CPR demonstration

A man performs CPR in a class from the Ozarks Red Cross. Note that his elbows are straight, not bent like they are on TV. This allows for more force as you lean over the victim.

by James Hubbard, M.D., M.P.H.

Although I’ve never had to perform CPR on a drowning victim, I’ve done it on others. And I can tell you, it’s a little more complicated and messy than what you what you see on TV. There, the victims almost always make it. Just a little light chest pressing, maybe a push or two on the stomach, then, when all hope seems lost, the person suddenly spits out a gob of water, and that’s that.

In real life, for one thing, you’ve really got to press hard on the chest—much harder than any live actor is going to stand for. For another, it’s not only water that comes up. About eighty percent of near-drowning victims vomit at some point during the resuscitation. Bet you’re not going to see that on the next version of Baywatch.

The Real Way to Perform CPR on a Near-Drowning Victim

These days hands-only CPR is the new, in thing for nonmedical responders. That is, no ventilation. Just good compressions of the chest at one hundred beats per minute (the same rhythm as “Stayin’ Alive,” or “Another One Bites the Dust,” depending on whether you’re an optimist or pessimist, I suppose). For times when someone’s heart just stops, it’s been found to work as well in the first few minutes as combining chest compressions with mouth-to-mouth.

But hands-only CPR is not the best way to go in a case of near-drowning because the person’s primary problem is lack of oxygen.

So, for near-drowning victims, you use the old method and start mouth-to-mouth breathing ASAP, even if the person is still in water, if that’s possible without endangering yourself.

Two more caveats before starting official CPR on dry land:

  1. Someone should call 911 ASAP.
  2. Unless you witnessed the drowning and are sure the person could not have possibly hit their head, treat the victim as if there could be a neck injury. For more on that, view my video here. (At 2:25, it shows how to turn someone with a possible neck injury.)

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The ABCs of CPR for Near-Drowning Victims

Turning a near-drowning victim.

When turning a near-drowning victim to drain water, assume a neck injury: Turn the entire torso, head, and hips, as demonstrated in this photo from the Ozarks Red Cross.

A. Open the airway.

  1. Sweep a couple of your fingers around in the mouth to remove any debris.
  2. If there’s water in the mouth, turn the person on their side or pull up their middle a bit to let it drain. Otherwise, don’t waste any more valuable time trying to get water out. It’s not coming.
  3. To open the airway, use the jaw-jut technique (because we’re assuming they could have a neck injury): place the fingers of both of your hands at the person’s jaw just below the ears, and jut the jaw forward (being careful not to move the neck).
  4. Place your ear close to their nose to listen for breathing. Watch for chest movement at the same time. It’s much easier if a second person can do this while you’re holding the neck and jaw.

If the person’s not breathing,

B. Blow.

Pinch the victim’s nose shut and seal your mouth over theirs. Keep the jaw jutted as best you can. Blow hard enough to see their chest rise. Repeat in 2 seconds. If the chest is not rising, check the airway again for trash, reposition the jaw, and make sure you have a good seal over the mouth.

C. Check for a wrist or carotid pulse.

If there is a pulse but no breathing, continue mouth ventilations at five-second intervals.

If there is no pulse, someone needs to get on their knees, palms on the victim’s chest, elbows straight, and push down to compress the chest about two inches. Repeat this every couple of seconds while counting out loud, “one, two, three.” When you get to thirty, someone give the victim two deep breaths. If you’re the only person there, you have to do this. Make sure the chest moves up. If it doesn’t, you’re not breathing hard enough, or you need to recheck the airway.

Okay, what happens after the inevitable vomiting? You turn the victim on their side again, wipe the vomit out with your fingers, and reposition them back on their back (making sure you move them with neck-injury precautions and that the airway is back open).

If all this seems difficult and confusing, it can be made a lot easier by taking a hands-on class at your local hospital or Red Cross. I promise, they’ll be patient with you, it won’t be embarrassing, and you’ll be glad you did.

Photos by Ozarks Red Cross on Flickr.