Drowning: Airway & Ventilation First
Objective: Treat drowning as a hypoxia problem — rescue ventilation, high-quality CPR if pulseless, and suction — not a ritual lung-drain.
Why This Is Hard
Bystanders want abdominal thrusts “to get the water out.” AHA 2025 special circumstances: drowning is a hypoxic arrest. Ventilation matters early. Heimlich is not a drowning algorithm.
- Scene safety: water, current, cold, boat. You cannot save them if you become the second drowning.
- Expect vomit. Suction is part of the airway, not a later chore.
- If pulseless: CPR with ventilations. Compression-only CPR is the wrong default for drowning.
Field Rules (Education)
- AHA 2025 Part 10: prioritize rescue breaths / ventilation in drowning because the arrest is hypoxic. Do not delay ventilation to “drain.”
- Pulse check is hard in cold water victims. If no signs of life, start CPR.
- C-spine: only if mechanism suggests trauma (dive into shallow water). Most pool drownings are not a board-first problem.
- After ROSC: they can look well and still crash from pulmonary edema. Destination and oxygen/CPAP per protocol.
Field Pitfalls
- Abdominal thrusts as the drowning plan.
- Compression-only CPR because “that is what we do for adults.”
- Becoming a victim — no PFD, no boat, no backup.
Practice
60-second drill
Partner: toddler face-down in a pool, no pulse. First three actions including whether you use compression-only CPR.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- AHA 2025 Part 10: Special Circumstances — drowning is hypoxic — ventilation is a priority; do not delay CPR to drain the airway of water
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.