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Drowning: why this one starts with breaths
A drowned person is oxygen-starved before the heart stops, so the sequence changes. Five breaths first, the water you should not try to drain, and the spinal-injury myth that costs time on a beach.
CPR in sixty seconds
- Unresponsive and not breathing normally? Gasping is not breathing. Treat it as a cardiac arrest.
- Call 112 (113 in Norway). Speaker on, phone on the floor. Stay on the line — the dispatcher will coach you.
- Push hard and fast in the centre of the chest: 5–6 cm in an adult, 100–120 per minute, letting the chest come all the way back up.
- Send somebody else for a defibrillator. Do not go yourself unless it is seconds away. Keep compressing.
- Turn the device on and do what it says. It decides whether to shock. After a shock, go straight back to compressions.
This is a reference written for bystanders, not a diagnosis, a training course or medical advice. It cannot tell you what is wrong with a particular person, and it does not replace the dispatcher on the other end of an emergency call — they can see what is near you and they will talk you through it. If you are worried about your own heart, or about a symptom, that is a conversation with a clinician rather than a page on a website.
Hypoxia first, heart second
Drowning kills by cutting off oxygen. By the time the heart stops, the blood is already depleted, which is why compression-only CPR — good for a sudden adult collapse — is the wrong tool here. Give five initial rescue breaths as soon as the person is out of the water and on a firm surface, then thirty compressions to two breaths. If you are a trained rescuer and it is safe, ventilation can begin in shallow water or at the boat before the person is fully landed; compressions cannot be done in water.
Do not try to get the water out
The reflex to turn a drowned person over, thump the back or press the abdomen to "empty the lungs" is old, persistent and harmful. Little water enters the lungs in most drownings, abdominal thrusts do not remove it, and both manoeuvres delay ventilation and cause vomiting and aspiration. Vomit is common during drowning resuscitation regardless — turn the head to the side, clear what you can see in a couple of seconds and continue.
Your own safety comes first, genuinely
A meaningful share of drowning deaths in this region are would-be rescuers. Reach with a pole, a branch or a jacket; throw a ring, a rope or anything that floats; row if there is a boat; swim only as a last resort and only if you are trained and strong. On ice, do not walk out — lie flat, spread your weight, push something out to them and call 112. A rescuer in the water is a second casualty and it stops the resuscitation before it starts.
The spinal-injury question
Routine immobilisation of the neck in drowning is not recommended, because it delays the airway and the risk is low in the great majority of cases. It matters when the history points to it: a dive into shallow water, a fall from height, a water-slide or surf injury, or obvious signs of severe trauma. In those cases keep the head in line with the body while you move them and while you open the airway, but never at the cost of not ventilating.
Cold water changes the timeline
In Baltic and Nordic water, submersion is usually cold-water submersion, and cold changes the arithmetic. Rapid cooling lowers the brain's oxygen demand and there are documented survivals with good neurological outcome after long submersions in very cold water, particularly in children. Resuscitation is therefore continued longer than usual, and the decision to stop belongs to the hospital, not to the beach. Start CPR and keep going.
Sources: European Resuscitation Council Guidelines · Finnish Red Cross (Suomen Punainen Risti) · checked 2026-09-08
Frequently asked questions
Should I do abdominal thrusts to get the water out?
No. They do not clear water from the lungs, they delay rescue breathing and they cause vomiting and aspiration. Go straight to five rescue breaths.
How long should we keep going after a cold-water drowning?
Longer than you would otherwise. Cold protects the brain, survival after prolonged cold-water submersion is documented especially in children, and the decision to stop is made in hospital after rewarming.
The person coughed and seems fine after being pulled out — is that the end of it?
No. Anyone who needed rescue from the water, inhaled water or lost consciousness should be assessed medically, because breathing problems can develop over the following hours.
What to do, right now
Is this a cardiac arrest?
Two checks decide it: not responding, and not breathing normally. The noisy gasping that fools nearly everyone, why a brief seizure at the start is a cardiac sign, and why a heart attack is a different emergency.
Hands-only CPR, in sixty seconds
Centre of the chest, 100 to 120 pushes a minute, 5 to 6 cm deep, let the chest come all the way back up, and do not stop. The rate, the depth, the fatigue problem, and a pacer that keeps you on the beat.
The emergency call, and the address problem
What the dispatcher asks, why the phone goes on speaker on the floor, how dispatcher-guided CPR works, and the single hardest question in a rural arrest: where exactly are you?
Using a defibrillator, step by step
Open it, turn it on, bare the chest, follow the voice. What the machine decides for you, what it will never do, and the one instruction people get wrong — go straight back to compressions after the shock.
Where the pads go, and what gets in the way
Right collarbone and left ribs, or front and back. Chest hair, sweat, snow, a medicine patch, a pacemaker lump, an underwired bra, a tattoo: which of these actually matter and what to do about each.
Everything on this subject
Before the emergency, there is a long quiet stretch
Blood pressure, resting heart rate, movement and sleep are the part of this you can act on for years beforehand. TempoLife keeps them in one place, free to start.