What should you do after you’ve pulled someone from the water who is drowning? If they are unresponsive and not breathing, three things must be done at once if there are enough people to perform them: call 911, begin CPR, look for an AED machine.

If you can’t call 911 and there is no AED machine, do CPR until you’re exhausted. However, know that just CPR seldom revives a person. It delivers blood to the brain in order to protect it from damage until professional assistance arrives but only rarely restarting the heart. An AED—automatic external defibrillator—can restart the heart if needed. Public swimming pools are becoming increasingly common sites for people to swim.)

If you’re by yourself, decide which one of the three stages to perform first. I’d spend no more than 30 seconds looking for an AED device if I was alone. CPR should be performed as soon as possible.

The following are the essentials. However, a few of the precise drowning resuscitation instructions may surprise you:

1. For drownings, old-fashioned CPR is still advised. Unless you’re specially trained, nowadays chest compressions are generally considered to be the only type of CPR—no mouth-to-mouth resuscitation. However, there are a few exceptions. Old-fashioned CPR – with respiratory efforts – is still suggested for victims who are prepubescent children or have hypothermia or near-drowning sufferers. You may even start mouth-to-mouth breathing after reaching dry land or in a boat. Begin chest compressions as soon as possible after getting to dry ground or in a boat.

In the past, mouth-to-mouth resuscitation was known as mouth-to-barrier resuscitation, implying that you should place a barrier between your mouth and the victim’s to prevent yourself from acquiring disease fluids. Commercial barriers are inexpensive; if you don’t have one, a piece of plastic or duct tape with a hole in the middle for your mouth is better than nothing. At least it’s something, but my new book Duct Tape 911 provides instructions for making your own protection.

2. Protect the neck even for drowning. It’s critical not to move a collapsed person’s head on land since they might have struck it, causing spinal damage. Moving the head slightly may lead to paralysis. The same applies to drowning victims. Water has the potential to harm bones, but there are a variety of circumstances where it may happen—such as while diving or on rocks, or during a long fall or trauma before falling in the water. So unless you’re sure the person hasn’t injured their head, neck, or back, avoid moving their neck. You must do whatever is necessary to get the patient out of the water, but at least when you begin chest compressions, perform the jaw thrust instead of tilting your head back. (For jaw-thrust instructions, click here; see “The ABCs of CPR.”)

3. You don’t need to be concerned about water in the lungs. Aside from perhaps flipping the victim upside down for a couple of seconds, you’re just wasting your time attempting to remove water from their lungs. Abdominal or chest thrusts to expel water have not been proven to improve survival rates. If you must turn the person, avoid moving the neck as much as possible. Using the log roll method, roll the head and body together as if they were both attached to one plank. This involves rolling the head and body in unison like two planks fastened together at one end. You may observe an example of this in this video, which begins around 2:25.

4. An AED could save the person, but it might also harm you. Please exercise caution. Keep in mind that an AED is powered by electricity. Remove wet clothes and towel and dry the chest region where the pads will be placed before using one. Anyone near the victim should keep themselves out of water as well. It’s quite simple to utilize an AED. Simply open it up, then press the power button. From there, the computer will take over.

Do you know how to do CPR? Do a log roll? If not, take a hands-on course. Soon, I’ll have a more comprehensive resuscitation and moving victim demonstration video for you to refresh your memory.

Photo credit: Blake Cheek/Unsplash

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