First Aid For Drowning: The Top Priorities

If you work or play in the outdoors in Canada, drowning is one of the big risks that need to be managed. Knowing the right first aid for drowning patients will equip you and the subject for the best outcomes.

Over the past 15 years or so, the research world arrived at a standard definition of drowning: 

It is useful to avoid any alternative phrases used to describe drowning. Drowning is primarily a low oxygen or “hypo” “oxia” event – Hypoxia! Keep this in mind as we work through the key aspects of managing a drowning patient.

Drowning patients need “old school” ABC’s, not the current CPR focus on compression (known as “CAB”, or Compressions, Airway, Breathing).  These patients need their airway cleared and immediate breathing.  

Drowning: The Initial Response

Here’s the primary question to ask when administering first aid for drowning: Is the patient breathing?

If the patient is not breathing, ventilate with five slow breaths using mouth to mask, BVM or mouth to mouth. The five-breath recommendation is all about filling the lungs with fresh air.  If possible, start the breathing as soon as possible – even while in the water if it is safe to do so.  Don’t worry about compressions until you get the patient to a hard, flat surface.  

Ventilation and extrication are the priorities – you are unlikely to require spine immobilization. Studies have shown that only 0.5% of drowning patient have potential for spine injury.  Use spine motion restrictions only when there are clear indications of a potential spinal injury, such as fall from height or trauma to the head.

In the “CAB” mindset, getting an Automated External Defibrillator (AED) is one of the first things to do.  However, AEDs are not crucial for a drowning patient in cardiac arrest.  Most drowning arrests are not in a shockable rhythm, so an AED will not be helpful. Focusing on AEDs can be distracting from what the arrest patient needs – air and good compressions.  

Continuing Care for Drowning Subjects

After the initial response is over and the patient is out of the water and safe, what comes next?  

In the dire situation that the patient is receiving CPR, the standard recommendations apply: 30 minutes of CPR, followed be a consideration to discontinue resuscitation for normal body temperature patients.  Hypothermic patients need to be re-warmed and evacuated with CPR – this is much easier said that done.  

For those drowning patients that do not experience cardiac arrest, the best course of treatment is the standard care for respiratory problems – PROP  (Position of comfort, reassurance, Oxygen, PPV).  Monitor the patient and track changes over time.  How the patient responds to care gives the rescuer a good indication for the evacuation plan.

Evacuation Considerations

When considering evacuation plans and next steps for a subject of drowning, the top priority is airway control and the patient’s breathing.  If a person maintained airway control and did not lose consciousness, then there is no need for evacuation.  

On the other hand, when you have a patient who may have lost consciousness and airway control, evaluate their respirations:

• If there is a mild cough but no other symptoms (no respiratory distress, no wheezing or other problems) it is reasonable to monitor the patient in the field. In a low risk tolerance situation (e.g. summer youth camp) a non-urgent evacuation is a reasonable plan.
• If there are persistent symptoms (such as respiratory distress and abnormal vital signs), a rapid evacuation to medical care is required.

First Aid For Drowning: It’s All About Air Time

Managing a drowning patient is all about air time.   Everyone needs air to live.  Drowning takes air away and our goal as rescuers is to get air back into the patient. 

Responding to a drowning event is one of the most stressful situations a wilderness first aid provider will face. Focusing on getting air to the patient will guide you through providing the best care possible. 

Written by Director of Raven Medical Curriculum, Len James.