There is nothing quite like the allure of the ocean. Whether you’re surfing the North Shore, snorkeling off Maui, or just enjoying a relaxing day at Waikiki, the water holds a special place in the heart of every islander and visitor to Hawaii. But with its beauty comes inherent risks. When an emergency strikes in the water, understanding the critical difference between a victim of drowning and a victim suffering from a sudden cardiac arrest is not just academic, it’s the difference between life and death.
As a community committed to ocean safety, and as the home of Defib Hawaii, we want to equip you with the knowledge that could save a life. Knowing how to properly perform Cardiopulmonary Resuscitation (CPR) in a marine environment, and when to prioritize rescue breaths versus chest compressions, is vital for anyone who loves the water.
The Core Difference: Cause of Oxygen Deprivation
While both scenarios result in a person being unresponsive and not breathing normally, the immediate cause of the emergency dictates the most effective CPR protocol.
Drowning: A Primary Breathing Problem
In a typical drowning event, the primary issue is the lack of oxygen (hypoxia) caused by the water entering the airway. This is often referred to as an asphyxial arrest.
- The Chain of Events: A person becomes overwhelmed in the water, water enters the lungs, and the body’s oxygen levels plummet. The heart, which is a muscle, eventually stops beating (cardiac arrest) because of the prolonged lack of oxygen, not due to a primary electrical issue.
- The CPR Priority: Because the immediate cause of the cardiac arrest is the lack of oxygen, the victim desperately needs air.
- Protocol Focus: Breaths first. You must prioritize getting oxygen into the victim’s lungs immediately.
Sudden Cardiac Arrest (SCA): A Primary Electrical Problem
SCA in the ocean environment is often caused by an underlying heart condition, or sometimes by the physiological shock of sudden immersion in very cold water (known as the cold shock response).
- The Chain of Events: The heart’s electrical system malfunctions, causing it to quiver uselessly (ventricular fibrillation, or VF) and immediately stop pumping blood effectively. The brain and body are deprived of oxygen-rich blood.
- The CPR Priority: The heart already has enough oxygen for a few minutes; the problem is that the heart isn’t circulating it. The priority is to manually circulate the existing oxygenated blood.
- Protocol Focus: Compressions first. You must prioritize chest compressions to move blood to the brain and vital organs.
CPR Protocols for Ocean Rescue
The American Heart Association (AHA) and other international guidelines provide specific guidance that first responders and bystanders should follow, particularly in drowning incidents.
The Drowning Victim: Breaths First
For a confirmed or suspected drowning victim, you must break the traditional “Compressions-Airway-Breathing (C-A-B)” sequence and revert to an Airway-Breathing-Compressions (A-B-C) approach, or at least deliver the initial breaths immediately upon rescue.
| Step | Action and Rationale |
| Initial Breaths | Deliver 5 initial rescue breaths immediately after securing the airway, before starting compressions. This is crucial to reverse the immediate, fatal hypoxia. |
| CPR Cycle | After the initial breaths, proceed with the standard CPR ratio: 30 compressions followed by 2 breaths (30:2). |
| Special Consideration | The pulse check is often difficult in a wet, cold environment. If the victim is unresponsive and not breathing normally (or only gasping), assume cardiac arrest and begin rescue breathing immediately. |
Pro Tip for Water Rescue: If you are a trained rescuer and can safely manage it, delivering rescue breaths while the victim is still in shallow water or being towed to the shore is ideal. Getting oxygen in as soon as possible dramatically increases survival rates for drowning victims.
The Sudden Cardiac Arrest Victim: Compressions First
If the victim collapses or becomes unresponsive while on a surfboard, paddleboard, or even on the beach, and the collapse was not preceded by struggling in the water, treat them as a standard SCA victim.
| Step | Action and Rationale |
| Initial Action | Immediately call 911/EMS and get an AED (Automated External Defibrillator) to the scene. |
| CPR Cycle | Begin with chest compressions: 30 compressions followed by 2 breaths (30:2). The priority is immediate circulation. |
| High-Quality Compressions | Push hard and fast in the center of the chest, aiming for a depth of at least two inches and a rate of 100 to 120 compressions per minute. |
Be Ready: The Defib Hawaii Call to Action
Ocean emergencies demand swift, decisive action. The fraction of a minute it takes to correctly identify the likely cause of the arrest and adjust your CPR
technique can be the difference between a tragedy and a successful rescue.
- Get Trained: Take an accredited CPR/AED course that includes specific training for water-related emergencies and drowning victims.
- Know Your Resources: Know the locations of Public Access Defibrillators (PADs) near your favorite beach spots. Many businesses and public areas in Hawaii have them, do you know where yours is?
- Practice Safety First: Never swim alone, and always adhere to posted safety warnings and lifeguard instructions.
The ocean is part of the fabric of life here. By understanding these life-saving protocols, we can all become better stewards and protectors of our community, ensuring that everyone who enters the water can return to shore safely.
Read More: What Are the Components of High-Quality CPR?
