Talant Imanalievich Kadyrov, a medical expert of MedElement, prepared a review material on how to understand that a person is drowning and manage to save him.
The reason for writing the material was the case when a 4-year-old boy drowned in a pool full of adults. The boy spent 3 minutes in the water, but due to the fact that no one knew how to properly perform cardiopulmonary resuscitation (according to the current ways of first aid in case of drowning), unfortunately, the boy died.

Tragic fact: MOST people don't realize how a child/adult actually drowns
The motion-picture industry (movies, TV programs, cartoons) is largely to blame for this, which demonstrates drowning in the form of a person waving his arms, creating a lot of splashing and calling for help: "Help! I'm drowning". 
A huge number of warning signs, again, provide misleading information on how people drown.
Children grow up absorbing from various sources of information (TV, cinema, warning signs about the danger of drowning) that drowning is when the arms are stretched straight up above the water, with the head completely above the water surface. And this is not at all what it looks like when a person drowns.
The truth is that people DROWN SILENTLY!
50% of children drown at a distance of no more than 20 meters from their parents, and in 10% of children - at a time when the parent does not take his eyes off the child, that is, parents have no idea that what they see is actual drowning. 

Parents expect that drowning should be accompanied by a lot of splashes, screaming, crying and calling for help. Therefore, unfortunately, without some training, many parents cannot recognize when their child is actually drowning.
Drowning is a very short and fast process: a drowning person's struggling for life lasts from 20 to 50 SECONDS.
Children are struggling to remain alive even less time. 
What are the TRUE signs that a person is drowning?

!!! A drowning person usually looks towards the shore.
!!!  His head is thrown back.
!!! The mouth is at water surface level.
!!! The body is in an upright position.
!!! The person makes movements of the limbs that resemble trying to climb an invisible ladder, or both arms are spread apart and move down from the surface of the water in an attempt to keep the mouth above the water level.

This is what a drowning person looks like: 

- The mouth is at water surface level, the head is thrown back, the person is gasping for air.
- If a person's hair cover his face, it is natural to remove hair off the face. But when a person is drowning, he is so focused on keeping his mouth above the water and so exhausted to stay on the surface that he doesn't have the energy to remove his hair off his face.

Here is another example of what a drowning person looks like, matching the diagram: the mouth is at water level, the head is thrown back, the body is in an upright position, and the hands are underwater trying to climb the ladder.

It must be understood that a drowning person is not capable of giving any signs that he is drowning.
Drowning starts with an utter panic. This is a sharp fear for one's life, and this fear/panic causes excessive agitation. In such situation, an involuntary and excessive response occurs with a rapid expenditure of energy and exhaustion.
If the person does not cope with panic, then most likely he will not survive and drown (at this very moment, this person is very dangerous for someone who tries to save him).
Everything that happens next is no longer under the control of the drowning person. The person is concentrated on keeping the mouth above the water level. He does this by throwing his hands out to the sides on the surface of the water and pushing his hands down (and never raises his hands up!) or makes movements with his hands like climbing stairs under water.

At this point, the person is not able to give any signs that he is drowning.
At the same time, the person tries to keep his mouth at water level at this very moment (throwing his head back), periodically, like a float, plunging his mouth under water. At this moment, when the person's mouth is either above or below the water, he is trying to gasp for air and has no way to make a cry to call for help.

And all these are involuntary reactions to the process of drowning. All the reactions described are instinctive and constitute reflexes from subcortical structures in an attempt to avoid drowning.

What needs to be done to save a drowned person 
This drowning sequence was derived from an evaluation of approximately 90,000 documented resuscitated drowning victims who were breathless and pulseless after being removed from the water.
1. After being delivered to the shore, the drowned person must immediately be laid horizontally on his back. The torso and head should be at the same level.

2. Open his mouth: if you see foreign bodies, then you need to remove sand, algae or other VISIBLE foreign bodies from the mouth. If the mouth is free, then bend over and "look, listen and feel" for the presence of breath.

3. If there is no breathing, then it is necessary to perform 5 mouth-to-mouth breaths, and immediately check the pulse on the carotid artery.

4. If there is no pulse, then start chest compressions (perform 30 continuous chest compressions) and then take 2 mouth-to-mouth breaths, and immediately start 30 chest compressions again, followed by 2 breaths and so on. The compression technique is described below. 

5. Continue non-stop cardiopulmonary resuscitation at a ratio of 30:2 (30 chest compressions and 2 mouth-to-mouth breaths) until the ambulance arrives, or until the casualty has spontaneous breathing and pulse, or until you are exhausted and can no longer continue cardiopulmonary resuscitation.

Technique for performing chest compressions (external cardiac massage)*
* Information from the website of the All-Russian Center for Emergency and Radiation Medicine named after A.M. Nikiforov
To be carried out only in the absence of a pulse! One mustn't do it if there is a pulse!

- Lay the person on a flat, hard surface. 
- Determine the location of the xiphoid process of the person affected The xiphoid process is the shortest and narrowest part of the sternum, its end.
Measure 2-4 cm up from the xiphoid process - this is the point of compression.
- Place the base of your palm on the compression point. In this case, the thumb should point either to the chin or to the stomach of the victim, depending on the location of the resuscitator. Place the other hand on top of the first hand, fold your fingers into a lock. Pressing is carried out strictly with the base of the palm - your fingers should not come into contact with the victim's sternum.
- Perform rhythmic thrusts upon the chest strongly, smoothly, strictly vertically, with the weight of the upper half of your body. On doing so, the chest should bend by 3-4 cm.

Be careful on the water, especially with children!


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