Near-drowning: first aid, hospital observation and oxygen deprivation

NHS inform describes drowning as beginning when your nose, mouth and air passages are submerged below the surface of a liquid. St John Ambulance puts it as someone having difficulty breathing because their nose and mouth are submerged. Near-drowning is the term people commonly use for a rescue that happens before death: the person has been successfully rescued, with or without the need for resuscitation.

The term hypoxic, which appears in this page's title, refers to hypoxia: NHS inform defines it as not enough oxygen in the body's tissues. The seriousness of an incident therefore depends on how long the oxygen supply was reduced and how quickly breathing and circulation were restored.

According to NHS inform, once the nose and mouth are covered by liquid the oxygen supply is cut off and the person loses consciousness. If this continues, the heart will eventually stop beating. Suddenly entering cold water carries particular risks: it can overstimulate the nerves, which may cause the heart to stop, cause hypothermia and make shock worse.

NHS inform adds that sudden immersion in cold water can cause spasm in the throat or make you inhale water, blocking the airways and leading to hypoxia and drowning. Inhaled or swallowed water may also be absorbed into the circulation and overload the brain, heart or lungs, and the effort of swimming can itself strain the heart.

Anyone can be involved in a water incident. NHS inform links drowning to swimming in strong currents, swimming in cold water, swimming or boating after drinking alcohol, suddenly entering cold water and the physical effort of swimming. It also notes that young children can drown in small amounts of water, including ponds and paddling pools, which is why close supervision of children near any water matters.

The first priority is to avoid creating a second casualty. NHS inform advises staying on dry land and holding out a stick, branch or rope for the person to grab, or throwing a float if one is nearby, and phoning 999 if you cannot help safely. St John Ambulance and the Red Cross both stress not putting yourself in danger.

Once the person is out of the water, check whether they respond and whether they are breathing, opening the airway by lifting the chin and tilting the head back. If they are unresponsive and not breathing normally, phone 999 or ask a helper to, and start CPR. NHS inform and St John Ambulance describe giving 5 initial rescue breaths followed by 30 chest compressions and 2 rescue breaths, repeated until help arrives, the person becomes responsive and starts breathing normally, or you are too exhausted to continue. The Red Cross explains that when someone has been drowning their lungs may be full of liquid, so rescue breaths are especially important to provide oxygen.

• If a defibrillator (AED) is available, attach it and follow its voice prompts while CPR continues.

• Be prepared for the person to bring up stomach contents; St John Ambulance says to roll them onto their side to clear the airway.

• If they start to cough, open their eyes, speak and breathe normally, put them in the recovery position.

• Cover them with warm clothes and blankets and replace wet clothing with dry if possible.

• Keep checking their breathing and level of response until help arrives, and be ready to give CPR again.

St John Ambulance states that people who have experienced near-drowning may need to be observed for a short period in hospital, and that medical advice should be sought even if they appear well in the immediate aftermath. The sources read for this page do not set out specific observation times, and practice is decided by the treating team, who will consider whether the person needed resuscitation, how they are breathing and how they were affected by cold.

NHS inform advises checking the person's breathing and level of response and, if needed, phoning 999 for more help. If someone who has been in the water becomes breathless, drowsy or confused afterwards, that is a reason to call for urgent help rather than wait.

The sources used for this page cover first aid and the immediate response rather than long-term outcomes, so they do not give recovery figures. What they do make clear is that the body's oxygen supply is cut off during drowning, and that the length of time without oxygen and the speed of rescue and resuscitation matter. The treating hospital team can explain what to expect for an individual person and arrange any follow-up.

A serious water incident can also be frightening for the person and for those who rescued them, and it is reasonable to ask your GP about support if it affects sleep, mood or confidence around water.

A drowning or near-drowning incident is an emergency handled through 999, the ambulance service and an NHS emergency department; there is no routine private route for the acute phase. If the person is admitted, the NHS team coordinates observation, intensive care if needed, and follow-up.

Later on, some people see private physiotherapists, psychologists or respiratory physicians for ongoing problems. Share what happened and any hospital reports with them so that they can see the full picture.