What to Do
in an
Emergency?

Drowning does not simply mean that “water is in the lungs.”

The internationally accepted definition describes drowning as a process in which breathing is impaired due to submersion or immersion in liquid.

The central problem is that the body is no longer receiving enough oxygen.

When a child goes underwater or inhales water, breathing can become blocked or severely restricted. As a result, oxygen levels in the blood begin to fall. The brain is particularly sensitive to a lack of oxygen.

That is why every minute counts during a water-related emergency.

The most important thing for parents to remember: the priority is not removing water, but restoring breathing.

What Happens in the Body During a Drowning Incident

When a child goes underwater, the body initially tries to protect the airways.

In many cases, breathing is held instinctively. At the same time, carbon dioxide levels in the blood begin to rise while the available oxygen supply gradually decreases.

As oxygen levels fall, the urge to breathe becomes stronger and stronger. Eventually, this urge may become so intense that water is inhaled involuntarily.

From that point on, the body's oxygen supply continues to deteriorate.

The brain is particularly vulnerable because it depends on a constant supply of oxygen and can store only very limited reserves. After just a few minutes without adequate oxygen, the first brain cells may begin to suffer damage.

If oxygen deprivation continues, other vital organs are gradually affected:

• Brain
• Heart
• Lungs
• Kidneys

Over time, this can lead to unconsciousness, respiratory arrest, and eventually cardiac arrest.

The Good News

There is no absolute point at which rescue automatically becomes hopeless.

Especially in children, successful rescues have repeatedly been reported even after longer periods underwater than initially expected.

That is why, in an emergency:

Act immediately. Call for help immediately. Begin resuscitation efforts immediately.

Why Cold Water Can Sometimes Play a Special Role

In young children, cold water can under certain circumstances trigger a natural protective response known as the diving reflex.

This reflex slows the heart rate while directing the body's remaining oxygen reserves toward vital organs such as the brain and heart.

In rare cases, this response may help reduce some of the effects of oxygen deprivation.

However, one thing is important to understand:

The diving reflex does not prevent drowning and does not replace rapid rescue.

It simply helps explain why successful resuscitations are sometimes possible in children even after longer periods underwater.

Why Seconds Matter

The sooner normal oxygen delivery is restored, the better the chances of a full recovery.

That is why modern first-aid guidelines for drowning emergencies focus on:

• Rapid rescue from the water
• Restoring breathing
• Early resuscitation
• Prompt activation of emergency medical services

The most important factor is not the exact amount of time spent underwater, but how quickly effective help begins.

In a water emergency, immediate action is essential.

The first steps are:

1. Get the child out of the water as quickly as possible—without putting yourself at risk.
2. Check the child's responsiveness.
3. Call loudly for help.
4. Have someone call emergency services.
5. Check for breathing.
6. If the child is not breathing normally, begin CPR immediately.
7. Continue until emergency medical services arrive.

Once the child is out of the water, breathing should be checked.

Do not spend more than about ten seconds doing so.

If the child is not breathing normally, resuscitation should begin immediately.

It is also important to think about your own safety.

Anyone entering the water without protection can quickly become a victim as well. Whenever possible, use rescue aids such as a pole, towel, lifebuoy, or floating object—especially in deeper water.

When a person suffers a cardiac arrest, chest compressions are often the main priority.

In drowning emergencies, the situation is different.

In most cases, the primary problem is a lack of oxygen.

That is why international resuscitation guidelines emphasize the importance of rescue breaths in drowning incidents. For children who are not breathing normally, European and British guidelines recommend giving several initial rescue breaths before continuing with a combination of chest compressions and rescue breathing.

As a general rule for children:

Infants (under 1 year)

• Cover both the mouth and nose with your own mouth.
• Give only enough air to make the chest visibly rise.
• Do not blow forcefully.

