In cold water drowning the hypothermia that ensues is protective, and full neurologic recovery has been documented in such cases with immersion times greater than 40 minutes. As with most prehospital emergencies, the priorities in caring for the drowning victim are the ABCs. Careful attention must be paid to airway management. Early intubation and positive airway pressure ventilation are essential to correct the hypoxia and airway damage. Cardiopulmonary resuscitation should be initiated on any patient in full arrest who has any chance of survival, especially with cold water drownings.
Cardiopulmonary resuscitation is ineffective in the water.
The patient should be moved to dry land, a boat or a dock where he or she can be put on a hard surface. Postural drainage and Heimlich maneuvers should be avoided unless an aspirated foreign body is suspected. Gastric dilation occurs in drownings, and attempts to drain the lungs may actually result in further aspiration of stomach contents. As drowning is often the result of diving accidents, protection of the C-spine is very important. Always remember to initiate spinal precautions as a soon as possible on all drowning patients.