Drowning occurs when a person’s breathing is impaired after being submerged or immersed in liquid. According to the World Health Organization (WHO), drowning causes around 300,000 deaths worldwide each year, with children under 5 accounting for nearly a quarter of these deaths.
Furthermore, water entering the airway can interfere with breathing and reduce the amount of oxygen available to the body. Severe cases can progress from respiratory arrest to cardiac arrest, making prompt recognition and appropriate emergency response important.
This article explains what happens to the body during drowning, the stages of drowning, how to respond to a drowning emergency, and what happens after rescue.
How Does Drowning Affect the Body?
Drowning primarily affects the body by interfering with normal breathing and oxygen exchange. The effects can extend to the airway, lungs, brain, and cardiovascular system as oxygen levels continue to decline. The exact progression varies according to the circumstances of the incident, the person’s condition, and how quickly the person is rescued.
What Happens to Your Lungs When You Drown?
When a person is drowning, normal breathing becomes impaired, and the lungs may not receive enough air to maintain adequate oxygen exchange. A person may cough, gasp, or make involuntary attempts to breathe as the body responds to reduced oxygen levels.
Water entering the airway does not mean that the lungs fill with water. Small amounts of aspirated water can interfere with normal gas exchange and contribute to lung injury. The resulting impairment can make it increasingly difficult for oxygen to enter the bloodstream.
As oxygen levels continue to fall, the brain becomes increasingly affected, while the heart and other vital organs may also begin to lose normal function.
What Happens to Your Airway When You Drown?
The airway plays an important role in the drowning process. When liquid enters the mouth or upper airway, the body may respond with protective reflexes such as coughing and involuntary airway closure. Laryngospasm, which involves involuntary tightening of the vocal cords, can temporarily interfere with airflow.
These protective responses can restrict airflow, making breathing less effective and reducing the oxygen available to the body’s tissues.
Therefore, drowning is primarily a respiratory emergency in which impaired breathing limits the body’s oxygen supply, rather than simply a condition in which the lungs fill with water. Severe hypoxemia can eventually lead to respiratory arrest and, if not corrected, cardiac arrest.
What Happens to Your Brain When You Drown?
The brain requires a continuous supply of oxygen to function normally. As breathing becomes impaired during drowning, less oxygen reaches the brain, affecting its normal function.
Early effects can include confusion, weakness, poor coordination, and difficulty responding appropriately. As oxygen deprivation becomes more severe, a person can lose consciousness.
Prolonged oxygen deprivation can cause serious neurological injury. This is one reason rapid recognition, rescue, and resuscitation are important after a drowning emergency.
What Happens to Your Heart When You Drown?
The heart is also affected as oxygen levels fall. During the earlier part of the drowning process, the body may respond to stress and falling oxygen levels with changes in heart rate and circulation.
As oxygen deprivation becomes severe, the heart can become progressively less effective at maintaining circulation. Drowning-related cardiac arrest is generally caused by severe hypoxemia rather than the sudden primary cardiac cause seen in many other cardiac arrest situations.
Once cardiac arrest occurs, blood is no longer circulated effectively to the brain and other organs. At that point, immediate resuscitation is required.
What Does Drowning Feel Like?
The experience can vary depending on how quickly breathing becomes impaired. Early signs may include difficulty breathing, coughing, gasping, panic, weakness, and difficulty staying afloat. As oxygen levels decline, confusion, poor coordination, and loss of consciousness may occur.
A person experiencing severe respiratory distress may be unable to call out or wave for help. Recognizing signs such as difficulty breathing, struggling to stay afloat, or being unable to keep the mouth above the water can help identify a drowning emergency.
What Are the Stages of Drowning?
Drowning can progress through several stages as a person’s breathing becomes increasingly impaired while submerged or immersed in water. The progression can vary depending on the person’s condition, the circumstances of the incident, and how quickly they receive help. Understanding these stages helps explain how a drowning emergency can progress from an initial struggle to severe respiratory and cardiac complications.
1. Struggling to Stay Above Water
The first stage may involve intense efforts to keep the mouth and nose above the water. A person may panic, move their arms and legs uncontrollably, gasp for air, or struggle to maintain a position that allows them to breathe.
As fatigue sets in, keeping the airway above the water becomes increasingly difficult. The person may stop responding to others or become unable to call for help, even while still conscious.
2. Submersion and Breath Holding
When a person can no longer keep their airway above the water, they may become submerged. They may initially hold their breath as a natural response to being underwater.
During this period, carbon dioxide continues to build up in the body, creating an increasingly strong urge to breathe. Eventually, the person may no longer be able to hold their breath voluntarily and may attempt to inhale.
3. Water Entering the Airway
When a person can no longer hold their breath, they may attempt to inhale while submerged, allowing water to enter the mouth and airway. Coughing and other protective reflexes may occur as the body attempts to protect the airway and lungs.
