Drowning rescue breathing overview

Overview

Rescue breathing for drowning is an emergency procedure used when someone has stopped breathing after being underwater. It involves giving breaths to the person to get oxygen into their lungs and help them start breathing again.

Drowning is more common than many people think. It can happen in seconds, even in shallow water. Worldwide, hundreds of thousands of people drown each year.

Drowning can happen to anyone, but young children (especially ages 1–4) and teenagers are at highest risk. Males are more likely to drown than females. People who cannot swim or who swim in unsupervised areas are also at greater risk.

Symptoms

Common symptoms

• Not breathing
• Unconsciousness
• Limp body
• Pale or blue skin, especially around the lips and fingertips (cyanosis)
• No pulse or weak pulse

Symptoms in children

• Silent drowning – children may not splash or cry for help
• Head low in the water, mouth at water level
• Eyes glassy or closed
• Hair over forehead or eyes
• Hyperventilating or gasping before becoming silent

Symptoms in older adults

• Same as general symptoms but may be mistaken for a heart attack or stroke
• Older adults may have weaker cough or gag reflex, making aspiration (water in lungs) more likely
• Confusion or drowsiness after a swim

Causes

Main causes

• Inability to swim or overestimating swimming ability
• Panic in water
• Alcohol or drug use before or during swimming
• Sudden medical events like a seizure, heart attack, or fainting in water
• Lack of supervision, especially for children
• Water currents, waves, or underwater obstacles

Risk factors

• Not having lifejackets or flotation devices
• Swimming alone or in unguarded areas
• Being very young or elderly
• Having a seizure disorder or heart condition
• Using alcohol or drugs near water
• Cold water temperature causing sudden shock or muscle cramps

When to see a doctor

See a doctor urgently if:

• After any drowning or near-drowning event – even if the person seems fine
• Any trouble breathing, coughing, or chest pain
• Acting confused, sleepy, or not acting normal
• Vomiting or fever within 24 hours of being in water
• If a child had any episode of submersion, even if they coughed and seemed okay

Book a routine appointment if:

• If you are concerned about your child’s swimming skills or water safety
• After a non-serious water incident with no symptoms, but you want reassurance

Diagnosis

Diagnosis of drowning is based on the event and symptoms. At the hospital, doctors will assess breathing, oxygen levels, and signs of water in the lungs. They may ask what happened, how long the person was under, and if rescue breathing was given.

Tests that may be done

• Pulse oximetry – a clip on the finger to measure oxygen in the blood
• Chest X-ray to check for fluid in the lungs (pulmonary edema)
• Blood tests to measure oxygen, carbon dioxide, and pH levels
• Electrocardiogram (ECG) to check heart rhythm
• CT scan or other imaging if head injury is suspected

What to expect at your appointment

At the emergency room, the team will first make sure the person is breathing and has a pulse. They may give oxygen, start intravenous fluids, and monitor closely. Most people are kept in the hospital for 24–48 hours to watch for complications. The person may feel tired or scared; the staff will explain each step.

Treatment

Treatment for drowning focuses on restoring breathing and preventing brain damage. Rescue breathing (giving breaths) is the first step before the person reaches the hospital. At the hospital, doctors may use oxygen, breathing machines, and medicines to help the lungs and heart recover.

Self-care at home

• If you are alone and someone is drowning, call your local emergency number immediately if you have a phone. If not, start rescue breathing for 2 minutes, then call.
• Lay the person on their back. Tilt the head back and lift the chin to open the airway.
• Pinch the nose shut. Give two gentle breaths, each lasting 1 second, watching for the chest to rise.
• Continue giving one breath every 5–6 seconds (about 10–12 breaths per minute) until the person starts breathing on their own or help arrives.
• If you are trained in CPR, combine rescue breathing with chest compressions (30 compressions, then 2 breaths).

Medical treatments

Medical treatment may include oxygen therapy, a breathing tube (intubation) and mechanical ventilation if the person cannot breathe well, and intravenous fluids to support blood pressure. Doctors may also use medications to treat lung inflammation or seizures. Warm blankets and heated fluids help if the person is hypothermic (very cold). In severe cases, a machine called ECMO can temporarily do the work of the heart and lungs.

When is surgery considered?

Surgery is rarely needed for drowning itself, but it may be required to treat injuries from a diving accident (like a spinal injury) or to remove objects blocking the airway.

Living with this condition

After a drowning incident, recovery can vary. Many people return to normal life after full recovery, especially if they received quick rescue breathing. Some may have lasting brain or lung damage that requires ongoing therapy. Follow your doctor’s advice and attend any recommended rehabilitation or check-ups.

Lifestyle tips

• If you have had a near-drowning, avoid swimming alone until fully recovered and cleared by a doctor.
• Learn basic water safety and swimming skills.
• Take a CPR and first aid course so you can help others.
• If you have a seizure disorder or heart condition, talk to your doctor about safe water activities.

Diet and exercise

A healthy diet and gentle exercise can help overall recovery. If you have lung damage, your doctor may recommend breathing exercises or pulmonary rehabilitation. Always start slowly and follow medical guidance.

Mental health and emotional wellbeing

A drowning event can be very traumatic – for the person who nearly drowned and for their family. Many people feel scared, anxious, or guilty afterward. These feelings are normal, but if they last or interfere with daily life, talk to a healthcare professional. A therapist or counsellor can help you process the event.

Prevention

Yes, many drownings can be prevented with simple steps. Supervision is key – always watch children near water, even if they know how to swim. Use lifejackets on boats and near open water. Learn to swim and teach your children. Fence off home pools with a self-closing gate. Avoid alcohol or drugs around water. Learn CPR – it can save a life.

Complications

If left untreated

• Brain damage from lack of oxygen (hypoxic brain injury)
• Fluid buildup in the lungs (pulmonary edema) – can develop hours later even if the person seemed fine
• Infection in the lungs (pneumonia) from water inhalation
• Heart rhythm problems
• Organ damage, including kidney or liver injury
• Death

Long-term outlook

With quick rescue breathing and medical care, most people survive drowning with little or no long-term harm. The outcome is best when the person is pulled from the water quickly and receives immediate breaths. Even if the person was under water for several minutes, survival is possible, especially in cold water. Each recovery is unique, and doctors will do everything they can to help.

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