"Near drowning" means a person almost died from not being able to breathe (suffocating) under water.

If a person has been rescued from a near-drowning situation, quick first aid and medical attention are very important.

• 6,000 to 8,000 people drown in the U.S. each year. Most drownings occur within a short distance of safety. Immediate action and first aid can prevent death.
• A person who is drowning usually can NOT shout for help. Be alert for signs of drowning.
• Suspect an accident if you see someone in the water fully clothed. Watch for uneven swimming motions, which indicate a swimmer is getting tired. Often the body sinks, and only the head shows above the water.
• Children can drown in only a few inches of water.
• It may be possible to revive a drowning person even after a long period under water, especially if the person was in very cold water.

• Leaving small children unattended around bathtubs and pools
• Drinking alcohol while boating or swimming
• Inability to swim or panic while swimming
• Falling through thin ice
• Blows to the head or seizures while in the water
• Attempted suicide

Symptoms can vary, but may include:

• Abdominal distention
• Bluish skin of the face, especially around the lips
• Cold skin and pale appearance
• Confusion
• Cough with pink, frothy sputum
• Irritability
• Lethargy
• No breathing
• Restlessness
• Shallow or gasping respirations
• Chest pain
• Unconsciousness
• Vomiting

When someone is drowning:

• Extend a long pole or branch to the person, or use a throw rope attached to a buoyant object, such as a life ring or life jacket. Toss it to the person, then pull him or her to shore.
• People who have fallen through ice may not be able to grasp objects within their reach or hold on while being pulled to safety.
• Do not place yourself in danger. Do NOT get into the water or go out onto ice unless your are absolutely sure it is safe.
• If you are trained in rescuing people, do so immediately if you are absolutely sure it will not cause you harm.

If the person's breathing has stopped, begin rescue breaths as soon as you can. This often means starting the breathing process while still in the water.

Continue to breathe for the person every few seconds while moving them to dry land. Once on land, give CPR if needed. For step-by-step instructions on rescue breathing, see the article on CPR.

Always use caution when moving a person who is drowning. Assume that the person may have a neck or spine injury, and avoid turning or bending the neck. Keep the head and neck very still during CPR and while moving the person. You can tape the head to a backboard or stretcher, or secure the neck by placing rolled towels or other objects around it.

Follow these additional steps:

• Keep the person calm and still. Seek medical help immediately.
• Remove any cold, wet clothes from the person and cover with something warm, if possible. This will help prevent hypothermia.
• Give first aid for any other serious injuries.
• The person may cough and have difficulty breathing onced breathing re-starts. Reassure the person until you get medical help.

• DO NOT go out on the ice to rescue a drowning person that you can reach with your arm or an extended object.
• DO NOT attempt a swimming rescue yourself unless you are trained in water rescue.
• DO NOT go into rough or turbulent water that may endanger you.
• The Heimlich maneuver is NOT part of the routine rescue of near drownings. Do not perform the Heimlich maneuver unless repeated attempts to position the airway and to use rescue breathes to get air into the lungs have failed and you suspect the person’s airway is blocked. Performing the Heimlich maneuver increases the chances that an unconscious person will vomit and subsequently choke on the vomit.

If you cannot rescue the drowning person without endangering yourself, call for emergency medical assistance immediately. If you are trained and able to rescue the person, do so and then call for medical help.

All near-drowning patients should be checked by a doctor. Even though the person may revive quickly at the scene, lung complications are common.

• Avoid drinking alcohol whenever swimming or boating.
• Observe water safety rules.
• Take a water safety course.
• Never allow children to swim alone or unsupervised regardless of their ability to swim.
• Never leave children alone for any period of time, or let them leave your line of sight around any pool or body of water. Drownings have occurred when parents left "for just a minute" to answer the phone or door.
• Drowning can occur in any container of water. Do not leave any standing water (in empty basins, buckets, ice chests, kiddy pools, or bathtubs). Secure the toilet seat cover with a child safety device.
• Fence all pools and spas. Secure all the doors to the outside, and install pool and door alarms.
• If your child is missing, check the pool immediately.

Knaut AL. Feldhaus KM. Submersion. In: Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006.