After drowning, the main problem is a lack of oxygen, so resuscitation guidelines include rescue breaths as well as chest compressions. Call 911. The 2024 American guidance says a trained rescuer should give CPR with rescue breaths, and that a rescuer who is untrained, unwilling or unable to give breaths can give chest compressions only until help arrives. This page explains what the guidelines say and why. It is an overview, not a training course.
Important: this page is not a substitute for a hands-on first aid or CPR course. Resuscitation is a practical skill that has to be learned and practised with an instructor and a manikin. We deliberately do not give step-by-step instructions for hand position, depth, speed or breath technique here. In an emergency, call 911 first, follow the instructions of the emergency call-taker, and use the training you have from a certified first aid or CPR course.
Why does drowning need rescue breaths?
The World Health Organization defines drowning as "the process of experiencing respiratory impairment from submersion/immersion in liquid" (WHO drowning fact sheet, 1 May 2026; the same wording appears in the 2005 WHO Bulletin consensus paper by van Beeck and colleagues, as reported in search-result text).
The abstract of the 2024 American Heart Association (AHA) and American Academy of Pediatrics (AAP) guidance explains the reason for rescue breaths: drowning usually progresses from respiratory arrest to cardiac arrest, so resuscitation should focus on restoring breathing as well as circulation (Dezfulian et al., Circulation, 2024, abstract read; full text is subscription-only).
What do the guidelines say?
Expert bodies agree that rescue breaths belong in drowning resuscitation. They do not give identical advice about how many breaths to start with. We set out what each says, with a link to each source, so you can see where they agree and where they differ. The table is not a set of instructions. A certified instructor will teach you one sequence, and an emergency call-taker will give instructions on the phone.
| Body and year | What it says (in our words) | How we checked it |
|---|---|---|
| European Resuscitation Council (ERC), 2021 | For a person in cardiac arrest from drowning, begin with five mouth-to-mouth or mouth-to-nose breaths (or ventilations with 100% oxygen if equipment is available), then 30 compressions alternating with two breaths. Trained rescuers may begin ventilation while still in the water. | Read in the German-language edition of the guideline on PubMed Central (Lott et al., Notfall + Rettungsmedizin, 2021). The English original (Resuscitation 161:152-219) was not opened. A corrigendum to the guideline exists (Resuscitation 167:91-93, per search results) and we did not check what it changed. The ERC released new guidelines in October 2025 (ERC news page); we did not read their drowning section, so the 2025 advice may differ. |
| AHA and AAP, 2024 | CPR for cardiac arrest after drowning should include rescue breaths as well as chest compressions (a Class 1 recommendation, as reported by Contemporary Pediatrics); that page gives no breath count. Anyone who is untrained, unwilling or unable to give breaths can give chest compressions only until help arrives. Trained rescuers should give supplemental oxygen if available. In-water rescue breathing only for specially trained rescuers, if it does not compromise their safety. | AAP news release and Contemporary Pediatrics read; Circulation abstract read; full guideline text not accessed. |
| AHA News, 12 November 2024 | Reports the AHA guidance as trained rescuers giving "two rescue breaths followed by 30 chest compressions". | Secondary: AHA's own news service (heart.org). The page could not be opened on the day of this review; the wording is from search-result text. It is not stated on the AAP release or Contemporary Pediatrics page we read, and we did not see it in the guideline itself. |
| Royal Life Saving Society Australia, September 2025 | In suspected drowning, recommends that trained rescuers such as pool lifeguards give two initial rescue breaths before cycles of 30 compressions and two breaths. | Secondary: position statement; the PDF could not be opened, so the wording is from search-result text. |
| American Red Cross, guidelines database | Says resuscitation after drowning starts with two rescue breaths, then cycles of 30 compressions and two breaths. Its 2021 focused update says five initial breaths are suggested based on current practice, and that agencies may adopt a protocol of five starting breaths for healthcare providers or trained lay responders. Where giving breaths is not possible, compression-only CPR should be done. | Secondary: guideline page and 2021 focused update. Neither could be opened (connection error and access denied), so the wording is from search-result text. |
| ILCOR, 2021 (draft for public comment) | Laypeople: begin with compressions (the "CAB" order). Trained people with a duty to respond (health professionals, lifeguards): consider giving rescue breaths first (the "ABC" order). No breath count. Both are "good practice statements" resting on indirect evidence. | ILCOR CoSTR page read; dated 6 December 2021 and marked draft. We did not find a final published version. |
| Philippine Red Cross | We found no Philippine Red Cross page that sets out drowning-specific resuscitation. Its training page lists CPR and first aid courses and does not mention drowning. | Philippine Red Cross Trainings page read. We have not asked the Philippine Red Cross what its courses teach about breaths for drowning. |
What this means for readers: rescue breaths are part of drowning CPR in every guideline we could find. The advice on how many breaths to start with is not identical: the ERC (2021) says five, the AHA News report, the American Red Cross (with a five-breath option for trained responders) and Royal Life Saving Society Australia say two, and ILCOR gives no number. Because of this we do not tell readers a single number. Get taught by a certified instructor, and if the instructor's number differs from what you read here, follow your instructor. On the phone, follow the emergency call-taker.
