective rescue breaths can be provided.
Your Safety Comes First
Before attempting a rescue, assess the situation. Entering dangerous water without appropriate training, ability or equipment can create another casualty.
Consider:
- Can you reach the person without entering the water?
- Are there strong currents, breaking waves or rip currents?
- Is the water extremely cold?
- Are there rocks, structures or other hazards?
- Do you have suitable rescue equipment?
- Do you have the skills required for the conditions?
Whenever possible, alert lifeguards or trained rescuers and use a reaching or flotation aid rather than entering dangerous water yourself.
A rescue tube, lifebuoy, surfboard or another suitable flotation device may help keep the person above water while reducing risk to the rescuer.
If rip currents are a risk at the location, understanding how to spot and escape a rip current can help you recognise the hazard before entering the water.
How to Recognise a Drowning Emergency
Drowning may be much quieter than people expect. Someone experiencing respiratory difficulty in the water may not be able to shout or wave because their immediate effort is focused on breathing and remaining above the surface.
Possible warning signs include:
- Difficulty keeping the mouth and nose above water.
- Little or no effective forward movement.
- Repeatedly disappearing below the surface.
- Difficulty reaching safety despite attempting to swim.
- Unusual quietness or inability to call for help.
- Complete submersion.
Treat suspected drowning as an emergency and summon professional help as early as possible.
Once the Person Is Out of the Water
Move the person onto a stable surface and quickly assess responsiveness and breathing.
If they are unresponsive, open the airway using a head tilt and chin lift, unless a specific circumstance requires a different approach.
Check whether they are breathing normally. Gasping or irregular abnormal breathing should not be treated as normal breathing.
If the person is unresponsive and not breathing normally, begin drowning-specific resuscitation immediately.
Call Emergency Services
Get professional help as early as possible.
If another person is present, direct that individual to call the local emergency number and bring an AED if one is readily available while you begin resuscitation.
If you are alone and have a phone available, use speakerphone where possible so you can communicate with the emergency dispatcher while providing care.
Follow the dispatcher's instructions. Emergency call handlers can guide you through the appropriate actions for your location and circumstances.
Give Five Initial Rescue Breaths
Current European Resuscitation Council guidance recommends five initial rescue breaths for a person who has drowned and is unresponsive and not breathing normally, when feasible and safe.
Open the airway using a head tilt and chin lift. Pinch the nose, create a seal over the mouth and give each breath while watching for visible chest rise.
If the chest does not rise, reposition the head to reopen the airway, improve your seal and try again.
The objective is effective ventilation. Avoid unnecessarily forceful breaths.
Begin CPR
After the initial rescue breaths, begin standard CPR if the person remains unresponsive and is not breathing normally.
For an adult, a commonly used European sequence is:
- 30 chest compressions.
- 2 rescue breaths.
- Continue repeating the 30:2 cycle.
Perform compressions in the centre of the chest at a rate of approximately 100 to 120 compressions per minute, allowing the chest to recoil between compressions.
Keep interruptions to chest compressions as short as possible while providing rescue breaths.
Continue CPR until professional rescuers take over, the person begins showing signs of life and breathing normally, the situation becomes unsafe or you are physically unable to continue.
What If You Cannot Give Rescue Breaths?
Rescue breaths are particularly important after drowning because oxygen deprivation is central to the emergency.
If you are trained and able to provide rescue breaths, include them as part of drowning resuscitation. If you cannot provide rescue breaths, do not delay helping. Call emergency services, begin chest compressions and follow the emergency dispatcher's instructions.
Practical CPR training is strongly recommended because it gives you experience performing both effective rescue breaths and chest compressions before you ever need them in an emergency.
Use an AED as Soon as Possible
If an automated external defibrillator is available, use it as soon as practical without unnecessarily delaying resuscitation.
Move the person away from standing water and dry the chest sufficiently for the AED pads to adhere.
Switch on the AED, attach the pads and follow its spoken instructions.
Continue CPR as instructed and minimise interruptions while the AED is being prepared.
Do Not Try to Drain Water From the Lungs
Do not delay rescue breaths or CPR by attempting to drain water from the lungs.
Do not hold the person upside down or spend time pressing the abdomen in an attempt to remove water.
The immediate priorities are effective ventilation, chest compressions when required and rapid access to professional emergency care.
