Airway and oxygenation are the priority. Hypothermia and cardiac arrest common in cold water submersion.
Steps by Cert Level
ALL: Ensure scene safety — water rescue requires trained personnel. Do NOT enter moving water without training/equipment. Once patient on shore: open airway, check breathing/pulse.
EMT: Immediate BVM ventilation. CPR if pulseless. O2 high flow. Spinal precautions if mechanism suggests injury (diving, trauma). Remove wet clothes, begin warming.
AEMT: IV access. NS bolus for hypotension. Temperature management — cold water drowning often has severe hypothermia.
PARAMEDIC: Intubation for airway protection. Treat hypothermia per protocol. Cardiac arrest: full resuscitation — especially in cold water (submersion up to 60+ min may survive neurologically intact). NG tube to decompress stomach.