First aid for drowning: 3 types, symptoms, algorithm of actions

Swimming is a great pastime for adults and children, allowing them to enjoy a fine summer day and improve their health. However, spending time in water often ends tragically. Statistics show that every year 5-6 thousand people die due to non-compliance with the rules of behavior on the water. These numbers can be significantly reduced if you know how to properly administer first aid in case of drowning. The rescuer has only a few minutes to clearly and in the correct sequence carry out the necessary actions to save a human life.

First aid for drowning - what to do?

The main threat that leads to a tragic outcome is the ingress of fluid into the respiratory tract and lungs. The volume of liquid ingested is directly related to the time a person spent under water.

First aid for drowning will be relevant when you are under water for three minutes.

After passing the five-minute mark, the chances of survival tend to zero.

The main thing to remember before providing first aid for drowning is that you should act carefully, calmly and calmly. It is natural that when a drowning person panics, he is fighting for his life. And it’s a completely different matter when the rescuer panics. An important point that will affect the likelihood of success is the presence of swimming skills. If you have completed basic training at school or university in physical education classes, then these will be quite enough (Figure 1). Be prepared for the fact that a drowning person may accidentally pull you under the water, hugging you tightly, because he is in a state of mortal panic. First aid techniques for drowning will vary depending on the amount of water in the lungs.

Figure 1. When rescuing a drowning person, be careful: the drowning person can drag you to the bottom too

There are various types of drowning, first aid for which will require special skill, and the primary ones are:

First aid for drowning in water will be most effective if during its implementation the chance of salvation is objectively high. For an unqualified rescuer, it will only work if a person floundering in the water was noticed immediately. Help him stabilize on the water, take a breath, cough up water and come to his senses. In situations where the victim’s lungs are filled with water, a forced march awaits you with the body at the ready. Swim up from behind and grab him by the armpits or, in extreme cases, by the hair. Turn the drowning person onto his back and swim to the shore, avoiding attempts to grab you;
First aid for someone drowned on land is a life-saving straw for someone who was in the water for more than three minutes and was quickly brought to shore in an unconscious state. In this scenario, it is necessary to begin providing first aid for drowning as quickly as possible. It will consist of a procedure to restore the pulse, expel water from the lungs and restore spontaneous breathing.

Causes leading to drowning

There are several reasons that provoke drowning:

Failure to comply with safety precautions while in the water: swimming during a storm warning, near ships, staying for a long time in a body of water that is too cold.
Neglect of the rules of safe diving underwater: violation of the integrity of the equipment, running out of air in the cylinders, prolonged hypothermia. The danger of this situation is that the drowned person cannot be provided with timely assistance, because it is not possible to detect him immediately. Moreover, its transportation to shore will take a longer time, which will complicate an already critical situation.
Exacerbation of diseases in the anamnesis, or the occurrence of pathology while in the water: an attack of epilepsy, loss of consciousness, convulsive syndrome, cardiovascular pathologies.
Murder.
Suicide.
Fear and panic attack when an emergency or dangerous situation occurs. Such situations arise when falling overboard a ship or choking on water, when a person is covered by a wave. A panic attack suppresses the will, forcing you to make chaotic body movements. The victim screams and calls for help. His strength is quickly depleted, which leads to drowning.
Jumping into a pond from a great height. There are 3 risk factors for drowning in this situation.

Impact on a hard surface, as a result of which the victim loses consciousness and fluid begins to flow into the lungs;
Damage to the vertebrae in the cervical region, due to which the victim is instantly paralyzed;
Cardiac arrest as a reflex factor that occurs due to a person suddenly entering a cold body of water.

In addition to the reasons listed, there are a number of factors that have been identified as a serious risk of drowning:

Being alone in the water;
Swimming after taking alcohol or drugs;
Taking water treatments after a heavy meal;
Presence of cardiovascular pathologies;
Staying in rivers with strong currents;
Pathologies of the eardrum.

Regardless of the causes and factors that provoked the tragedy, first aid to a drowning person must be provided as soon as possible, since only 5-15 minutes separate the victim from the tragic outcome: after this time, cardiac arrest occurs.

