What to Do After Someone Nearly Drowns

Someone is out of the water. They are coughing, or they are not, and they say they are fine. The single most important thing to do now is to get them medical attention anyway. Fire and rescue services across the UK are consistent on this: if you get someone out of the water, they will need medical attention, even if they seem okay¹. The reason is that drowning can happen at a later stage if water has already entered the lungs, and it can cause death up to 48 hours after the near-drowning incident¹.

So the order is: call for help if you have not already, get them out of the wind, get them dry and warm, and keep checking their breathing and level of response until the ambulance arrives³. Do not let them talk you out of being checked over.

If the person is still in the water, do not go in after them. Call 999, tell them to float on their back, and throw them something that floats⁴. Once they are out, the aftercare below is what matters.

Get medical help straight away, even if they seem fine

The instinct after a water rescue is relief. They are out, they are talking, they are embarrassed. That is exactly the moment the advice is hardest to follow and most important. "Make sure you get medical care immediately," is the instruction from Mid and West Wales Fire and Rescue Service⁵. Surrey Fire and Rescue Service puts it in plain terms: if the person manages to get out of the water, they will need medical attention, even if they seem okay².

The mechanism behind that advice is delayed deterioration. Water that has gone down the airway can cause problems after the event, not during it. Fire and rescue guidance states that drowning can occur at a later stage if water has already entered the lungs, and that it can cause death up to 48 hours after the near-drowning incident¹. That 48 hour window is why a person who is walking and talking on the bank still needs to be seen.

Signs can be easy to miss. The same guidance notes that signs of drowning can often go unnoticed, even if there are other people nearby³. Someone who slipped under briefly, swallowed water and came up spluttering may not look like a casualty at all.

If you are helping after a flood rather than a swim, the same principle applies. Public Health Wales and Surrey County Council both advise checking that there are no immediate physical health needs, for example those that may require an ambulance or a hospital visit⁶. If someone has been in flood water, that check comes before anything else.

Once they are out of the water: shelter, dry clothes and warmth

Getting them out is only half the job. A wet person in cool air loses heat quickly, and the priority shifts to shelter and warmth while you wait for the ambulance.

NHS inform's drowning first aid guidance sets out the sequence. Once the person is out of the water, shield them from the wind if possible. Replace any wet clothing with dry clothing if you can. Check the person's breathing and level of response, and if needed, phone 999 for more help³. If they are showing signs of hypothermia, cover them with warm clothes and blankets, replace wet clothes with dry ones if possible, and keep checking their breathing and level of response until help arrives³.

The hypothermia guidance adds detail that matters here. Remove wet clothing and replace it with dry clothes, wrap the person in blankets, a sleeping bag or a dry towel, and make sure their head is covered. Do not remove your own clothing to give to the person⁹. You need to stay warm yourself to keep helping.

The RNLI's cold water advice is blunt: once out of the water, get warm as quickly as possible, and put lots of layers on including a woolly hat¹⁰. North Wales Fire and Rescue Service adds a list of things not to do for a rescued casualty: do not rub their skin, do not apply hot water, and do not give them an alcoholic drink. Keep them wrapped up so they warm up gradually¹¹.

Shielding them outdoors

If you are away from buildings, use what the weather guidance offers. When caught outside during high winds, take cover next to a building or under a secure shelter¹². After a storm, do not walk too close to walls, buildings and trees, as they could have been weakened¹³. Put something solid between the person and the wind, get them off the ground if you can, and keep them wrapped.

Replacing wet clothing

If you have been swimming yourself, Forestry and Land Scotland advises having a hot drink and warm dry clothes ready for afterwards, and cleaning your wetsuit and gear in clean water and drying it thoroughly¹⁴.

Why a hospital may want to watch them for a while

The hospital's job after a near-drowning is observation as much as treatment. Because deterioration can come hours later, the clinical question is not "are they well now?" but "will they still be well tomorrow?" Fire and rescue guidance is explicit that the risk extends up to 48 hours after the incident¹. A period of monitoring lets staff catch a change early.

This is also why the advice does not soften for people who feel embarrassed or who insist they are fine. The ambulance service's own guidance for what to do while waiting is to stay calm¹⁵. That applies to you as much as to them: a calm, matter-of-fact explanation of the 48 hour risk is more persuasive than alarm.

If the person is reluctant, it helps to have the facts ready:

• Drowning can occur at a later stage if water has already entered the lungs¹.
• It can cause death up to 48 hours after the near-drowning incident¹.
• Signs of drowning can often go unnoticed, even with other people nearby³.
• Medical attention is needed even if they seem okay².

If they still refuse, do not argue indefinitely. Keep them warm, stay with them, and watch their breathing and level of response. Call 999 if anything changes. The ambulance service's guidance on calling 999 lists drowning as a reason to call¹⁶.

What to keep an eye on in the hours afterwards

If someone has been checked and sent home, or is waiting to be seen, your role is observation. NHS inform's instruction is to keep checking their breathing and level of response until help arrives³. Carry that forward: check regularly, and act on any change.

Watch for breathing that becomes laboured, a level of response that dips, or a person who becomes drowsy or difficult to rouse. If you are worried at any point, call 999. The ambulance service lists drowning among the situations where you should call¹⁶.

Keep them warm and settled. Do not give them alcohol, and do not rub their skin or apply hot water, per the fire and rescue guidance for rescued casualties¹¹. If they are conscious and thirsty, the hot weather first aid guidance for heatstroke says to give water to drink if they are conscious¹⁷; that is a reasonable general principle for a conscious, alert person after a rescue, but it does not replace medical assessment.

Children after a near-drowning

Children need the same response, and the same trip to be checked. Surrey Fire and Rescue Service's guidance is that children should always be supervised by an adult near water². That is prevention, but it also tells you how quickly a child can get into difficulty. Signs of drowning can often go unnoticed, even if there are other people nearby³.

Northern Ireland's summer safety advice adds a practical point for anyone watching children in the water: make sure you have someone watching you and that they have a way to call for help¹⁸. If a child has been in the water and needed help, treat it as a medical matter, not a scare that passed.

Where to get help

Call 999 immediately for anyone in trouble in the water. If you are near the coast, ask for a coastguard; if you are inland, ask for the fire and ambulance services¹. The same instruction appears across fire and rescue services: phone 999, ask for the fire service if inland or the coastguard if by the sea⁴. If you see someone who you think may be planning to harm themselves near water, call 999⁵.

For the wider picture on helping someone in cold water, see Cold Water Shock: Staying Safe and Helping Someone in the Water. If you need to check breathing or start CPR while you wait, How to Check if Someone Is Breathing and How to Do CPR: Hands-Only Steps for Adults set out the steps. For the order of a primary survey, see What to Do First: Danger, Response, Airway and Breathing, and for keeping a casualty warm while help comes, How to Treat Hypothermia at Home.