by Laura Williamson, American Heart Association

Credit: Pixabay/CC0 Public Domain

As people flock to pool parties, sandy beaches and other water adventures to cool off this summer, experts say learning CPR and some water safety basics also should be at the top of the to-do list.

"In general, I'm an advocate for everyone getting CPR training," said Dr. Katherine Berg, associate director at the Center for Resuscitation Science at Beth Israel Deaconess Medical Center in Boston and an associate professor of medicine at Harvard Medical School.

"But preventing drowning incidents is even more important than CPR training. Ideally, every kid should learn how to swim."

After decades of decline, drowning rates in the U.S. are on the rise, according to a recent Centers for Disease Control and Prevention report. The climb began following the onset of the COVID-19 pandemic in 2020, when people started spending more recreational time in the water with limited supervision.

In 2022—the latest year for which data is available—4,509 people in the U.S. died from drowning, with the highest rates among the youngest and oldest members of the population. Drowning deaths rose 28% between 2019 and 2022 among children ages 1 to 4, who had the highest rate every year.

CDC researchers also found males consistently had higher drowning rates than females, with the highest rates among American Indian, Alaska Native and Black people.

CPR is used to treat drowning because water blocking the airway can slow or stop the flow of oxygen to the brain, leading to cardiac arrest. When that happens, it's necessary to open the airway and perform chest compressions with rescue breaths to maintain blood flow and restore oxygen to the brain, a potentially lifesaving technique that may also prevent organ damage.

"All parents or people taking care of children should learn CPR," said Berg, who helped write the American Heart Association's CPR guidelines in 2020. "Even children as young as 11 or 12 can perform effective CPR."

Although good swimmers can still drown, not knowing how to swim is a major contributor to drowning deaths, experts say. Research shows formal swim lessons can reduce the risks, but many people never get them.

In a national survey, roughly 40 million adults said they did not know how to swim, and more than half of U.S. adults said they had never taken a swim lesson. The 2023 survey by the National Center for Health Statistics showed Black adults were most likely to report not knowing how to swim, with more than one-third saying they hadn't learned, compared to 26% of Hispanic and 7% of white adults.

"If you intend to be in or around water, you need to learn how to swim," said Nadine Ford, director of Evolutionary Aquatics in Charlotte, North Carolina. Ford said her classes focus on the strength and potential of Black adult swimmers, helping people overcome fears or negative messages that may have prevented them from learning earlier in life.

For example, a parent who was afraid of water or who had a bad experience may have passed on those feelings to their children, cautioning them to stay away from water, Ford said.

"When people are told what they can't do, they will embody it," she said. If someone is taught to be afraid of water, "that's going to make you apprehensive."

But Ford said there are other reasons adults may not know how to swim: Some people may not have had access to lessons or places to swim, while others may be embarrassed to admit they never learned as children.

Ford helps change the way adults look at swimming by giving them the information and skills they need to feel safe.

Water safety

Drowning often occurs because people don't understand the risks associated with being in and around water, Berg said.

Even people who don't swim should have a basic understanding of water safety if they're planning to go out on a boat, fishing or even to a water park, said Ford, who teaches adults what to do in case they fall into water accidentally—and how to avoid doing so.

"There is a difference between learning how to swim and being water competent," she said. "Plan for the unexpected. Get familiar with the body of water you're going on. If there's a dam, find out what time the water gets released. If there's been a heavy rain, maybe it's best to sit it out and let the water subside first. Be aware of currents. If you can't see the bottom of a lake or river, don't jump in it. And even if you can swim, know how to use a life vest and make sure you have one."

Also, she said, "don't drink alcohol or do anything that's going to impair your judgment. It's not worth it."

Ford shows people how to blow bubbles to relax and how to float on their front and back. That way if they fall in, "all they have to do is get on their back and kick to safety," she said.

Role of CPR

CPR for both adults and children in cardiac arrest includes two rescue breaths after every 30 compressions. Breaths are especially important in children because cardiac arrest is often due to respiratory issues. Adults more typically experience cardiac arrest because of a heart attack or an irregular heartbeat known as an arrhythmia.

"For lay rescuers who are not trained in conventional CPR, hands-only CPR is recommended for adults and teens," Berg said. But if CPR is being performed for cardiac arrest following a drowning incident "the airway is an issue for both adults and children, and rescue breaths should be included."

When providing aid during a drowning, the first thing to do is to call 911 or have someone else do so. Then assess whether the person is conscious or breathing, Berg said. If the person does not respond and is not breathing regularly, assume they are in cardiac arrest. "Don't bother to feel for a pulse, which can be difficult for a lay person to identify," she said. "Start CPR. Rescue breaths should be part of that care."

If the person providing aid does not know how to administer rescue breaths or is uncomfortable doing so, they should still give chest compressions until medical help arrives, Berg said.

Keeping kids safe

Prevention and basic water safety are the first steps to reduce the risk of death around the water.

Ford said parents who take their children to swimming pools should know where telephones are located as well as safety equipment, such as safety rings that can be tossed to people to hold onto.

"If you take your kids to the pool, watch them," she said. "Don't think someone else is going to babysit your kids, and don't rely solely on lifeguards."

For adults and children, life jackets approved by the U.S. Coast Guard can prevent drowning by keeping water out of their airway, according to the American Academy of Pediatrics. Laws regarding the use of life jackets vary by state. However, the AAP notes that air-filled swim aids, such as inflatable armbands, are toys that can deflate or slip off and should not be used instead of life jackets.

Ford recommends against the use of flotation devices that go around a small child's arms because the devices can push their arms up while their heads go under.

The best thing to do, she said, is send children to swim class. "Get the kids water-safe."

And learn CPR, she said. Taking a class isn't necessary to perform CPR. But "talk to your doctor or health care provider or a local fireman and find out what are the basics to help someone survive until help arrives."

Provided by American Heart Association