Primary or “wet” drowning

When, with the last of his strength, a person grasping at the opportunity to escape flounders in panic and tries to stay on the surface, he swallows huge volumes of liquid. By filling the space inside the alveoli, water does not allow oxygen to penetrate into the blood, thus disrupting the natural oxygen cycle in the body. This causes a state of oxygen deprivation called hypoxia, which can cause the skin to turn blue. Also noticeable signs will be swollen veins in the neck and pink foam from the throat.

Figure 2. After you have pulled the drowning person out of the water, clean his mouth from algae and other dirt, and then proceed to remove fluid from the stomach and respiratory tract

To avoid death, you need to know how to provide first aid to a drowning person (Figure 2):

Spending extra time checking your pulse can play a cruel joke, so it’s better to skip this moment;
Begin the procedure of cleansing the stomach of excess fluid;
Throw the adult belly down over a thigh or bench, then press firmly onto the back. A small child can be turned upside down and shaken;
Clean the oral cavity from sand and algae;
Next, trigger the gag reflex by sticking two fingers deep into the throat and pressing on the tongue;
If vomiting occurs, you can relax, because this indicates the presence of a pulse;
If the gag reflex does not follow, you need to start the procedure of chest compressions;
When the moment has come to remove water from the lungs, grab the person by the armpits from behind and begin to squeeze the sides of the chest. At the same time, insert two fingers into the drowned man’s throat;
As soon as the victim stops coughing up liquid, turn him on his side and cover him with something warm: a blanket, a towel, outerwear.

How long does a person remain alive if he loses the ability to breathe?
Brain cells remain viable under hypoxic conditions for no more than 5-6 minutes. Although when drowning in cold water, this time may increase. In any case, assistance to the victim must be provided before the medical team arrives. In this situation, minutes matter. This is why knowing how to provide help is very important. Not all people, however, are ready to answer the question, much less show in practice how to act correctly in the event of drowning. And this is very sad. For some reason, many people believe that only employees of specialized services should have such skills, but an ordinary person far from medicine does not need to know this. But life sometimes puts people in difficult situations. It’s very scary to see a loved one die and not know how to help him.

What is drowning? This is a life-threatening condition characterized by the inability to breathe as a result of a person falling into water or other liquid. This often causes the airways to fill with water, although this is not strictly necessary. Death from respiratory failure can occur even if the lungs remain “dry.” By the way, different types of drowning are distinguished based on this criterion.

Classification according to the mechanism leading to death.

Types of drowning and their characteristics:

- True drowning. It is called that because in this case water (or other liquid) enters the lungs. The pathological processes underlying true drowning differ depending on whether the drowning occurred in fresh or salt water.

In the first case, water quickly penetrates from the alveoli into the vascular bed, thinning the blood and destroying red blood cells.

Salt water, on the contrary, promotes the release of plasma from the vessels, which is accompanied by thickening of the blood, as well as the development of pulmonary edema.

- Asphyxial drowning. In this case, water does not enter the lungs, since the glottis closes, protecting the airways from liquid penetration into them. However, breathing still becomes impossible, because with laryngospasm, air is also not allowed to pass through. A person dies from suffocation.

- Syncopal drowning. The main cause of death is reflex cardiac arrest. The lungs remain “dry”. A similar situation is possible when drowning in very cold water.

Classification according to the color of the victim’s skin.

Types of drowning based on skin color:

- White asphyxia. As the name suggests, it is characterized by pronounced pallor of the skin. Occurs when the respiratory tract is not flooded with liquid. This type is most typical for the syncope mechanism of drowning, when death occurs as a result of cessation of cardiac activity.

- Blue asphyxia. Occurs when the victim makes breathing movements, as a result of which the lungs fill with water. The skin becomes bluish due to severe hypoxia. Death occurs due to respiratory failure. Cardiac arrest occurs after breathing has stopped.

Appearance of the victim.

