Drowning and Submersion




  • Submersion in water regardless of depth
  • Possible trauma to C-spine
  • Possible history of trauma (i.e., diving board)
  • Duration of immersion
  • Temperature of water or possibility of hypothermia


Significant Findings:


  • Unresponsive
  • Mental status changes
  • Decreased/absent vital signs
  • Vomiting
  • Coughing
  • Apnea
  • Stridor
  • Wheezing
  • Rales




  • Trauma
  • Pre-existing medical problem
  • Pressure injury (i.e., diving)
  • Barotrauma
  • Decompression sickness
  • Post-immersion syndrome
  • Hypothermia




  • 12-Lead EKG
  • Obtain BGL
  • Initiate IV


Respiratory distress, wheezing, rales?


  • Yes


    • Consider CPAP (EMT)



  • No


Hypothermia ≤ 95⁰F (35⁰C)?


  • Yes



  • No


    • See appropriate protocol based on symptoms


    • Notify receiving facility or contact Medical Control




  • Drownings have a high index of suspicion for possible spinal injuries.
  • Regardless of water temperature - resuscitate all patients with unknown submersion time of ≤ 30 minutes.
  • If submersion time ≥ 90 minutes consider moving to recovery phase instead of rescue, unless water temperature is < 43° F.
  • Some patients may develop delayed respiratory distress.
  • All victims should be transported for evaluation due to potential for worsening over the next several hours.
  • Drowning is a leading cause of death among would-be rescuers.
  • Allow appropriately trained and certified rescuers to remove victims from areas of danger.
  • With pressure injuries (decompression/barotrauma), contact Divers Alert Network at 1-919-684-9111 for guidance.
  • Consider hypothermia in all drownings.
  • Transport should be strongly advised on all patients who's head was submerged underwater.