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Lesson

Drowning: Airway & Ventilation First

10 min Airway & Breathing Skip to quiz

Objective: Treat drowning as a lack of oxygen. Give rescue breaths. If there is no pulse, do cardiopulmonary resuscitation (CPR) with breaths. Suction vomit. Do not delay breaths to drain the lungs.

Why this matters

Bystanders want abdominal thrusts to get the water out. Drowning is a lack of oxygen. The lungs and the brain ran out of air.

Start rescue breaths early. The Heimlich maneuver is not the drowning treatment. Do not delay breaths to drain the lungs.

Key points
  • Scene safety comes first. Check the water, the current, the cold, and whether you need a boat. You cannot help if you become the second drowning.
  • Expect vomit. Suction during the first breaths. Do not save suction for later.
  • If there is no pulse, do cardiopulmonary resuscitation (CPR) with breaths. Compression-only CPR is the wrong default for drowning.

Clinical sequence

  1. Get the patient out without becoming a second drowning. Do not go in with no flotation, no boat, and no backup.
  2. Open the airway. Expect vomit. Suction as part of the first breaths. Do not wait.
  3. If the patient is not breathing, start rescue breaths right away. Do not delay breaths to drain the lungs. Do not use routine abdominal thrusts to empty the lungs.
  4. If there is no pulse, start CPR with breaths. Do not use compression-only CPR as the default for drowning.
  5. Protect the neck only if the story suggests trauma, such as a dive into shallow water. Most pool drownings are not a reason to delay breaths for a backboard. Neck care does not replace ventilation.

Teaching points

  • Drowning arrest is from lack of oxygen. Breaths are part of the resuscitation. Do not delay them to drain water.
  • The pulse is hard to feel in a cold-water victim. If there are no signs of life, start CPR with breaths.
  • After return of spontaneous circulation (ROSC), the patient can look well and then worsen from fluid in the lungs. Choose the destination. Give oxygen, or continuous positive airway pressure, per protocol.

Common errors

  • Using abdominal thrusts as the drowning plan.
  • Using compression-only CPR because that is what the crew does for adults.
  • Going into the water with no personal flotation device, no boat, and no backup.

Practice

One-minute check

Partner: a toddler is face-down in a pool and has no pulse. Name the first three actions. Say whether you use compression-only CPR. Say why drowning is not treated with abdominal thrusts.

Related: BVM, CPR.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. Current drowning teaching prioritizes:
2. Should you routinely use abdominal thrusts (Heimlich) on a drowned patient to “empty the lungs”?
3. If they are pulseless after you get them out of the water:
4. When should drowning become a C-spine problem on scene?
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