- Treatment

Ensure personal safety and minimise the danger to yourself at all times.

If possible, attempt to save the drowning victim without entering the water. Talk to the victim, use a rescue aid (e.g. stick or clothing), or throw a rope or buoyant rescue aid if the victim is close to dry land. Alternatively, use a boat or other water vehicle to help with the rescue.

Avoid entry into the water whenever possible. If entry into the water is essential, take a buoyant rescue aid or flotation device. It is safer to enter the water with two rescuers than alone.

Remove the victim from the water and start resuscitation as quickly and safely as possible. Cervical spine injury is uncommon in drowning victims.

Prompt initiation of rescue breathing or positive pressure ventilation increases survival. Rescue breathing can be initiated whilst the victim is still in shallow water provided the safety of the rescuer is not compromised.

As soon as the victim is removed from the water, check for breathing. If the victim is not breathing (or is making occasional gasps), start chest compressions immediately. Continue CPR in a ratio of 30 compressions to two ventilations.

Dry the victim’s chest before placing defibrillation electrodes.

Regurgitation of stomach contents is common following resuscitation from drowning; if this occurs, turn the victim’s mouth to the side and remove the regurgitated material.

Once advanced life support is possible, you should do the following:

• give high-flow oxygen
• consider early tracheal intubation and controlled ventilation.
• in the event of cardiac arrest protect the airway of the victim early in the resuscitation attempt
• differentiating respiratory from cardiac arrest is particularly important in the drowning victim
• if the victim is in cardiac arrest, follow standard advanced life support protocols
• give IV fluid to correct any hypovolaemia

Points to consider in post resuscitation care include the following:

• victims of drowning are at risk of developing acute respiratory distress syndrome (ARDS) after submersion and standard ventilation strategies should be used
• pneumonia is common after drowning
• if submersion occurs in icy water, hypothermia may develop rapidly and provide some protection against hypoxia
• take a careful history in survivors of a drowning incident to identify features suggestive of arrhythmic syncope

There are no differences in the treatment of victims of fresh or sea water drowning.