Different types of drowning have certain differences in clinical manifestations. If the victim was conscious at the time of immersion in water, the scenario for the development of events looks something like this. A man tries to escape by swallowing water. Breathing becomes impossible, the body experiences hypoxia, as a result of which a characteristic bluish coloration of the skin appears. Dilatation of the veins of the neck is often observed. Pink foam comes out of the mouth. If a person is removed from the water during the agony stage, breathing and cardiac activity may still persist.

If drowning was preceded by depression of the functions of the central nervous system (drunkenness, poisoning, intoxication), laryngospasm often occurs. The lungs do not fill with water, but death also occurs as a result of asphyxia. The skin acquires a bluish tint.

Syncopal drowning occurs due to severe fright or cold shock. The cessation of cardiac activity comes first in the pathogenesis. The skin is pale, there is no discharge of liquid and foam from the victim’s nose and mouth, which is typical for other types of drowning. White asphyxia is most favorable for resuscitation; the time of clinical death with it can be significantly prolonged.

Basic principles of drowning rescue.

Types of drowning are varied and require different approaches to providing assistance, but the general principles remain the same in all cases. All activities include 2 stages:

— Removing the victim from the water.

— Providing assistance on shore.

How to save a drowning person? No matter how different the types of drowning are, first aid for drowning should begin with ensuring the safety of the rescuer himself. A drowning person (if he is still conscious) can behave extremely inappropriately. That is why, when pulling a victim out of the water, you should be careful. Otherwise, the rescuer risks finding himself in the role of a drowning person.

If the person is close enough to the shore, you can try to reach him with a stick, use a rope or other devices to pull him out. If the victim is too far away, you will have to swim to get to him. The main thing in this situation is not to forget about the danger, because the victim can drown his savior. Therefore, you need to act quickly and unceremoniously. It is best to swim up to the drowning person from behind and wrap one arm around his neck, you can grab his hair (this is even safer), and then pull him to land as quickly as possible.

Remember: you don’t need to get into the water if you’re not a good swimmer!

Types of drowning, first aid for drowning. Actions on shore

There are different types of drowning, and their signs are discussed above. This knowledge must be taken into account when providing assistance to the victim.

“Everything is extremely simple if the person removed from the water is conscious. The main actions will be aimed at warming him up and calming him down.

- If a person is unconscious, the first thing to do is remove water from the respiratory tract. In case of white asphyxia, this is not necessary; you can immediately begin resuscitation.

— For the blue type of drowning, we first clear the mouth and nose of algae, sand, etc. Then we press on the root of the tongue, thereby determining the presence of a gag reflex. The preservation of the latter means that the victim is alive, so the primary task will be to remove water from the lungs and stomach. To do this, we turn the victim onto his stomach, turn his head to the side, induce vomiting several times, and press on his chest. Then we repeat these steps every 5-10 minutes until water stops coming out of the mouth and nose. It is necessary to monitor breathing and pulse, and be prepared to perform resuscitation.

— If there is no gag reflex, it is urgent to check the presence of life support functions of the body. Most likely there won't be any. Therefore, you should not spend a lot of time removing water from the lungs (no more than 1-2 minutes), but begin resuscitation as quickly as possible.

Features of resuscitation for drowning

Above were various approaches to helping the victim. There are different types of drowning; it is not surprising that the measures they require are different. However, cardiopulmonary resuscitation is always performed according to a specific plan, which is not influenced by the causes that led to clinical death.

What is included in the revitalization package?

— Restoration of airway patency.

- Artificial respiration.

- Indirect cardiac massage.

No matter how different the types of drowning, first aid always begins with clearing the mouth and nose of sand, algae, vomit, etc. Then water is removed from the lungs. For this purpose, the victim should be turned face down and placed with his stomach on his knee. The head will thus be lower than the body. Now you can press on the chest, stimulating the flow of fluid from the lungs. If help is provided to a small child, you can throw him over your shoulder, head down, or even take him by the legs and turn him over, thereby creating more favorable conditions for the flow of water from the lungs.

