a hand trying to catch a lifebuoy

How To Perform CPR on a Drowning Casualty

How To Perform CPR on a Drowning Casualty in 10 steps:

  1. Stop and assess for danger and make sure it’s safe for you to proceed.
  2. If they’re lying in the water, drag them out of the water onto the shore or vessel and lie them on their back on a hard surface such as the sand or deck.
  3. Consider cross contamination issues – use gloves and a CPR face shield.
  4. Check to see if the casualty is alert. Think AVPU: are they wholly Alert, only responding to Voice commands, only responding to Pain or totally Unresponsive?
  5. If totally unresponsive, shout for help!
  6. Check their airway – tilt their head back, lift their chin and look inside their mouth. If there is obvious sea water, sand or seaweed in there, tilt their head and shoulders to the side and pat them firmly on the back to help it out. Then put them carefully back onto their back.
  7. Check their breathing – Look, listen, feel – Look at their belly whilst putting your face sideways onto theirs – you can then listen for breathing and feel any breaths. Do this for up to 10 seconds, counting the breaths.
  8. If they’re not breathing effectively or at all, give them FIVE rescue breaths followed by 1 minute of CPR in cycles of 30 chest compressions to 2 rescue breaths. Hands in the centre of their chest, arms straight, shoulders over your hands, press the chest by five to six centimetres. The rate is 100-120 compressions per minute. This initial response gives them some oxygen circulating in their system immediately and gives them a better chance of recovery.
  9. THEN phone 999/112 immediately and ask for an ambulance, tell them where you are and that you’ve got a non-breathing unresponsive casualty who you suspect has drowned. Once the emergency services are on their way, you must continue with CPR  – 30 compressions to 2 breaths – continuously until help arrives. Get others to help with the compressions to share the workload as it is a physically demanding technique over time. Expect the casualty to vomit – if they do, move their head and shoulders sideways to help it come out and ensure their airway is clear afterwards then continue with CPR.
  10. With this sequence the casualty might have a re-oxygenated bloodstream and the heart might start beating effectively again and you may see signs of circulation. The casualty might flush pink and we might see signs of life. Don’t stop CPR until they’re effectively breathing around 12-18 breaths per minute or 2-3 every 10 seconds or they become wholly alert or alert to voice command or pain and are breathing on their own. If you’re sure they’re breathing on their own, put them in the recovery position and monitor them until the ambulance arrives.

A few points to remember about drowning:

Drowning is when your lungs are overwhelmed by water and the heart and brain are deprived of life giving oxygen. Drowning does not always lead to death but can lead to life changing illness or injury due to the impact of airway impairment for a period of time.

Combined with the potential of cold water response, it is crucial to identify they are drowning and immediately deal with the situation.

Drowning is not like in the movies – someone who is drowning will not be able to shout, wave or splash about. They will be still and quiet and struggling to use their limbs. However, if someone IS shouting or waving, they WILL probably need help before things get worse for them.


In summary – for drowning CPR, as soon as we realise the casualty is not breathing, we’re going to give the casualty five rescue breaths.

We will do 30 compressions, two breaths, 30 compressions, two breaths, 30 compressions, two breaths.

The casualty in that initial sequence may well come round. If they haven’t come round we need to call the emergency services on 999/112 and tell them where we are. Tell them we suspect drowning, we’re starting CPR again and that we need an AED.

While waiting for help to arrive we’re going to continue our CPR protocol of 30 compressions, then 2 breaths continuously.