Children (approximately 1 year to puberty)

• Pinch the nose closed.
• Use mouth-to-mouth rescue breathing.
• Give only enough air to make the chest visibly rise.

Duration of a Rescue Breath

Each rescue breath should last about 1 second. Deliver it gently and steadily—do not blow harder than necessary.

Key Steps at a Glance

1. Rescue the child from the water while ensuring your own safety.
2. Check for responsiveness.
3. Call for help and contact emergency services.
4. Check for breathing.
5. If the child is not breathing normally, begin resuscitation immediately.
6. Follow the instructions of the emergency dispatcher.
7. Continue resuscitation until professional help arrives or the child resumes normal breathing.
   
   

For complete and up-to-date resuscitation guidelines, refer to recognized organizations such as the German Red Cross (DRK), the European Resuscitation Council (ERC), the American Heart Association (AHA), or other established health and rescue organizations in your country.

Even if a child appears stable after a water-related incident, it is important to remain observant.

Medical evaluation is recommended if any of the following symptoms occur:

• Persistent coughing
• Shortness of breath
• Rapid or labored breathing
• Bluish lips
• Unusual tiredness
• Confusion
• Unusual behavior
• Chest pain
• Repeated vomiting
• A worsening condition after initially seeming well

Many medical sources emphasize that, if symptoms develop after a water incident, they usually appear within the first few hours.

If a child briefly swallows water but immediately returns to normal, breathes comfortably, plays as usual, and shows no symptoms, this is generally less concerning.

However, when in doubt:

It is always better to seek medical advice.

Terms such as “dry drowning,” “secondary drowning,” or “delayed drowning” are often mentioned in the media and on social media.

However, these terms are considered problematic from a medical perspective.

Experts recommend avoiding them because they can cause unnecessary concern and do not accurately describe what is happening.

A more accurate explanation is:

After a water-related incident, breathing problems can occasionally develop if water has been inhaled or if the lungs have become irritated.

This is not a mysterious form of “drowning later on,” but rather a possible complication following an incident in the water.

For parents, the important thing is not the terminology, but observation:

Has the child truly returned to normal?

Or are there warning signs that require medical attention?

No parent wants to imagine a water-related emergency.

Yet preparation is one of the most effective ways to improve safety.

Helpful measures include:

• Taking a first-aid course focused on children
• Refreshing CPR skills regularly
• Knowing the local emergency number
• Clearly assigning supervision responsibilities around water
• Keeping rescue equipment near the pool
• Introducing children to water from an early age
• Teaching children to swim as early as appropriate
• Securing pools, ponds, and other water hazards
  

When it comes to children, rapid assistance can make a critical difference.

A first-aid course provides not only knowledge, but also the confidence to act when it matters most.

...that the human brain accounts for only about 2% of body weight but consumes around 20% of the body's oxygen? That is why it is especially sensitive to oxygen deprivation.

...that in a drowning emergency, the biggest problem is usually not water in the lungs, but the lack of oxygen throughout the body?

...that when water reaches the airways, the body can reflexively close the vocal cords? This helps keep water out, but it also prevents enough air from reaching the lungs.

...that cold water can, under certain circumstances, trigger a natural protective response? During this response, the heart rate slows and the body directs its oxygen reserves toward vital organs.

...that the first seconds in cold water are often more dangerous than the later effects of hypothermia? The so-called cold shock response can cause involuntary gasping and breathing difficulties.

...that successful resuscitations of children have been documented even after extended periods underwater? That is why emergency medicine follows an important principle: resuscitation efforts should never be stopped prematurely.

The content on this page is based, among other sources, on information and recommendations from:

• German Resuscitation Council (GRC)
• DLRG (German Life Saving Association)
• European Resuscitation Council (ERC)
• American Heart Association (AHA)
• World Health Organization (WHO)
• Centers for Disease Control and Prevention (CDC)
• Royal Life Saving Society UK (RLSS UK)
• Royal National Lifeboat Institution (RNLI)