2024 AHA Update on Drowning Protocols: What HeartSaver, BLS, and PALS Providers Need to Know
Drowning remains a leading cause of accidental death worldwide, and timely, effective resuscitation is crucial for survival. In 2024, the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) released a Focused Update on Resuscitation Following Drowning, incorporating new and updated guidelines based on the latest research.
This landmark update consolidates all drowning-specific recommendations into a dedicated section, making it easier for HeartSaver, Basic Life Support (BLS), and Pediatric Advanced Life Support (PALS) instructors and providers to access the most up-to-date, evidence-based protocols for treating drowning victims.
Why This Update Matters
For the first time, all drowning-specific guidelines are housed in one dedicated chapter within the AHA Guidelines for CPR and Emergency Cardiovascular Care (ECC). Previously, these recommendations were spread across multiple sections, including the Basic Life Support, Advanced Life Support, and Special Circumstances chapters.
The 2024 Focused Update includes 11 recommendations: two are updates to prior guidelines, while nine are entirely new. These updates are based on systematic reviews conducted between 2021 and 2023 by the International Liaison Committee on Resuscitation (ILCOR), ensuring they reflect the most current scientific evidence.
The Drowning Chain of Survival
A significant highlight of the update is the emphasis on the Drowning Chain of Survival, which outlines the critical steps in drowning prevention and response. This framework helps trained rescuers and bystanders understand the stages of drowning and the best interventions at each stage.
The five links in the Drowning Chain of Survival are:
● Prevent drowning – Follow water safety practices and educate the public.
● Recognize distress – Identify a struggling swimmer early and call for help.
● Provide flotation – Assist with flotation devices to prevent full submersion.
● Remove from water – If safe, remove the victim as soon as possible.
● Provide care as needed – Start rescue breathing and CPR immediately if required.
Key Updates and New Recommendations for Rescuers
Airway and Ventilation Are Top Priorities - Unlike cardiac arrest from other causes, drowning-related cardiac arrest is almost always due to hypoxia (oxygen deprivation). As a result, ventilation should take priority. Rescuers should initiate rescue breaths as early as possible. This means starting with airway, breathing, and chest compressions (ABC approach) instead of the traditional CAB approach (compressions first). Immediate ventilation can prevent cardiac arrest or improve survival rates.
In-Water Rescue Breathing Can Be Life-Saving - For the first time, the AHA supports trained rescuers performing in-water rescue breathing if it is safe. If trained rescuers are confident in their ability and safety, they may administer rescue breaths before removing the person from the water. Providing early ventilation can prevent hypoxia-related cardiac arrest, increasing the chances of survival.
Oxygen Administration Is Strongly Recommended - If available, oxygen should be administered as soon as possible to drowning victims experiencing cardiac arrest. Oxygen therapy can reduce brain damage caused by prolonged hypoxia.
AEDs Are Useful—But Not Always Necessary - While automated external defibrillators (AEDs) remain a critical part of resuscitation, most drowning-related cardiac arrests are not caused by shockable rhythms (like ventricular fibrillation). AEDs should still be used, but rescuers should prioritize ventilation and chest compressions first. Early ventilation and oxygenation offer a greater survival advantage than immediate defibrillation in drowning cases.
Chest Compressions-Only CPR May Be an Option - If a rescuer is untrained, unwilling, or unable to provide rescue breaths, the AHA now says it is reasonable to perform compression-only CPR until help arrives. While rescue breaths remain the preferred approach, chest compressions alone are better than no CPR at all.
How These Updates Affect HeartSaver, BLS, and PALS Training
The AHA emphasizes that, for now, there are no immediate changes to course materials or manuals. However, instructors are encouraged to discuss the new recommendations when teaching drowning resuscitation.
HeartSaver Course Updates
● No official course changes yet.
● Instructors should highlight the importance of early rescue breaths during drowning-related emergencies.
BLS Course Updates
● No course modifications at this time.
● The BLS Provider Manual now references drowning-specific guidelines.
● Instructors should discuss why the ABC approach is preferred for drowning victims.
PALS Course Updates
● No immediate updates to course materials.
● Instructors should reference the new PALS provider manual sections discussing drowning resuscitation.
What This Means for Rescuers and Educators
These 2024 updates reflect the latest science on improving survival after drowning. Whether you’re a lifeguard, healthcare provider, or bystander, these changes emphasize early ventilation, airway management, and appropriate AED and oxygen therapy use.
For ACLS Academy instructors: While formal training materials haven’t changed yet, it’s critical to educate students on these new guidelines during HeartSaver, BLS, and PALS courses.
For rescuers and laypersons: Remember that immediate action saves lives. Whether it's rescue breaths in the water or starting CPR until EMS arrives, every second counts in a drowning emergency.
Stay Prepared, Stay Trained
The AHA’s 2024 drowning-focused update reinforces the importance of quick action, early ventilation, and evidence-based resuscitation strategies. While no official course updates have been made yet, ACLS Academy remains committed to delivering the most current training so that providers are fully prepared to respond to drowning emergencies. To learn more, the recommendations are published in the flagship, peer-reviewed journals of the AHA and AAP organizations, Circulation and Pediatrics. The publication in AHA’s journal, Circulation, provides updated and new recommendations for the resuscitation of both adults and children following drowning. In contrast, the publication in the AAP journal, Pediatrics, focuses on the resuscitation of children following drowning and highlights pediatric literature. A joint AHA/AAP webinar event recording is also available for updated recommendation highlights.
Stay informed. Stay trained. Save lives.
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