These responses can interfere with effective breathing, reducing the amount of oxygen available to the body. Continued exposure can worsen respiratory distress and make normal breathing increasingly difficult.
4. Severe Oxygen Deprivation and Loss of Consciousness
As breathing becomes increasingly impaired, the body receives less oxygen than it needs to function normally. The brain is particularly sensitive to this change, so confusion, weakness, poor coordination, and reduced responsiveness may develop.
With continued deprivation, the person can lose consciousness and become unable to protect their airway or respond to the situation. At this point, immediate rescue and resuscitation are critical.
5. Respiratory Arrest and Cardiac Arrest
Severe respiratory impairment can eventually cause breathing to stop completely, known as respiratory arrest. Without effective breathing, the amount of oxygen available to the brain, heart, and other organs continues to fall.
If normal breathing is not restored, the heart can also stop functioning effectively, resulting in cardiac arrest. Drowning-related cardiac arrest is generally caused by severe oxygen deprivation, which is why rescue breathing is an important part of resuscitation after drowning.
6. Death
Without successful rescue and resuscitation, prolonged oxygen deprivation can cause irreversible injury to the brain and other vital organs. When circulation and breathing cannot be restored, the drowning emergency can result in death.
Not every drowning follows these stages in the same order or at the same rate. Early rescue and appropriate emergency care can interrupt this progression and significantly improve the possibility of survival.
What Should You Do If Someone Is Drowning?
During a drowning emergency, prompt action is essential to limit the effects of oxygen deprivation and reduce the risk of serious complications. The 2024 American Heart Association and American Academy of Pediatrics focused update highlights the importance of prompt resuscitation and appropriate emergency care following drowning.
1. Get the Person Out of the Water Safely
Remove the person from the water as quickly as possible without putting yourself at risk. If they are within reach, use a reaching aid, rope, or flotation device to help bring them to safety. Enter the water only if you are trained and can do so safely.
Once the person is out of the water, place them on a firm, safe surface where you can assess their condition and provide care.
2. Call 911 and Get Emergency Help
Call 911 as soon as possible and provide the location and information about the person’s condition. If other people are present, ask someone to call 911 while you assess the person. Ask another person to get an AED if one is available.
Anyone who requires resuscitation following drowning, including a person who only requires rescue breaths, should receive medical evaluation, monitoring, and treatment.
3. Check Responsiveness and Breathing
Check whether the person responds when you speak to them and gently tap their shoulder. Then check whether they are breathing normally.
If the person is unresponsive and not breathing normally, begin CPR immediately. Gasping or irregular breathing is not considered normal breathing.
4. Provide Rescue Breaths and CPR
For cardiac arrest following drowning, CPR with rescue breaths and chest compressions is recommended. During single-rescuer CPR, adults, children, and infants receive 30 chest compressions followed by 2 rescue breaths, with the compression technique adjusted according to age and size. See our guide to CPR techniques for infants, children, and adults for detailed instructions.
Continue CPR until emergency medical help arrives, the person shows clear signs of recovery, or the scene becomes unsafe. If a rescuer is untrained, unwilling, or unable to provide rescue breaths, chest compression-only CPR is still reasonable.
5. Use an AED When Available
After removing the person from the water, dry their chest before applying the AED pads. Once the pads are attached, follow the AED prompts and allow the device to analyze the heart rhythm. Resume CPR as directed by the AED.
Although many drowning-related cardiac arrests are caused by severe hypoxemia rather than a shockable rhythm, an AED may be lifesaving when a shockable rhythm is present.
6. Continue Care
Continue CPR and follow the AED instructions until emergency medical personnel take over, the person shows clear signs of recovery, or the scene becomes unsafe.
If the person is breathing normally but remains unresponsive, continue monitoring their breathing and follow the guidance from emergency medical services. Anyone who required resuscitation after drowning should receive medical evaluation, even if normal breathing returns.
Can Someone Survive a Drowning Emergency?
Drowning does not always result in death. A person may survive when the drowning process is interrupted before severe and irreversible injury occurs, particularly when rescue and effective resuscitation begin quickly.
Outcomes can depend on factors such as the severity and duration of oxygen deprivation, the person’s condition, how quickly they are removed from the water, and how soon effective ventilation and CPR begin.
Even when a person appears to recover after being removed from the water, the event should not automatically be considered resolved. Anyone who requires resuscitation following drowning should receive medical evaluation because respiratory and other complications can develop after the initial emergency.
Drowning Prevention and CPR Training
Drowning prevention starts with reducing risks before an emergency occurs. Active supervision, water safety awareness, appropriate flotation equipment, recognition of distress, and safe rescue practices can help prevent drowning and improve preparedness around water.
At Bayside CPR, we offer Heartsaver CPR AED and Heartsaver First Aid CPR AED courses that provide practical training for responding to breathing emergencies, cardiac arrest, and other situations that can occur during a drowning incident. You can complete your training in a single day and receive an official eCard that is recognized across the United States.
