First aid for drowning or nearly drowning

Some signs and symptoms that can appear in a patient who has just experienced drowning or a near drowning accident are:

• Unconsciousness
• Not moving
• Inability to arouse the patient by touch or sound
• Not breathing
• Cold or bluish skin
• Abdominal swelling
• Chest pain
• Cough
• Shortness of breath
• Gasping for air
• Spluttering water or fluid from the mouth
• Vomiting
• Irritability or unusual behaviour
• Low energy or sleepiness after a water incident

Steps to take to rescue a drowning person and give first aid are as follows: 

• On sighting a drowning person, immediately alert the lifeguard or call for help.
• If you are a trained and confident swimmer, dive in to rescue the person.
• After successfully bringing the drowning person to the surface of the water, make way to a dry surface or dry land.
• Lay the drowning victim flat on a dry surface and kneel beside them. Make sure to move the patient with their head, neck, back and legs aligned, in case of a possible spinal injury.
• Check for signs of breathing:
  • Place your ear at the drowning victim’s nose and mouth to hear breath sounds if present.
  • Check whether warm moist air of expired breaths is felt on your cheek or hand when placed near the victim's nose and mouth. A mirror or glass can be kept below the nostrils of the drowning victim to check for fogging, which would indicate the person is breathing. 
  • Check for upward and downward movements of the chest which occur with inhalation and expiration.
• Check the drowning victim's pulse at the wrist (radial pulse), along the border of the forearm on the side of the thumb. Check the pulse for ten whole seconds.
• Check the drowning victim’s pulse at the neck (carotid pulse), along the border of the muscle (sternocleidomastoid) that becomes prominent upon turning the patient’s head sideways. Check the pulse for ten whole seconds.
• If the drowning victim is not breathing and does not have a pulse, begin CPR (Cardiopulmonary Resuscitation) immediately.
  • If untrained or unsure, only give chest compressions as follows (to adults or children): 
    • Lay the person flat on their back, kneel next to them and clear the area surrounding them.
    • Position your hands with the palm of one hand over the back of the other and fingers interlocked.
    • Place your hands on the patient's chest with the palm of the lower hand over the centre of the chest. When giving CPR chest compressions to a baby or infant, don’t use the whole hand, only use two fingers to compress the central chest area between the nipples. 
    • Keep your elbows straight and position your shoulders directly above your hands.
    • Push straight down with the weight of your entire body to compress the patient's chest to a depth of 2 inches.
    • Push hard at a rate of 100 to 120 compressions a minute.
    • Continue chest compressions till there is any sign of movement in the patient, they begin breathing or the emergency medicine team is ready to take over.
  • If trained in CPR, mouth to mouth breathing should be given along with chest compressions. The following step should be kept in mind: 
    • After laying the person on a flat dry surface, loosening restrictive clothing, clearing the surrounding area and calling for help, kneel beside them. 
    • Pinch the nose of the victim, closing their nostrils shut. Take in a normal breath and cover the victim's mouth with yours to create an airtight seal. 
    • Proceed to give 2 breaths, each one second long, and watch for the drowning victim’s chest to rise.
    • Following two mouth-to-mouth breaths, give 30 chest compressions (in the same way as described above).
    • Continue the cycle of 30 chest compressions followed by two mouth-to-mouth breaths (each one-second-long) in close succession till the patient restarts breathing, gains consciousness or the medical emergency team arrives.
    • If possible, CPR should be conducted by two people working as a team to prevent fatigue. While one person can position themselves to give chest compressions the other can give mouth-to-mouth breaths in a coordinated manner.
• Dry and cover the patient to prevent further loss of body heat. Rubbing their hands, feet, legs, arms and back can also help keep them warm. After regaining consciousness, the patient should be wrapped in a blanket.
• Even after successful resuscitation of a drowning patient with first aid, medical assessment is necessary to rule out lung injury, bodily harm suffered in the accident and concussion.

(Read more: First aid types and tips)

Depending on the severity of the case, there could be some short-term and/or long-term complications of drowning and near-drowning. Some of them are:

• Pneumonia
• Acute respiratory distress syndrome
• Brain damage due to hypoxia or head injury
• Chemical and fluid imbalances in the body like respiratory acidosis
• Spinal injuries
• Brain death or coma
• Variable loss of body functions and limb movements