What can I do before help arrives?
This is the high-level picture, taken from the 2024 AHA/AAP update as reported by the AAP news release. Details are learned in a course.
- Call or ask someone to call 911. In the Philippines, 911 is the national emergency number (DILG, September 2025). See Recognising drowning and getting help.
- Get the person out without endangering yourself. Do not enter the water unless you are trained. A 2021 scoping review recommends "Reach, Throw, Don't Go" for untrained bystanders (Barcala-Furelos et al., American Journal of Emergency Medicine).
- Treat someone who is not breathing normally or is unresponsive as in cardiac arrest. The AAP release says anyone removed from the water without normal breathing or consciousness should be presumed to be in cardiac arrest, with CPR started immediately.
- If you are trained, the guidance says CPR should include rescue breaths as well as chest compressions.
- If you are untrained, unwilling or unable to give breaths, the guidance says chest compressions only are reasonable until help arrives.
- An AED (automated external defibrillator) can be used once the person is out of the water. The AAP release says it should not delay the start of CPR, and that once CPR is under way, the AED can be attached to check for a shockable rhythm.
- Everyone who needed any resuscitation, even only rescue breaths, should go to hospital for evaluation, monitoring and treatment (AAP news release, 12 November 2024).
Surf Life Saving New Zealand's description of the last link of the drowning chain adds staying with a breathing person until help arrives, and seeking medical attention for anyone with symptoms (Surf Life Saving New Zealand, 2014).
We do not cover foaming from the mouth, vomiting, positioning for recovery, or hypothermia here because we have not been able to confirm those points from a guideline we could read. (The AAP release does say how to position an unconscious person when removing them from the water, which is covered in The drowning chain of survival.)
Why is a course better than an article?
Getting breaths in properly, giving compressions at the right depth and speed, and handling an AED under stress are skills that need supervised practice. The Philippine Red Cross lists these courses on its training page:
| Course | Length | For (as listed) |
|---|---|---|
| Basic Life Support (BLS) CPR | 8 hours | Ages 18 and above; healthcare and first responders such as nurses, law enforcement, EMS, firefighters and lifeguards |
| Basic Life Support Adult CPR for Lay Rescuers | 8 hours | Laypersons trained in adult life-saving measures |
| Basic Life Support Child and Infant CPR | 8 hours | Parents, guardians, teachers, babysitters and others caring for children |
| Emergency First Aid | 8 hours | Ages 13 and above, including students, household helpers and community workers |
| Standard First Aid and BLS-CPR with AED | 4 days (32 hours) | Listed for workplace requirements and emergencies |
The same page lists a trunkline, +63 2 8790 2300, and says nothing about schedules or fees; contact the Philippine Red Cross or your local chapter to ask. It does not mention drowning in the course descriptions, so ask the provider whether a course covers drowning-specific resuscitation. It also lists water safety programmes (Learn to Swim, Basic Water Safety and Rescue, Lifeguarding and Swift Water Rescue).
The Philippine Life Saving Society (PLSS) has run lifesaving training with local partners. A five-day "Basic Water Safety Rescue and Lifeguarding" course in San Carlos City in November 2022 covered resuscitation and emergency care among other topics (Visayan Daily Star), and PLSS Cordillera delivered a first aid and water safety training at the University of Baguio in November 2024 (University of Baguio). We did not find a PLSS course catalogue, so ask PLSS directly.
If you supervise a pool, resort or school outing, ask staff whether they hold current certificates. See Lifeguards and water safety organisations in the Philippines.