What If the Person Vomits During CPR?
Vomiting can occur during resuscitation after drowning.
If vomit obstructs the airway:
- Turn the person briefly onto their side as needed.
- Allow material to drain from the mouth.
- Remove visible obstruction that can be cleared safely.
- Return the person onto their back.
- Reopen the airway.
- Resume resuscitation as quickly as possible.
Avoid prolonged interruptions to CPR.
If Normal Breathing Returns
If the person begins breathing normally again, stop CPR and continue monitoring them closely.
If they remain unresponsive but are breathing normally, place them in the recovery position when appropriate and continue checking their breathing.
Keep emergency services informed of any changes in their condition and be prepared to restart CPR if normal breathing stops.
Protect the Person From Further Heat Loss
Cold water, wet clothing, wind and cold ground can continue lowering body temperature after the person has left the water.
Without delaying essential resuscitation:
- Protect the person from wind.
- Remove wet clothing when practical.
- Replace it with dry clothing or blankets.
- Insulate the person from cold ground.
- Continue monitoring breathing and responsiveness.
For more information about recognising and preventing dangerous cooling in and around the water, read our guide to hypothermia in cold water.
Does Someone Need Medical Attention After Drowning?
A person who has experienced drowning should receive appropriate professional medical assessment, particularly when there has been loss of consciousness, abnormal breathing, persistent coughing, breathing difficulty or any need for rescue breathing or CPR.
Do not assume the emergency is over simply because the person appears to improve. Follow the advice of emergency services and healthcare professionals.
Common Drowning First Aid Mistakes
- Entering dangerous water without considering your own safety.
- Delaying professional help.
- Assuming drowning will always involve shouting or obvious struggling.
- Forgetting the importance of rescue breaths after drowning.
- Delaying CPR while attempting to drain water from the lungs.
- Interrupting CPR for unnecessary periods.
- Delaying AED use when one is available.
- Assuming someone who appears to recover cannot deteriorate again.
- Failing to protect the person from further heat loss.
Frequently Asked Questions
How many rescue breaths should you give after drowning?
Current European Resuscitation Council guidance recommends five initial rescue breaths for a person who has drowned and is unresponsive and not breathing normally, when feasible and safe. Standard CPR should then be started if the person remains unresponsive and is not breathing normally. Follow your local emergency dispatcher and current local resuscitation guidance.
Should you perform hands-only CPR after drowning?
CPR including rescue breaths is preferred after drowning because lack of oxygen is central to the emergency. If you cannot provide rescue breaths, do not delay helping. Call emergency services, begin chest compressions and follow the emergency dispatcher's instructions.
Should you remove water from the lungs before starting CPR?
No. Do not delay ventilation or chest compressions by attempting to drain water from the lungs. Begin appropriate resuscitation as quickly as possible.
Can you use an AED on someone who has drowned?
Yes. Use an AED as soon as one is available. Remove the person from standing water, dry the chest sufficiently for the pads to adhere and follow the AED's instructions.
What should you do if someone starts breathing again after drowning?
Continue monitoring their breathing and responsiveness. If they remain unresponsive but are breathing normally, use the recovery position when appropriate, protect them from heat loss and follow the instructions of emergency services.
Should someone be medically assessed after drowning?
Professional medical assessment is important after drowning, especially when the person has been unconscious, has abnormal or difficult breathing, continues coughing or required rescue breathing or CPR. Follow the advice of emergency services even if the person initially appears to recover.
Final Thoughts
Drowning is a time-critical emergency in which the first actions of people nearby can matter enormously. Protect yourself during the rescue, call for professional help early and assess breathing as soon as the person is safely out of the water.
If they are unresponsive and not breathing normally, drowning resuscitation places particular importance on ventilation. Current European guidance recommends five initial rescue breaths when feasible and safe, followed by standard CPR and use of an AED when available.
Reading about these steps is not a substitute for practising them. Anyone who regularly surfs, kitesurfs, windsurfs, swims or spends time around open water can benefit from completing an accredited first aid and CPR course with practical resuscitation training.
Disclaimer
This article provides general educational information and does not replace accredited first aid training, professional medical advice or instructions from emergency services. Resuscitation protocols can vary between countries and may change as guidelines are updated. In an emergency, contact your local emergency services immediately and follow the instructions of the emergency dispatcher.