Where does this fit in the chain of survival?
Care is the fifth and last link of the drowning chain of survival. The earlier links, from prevention to flotation, are meant to make this step less necessary. See The drowning chain of survival. A floating rescue aid within reach is one way of supporting the flotation link. Our Safety Buoys are designed for that, but they do not replace training.
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Sources
- World Health Organization. Drowning (fact sheet), 1 May 2026. https://www.who.int/news-room/fact-sheets/detail/drowning
- van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJLM. A new definition of drowning: towards documentation and prevention of a global public health problem. Bulletin of the World Health Organization 83(11):853-856, 2005. https://pubmed.ncbi.nlm.nih.gov/16302042/ (details from search-result text)
- Dezfulian C, McCallin TE, Bierens J, et al. 2024 AHA and AAP Focused Update on Special Circumstances: Resuscitation Following Drowning. Circulation 150:e501-e516, 2024. https://doi.org/10.1161/CIR.0000000000001274 (abstract only)
- American Academy of Pediatrics. Updated guidance says CPR with breaths essential for cardiac arrest following drowning, news release, 12 November 2024. https://www.aap.org/en/news-room/news-releases/aap/2024/updated-guidance-says-cpr-with-breaths-essential-for-cardiac-arrest-following-drowning/
- Contemporary Pediatrics. AAP, AHA update guidance for resuscitation following drowning, 12 November 2024. https://www.contemporarypediatrics.com/view/aap-aha-updates-guidance-for-resuscitation-following-drowning
- American Heart Association News. CPR with rescue breaths vital to resuscitation after drowning, new guidelines say, 12 November 2024. https://www.heart.org/en/news/2024/11/12/cpr-with-rescue-breaths-vital-to-resuscitation-after-drowning (page not opened; wording from search results)
- Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation 161:152-219, 2021. https://doi.org/10.1016/j.resuscitation.2021.02.011 (drowning section read in the German-language edition, Notfall + Rettungsmedizin 24(4):447-523, 2021, https://pmc.ncbi.nlm.nih.gov/articles/PMC8190767/)
- European Resuscitation Council. Launch of ERC Guidelines 2025 (news page). https://erc.edu/launch-of-erc-guidelines-2025 (drowning section of the 2025 guidelines not read)
- Royal Life Saving Society Australia. Position statement on ventilations and compressions, September 2025. https://www.royallifesavingwa.com.au/__data/assets/pdf_file/0010/118765/RLSSA-Position-Statement-Ventilations-and-Compressions.pdf (not opened; wording from search results)
- American Red Cross. Guidelines database, "Drowning Process Resuscitation". https://guidelines.redcross.org/guidelines-database/drowning-process-resuscitation/ (not opened; wording from search results)
- American Red Cross. Focused Updates and Guidelines 2021. https://www.redcross.org/content/dam/redcross/training-services/scientific-advisory-council/American-Red-Cross-Focused-Updates-and-Guidelines-2021.pdf (not opened; wording from search results)
- International Liaison Committee on Resuscitation. CoSTR: CAB or ABC in drowning, draft for public comment, 6 December 2021. https://costr.ilcor.org/document/cab-or-abc-in-drowning-bls-856-tf-systematic-review
- Barcala-Furelos R, et al. Lay-rescuers in drowning incidents: a scoping review. American Journal of Emergency Medicine, 2021. https://ajemjournal.com/article/S0735-67572100072-3/fulltext
- Surf Life Saving New Zealand. "Creating a Drowning Chain of Survival", July 2014. https://www.surflifesaving.org.nz/news/2014/july/creating-a-drowning-chain-of-survival/
- Philippine Red Cross. Trainings. https://redcross.org.ph/trainings
- Department of the Interior and Local Government, Region IV-A. Unified 911, 5 September 2025. https://calabarzon.dilg.gov.ph/one-number-for-all-emergencies-unified-911-to-launch-nationwide/
- Visayan Daily Star. "Water-related workers undergo training", 29 November 2022. https://visayandailystar.com/?p=31514
- University of Baguio. "University of Baguio Empowers Future Professionals with Life-Saving Skills", December 2024. https://scjps.ubaguio.edu/university-of-baguio-empowers-future-professionals-with-life-saving-skills/
Last reviewed: 12 October 2026. Resuscitation guidelines are revised periodically; check that this page matches the latest guidance.