Next, we move on to performing the triple Safar maneuver. The victim should be laid on a hard surface, his head should be thrown back, his lower jaw should be pushed forward with his fingers and his mouth should be opened by pressing on the chin. Now you can start artificial respiration. Pressing your lips tightly to the victim’s mouth, we exhale. The criterion for effectiveness will be the rise of the chest. After two exhalations, we begin indirect cardiac massage. We place the base of the right hand on the lower third of the sternum, and place the left hand on top of the right. We begin to perform chest compressions, making sure that the arms remain straight and do not bend at the elbows. The ratio of exhalations to compressions should be 2 to 30 (2 exhalations, 30 compressions) regardless of whether one or two rescuers perform resuscitation.

Never forget about the rules of behavior on the water. It is easier to prevent a tragedy than to try to correct it. Remember: life is given only once. Take care of her and don't play with death.

Asphyxial or “dry”

Pale skin and fine pink foam from the lungs are indicators of dry drowning. The reasons preceding this are severe relaxation of the nervous system in a state of alcoholic intoxication, or any other disturbances in the functioning of the central nervous system. “Dry” is a fairly common type, caused by an involuntary spasm of the glottis due to liquid entering it, causing irritation.

Figure 3. Scheme of manifestation of laryngospasm during “dry” drowning

By closing the entrance to the lungs, laryngospasm leads to suffocation due to oxygen deficiency (Figure 3). However, the liquid does not penetrate the lungs until the person loses consciousness and the relaxation phase sets in, making rescue many times easier. Therefore, you can skip the phase of squeezing fluid out of the lungs and immediately move on to more necessary procedures.

The first aid that should be provided to a drowned person will be very simple, but requires preliminary training or experience:

Lay the victim stomach up on a hard surface. For example, on a hard wooden bed or concrete slabs;
Begin the resuscitation procedure;
Without bending your elbows, place your hands on the victim’s chest;
Push with your entire body every half second;
Tilt the victim's head back until an obtuse angle is formed between the chin and neck;
Alternate compressions with artificial ventilation using the mouth-to-mouth principle (Figure 4);
Pinch the patient's nose and take a sharp breath;
Exhale sharply into his mouth and open his nose;
Carry out the procedure at intervals of 4-5 seconds. The recommended frequency is 2 exhalations per 30 compressions;
When a pulse appears and spontaneous breathing appears, you can calm down and provide further assistance: help the victim get to the nearest warm room for further warming with tea and a warm blanket.

Figure 4. First aid steps for dry drowning

Types of drownings

When the victim is pulled ashore, it is necessary to quickly assess what type of drowning was encountered, since the first aid algorithm will depend on this.

There are two main types of drowning:

Blue, or wet (sometimes also called true drowning) - when a large amount of water has entered the stomach and respiratory tract. The victim’s skin turns blue because water, quickly entering the bloodstream, dilutes the blood, which in this state easily seeps through the walls of blood vessels, giving the skin a bluish tint. Another sign of wet or blue drowning is that a large amount of pink foam is released from the victim’s mouth and nose, and breathing becomes bubbling;
Pale or dry (also called asphyxial drowning) - when during the process of drowning the victim experiences a spasm of the glottis and water does not penetrate the respiratory tract. In this case, all pathological processes are associated with shock and suffocation. Pale drowning has a more favorable prognosis.

Syncopal drowning

This type of drowning occurs due to reflex cardiac arrest, provoked by temperature shock caused by entering ice water from a hot environment. Intense physical activity, such as running, which heats up the body, will also be risk factors. Intoxication and overeating will also not be beneficial and will only increase the risk of drowning.

Figure 5. If you pulled a drowning person out of cold water, the chances of saving him are higher than saving him in the warm season

Visually, the victim will stop all actions and begin to drown due to the shutdown of all higher nervous activity and the absence of any motor skills. Therefore, it is necessary to dive for the drowning person as quickly as possible and try to pull him to shore.

First aid for drowning will consist of resuscitation procedures for artificial ventilation and chest compressions (Figure 5).

If this happened in icy water, then the chances of survival will increase. Due to the slowdown of all biological processes in a cold environment, including oxygen metabolism, this will allow the drowned person to be restored to their condition even after 10 minutes.

Actions after first aid

After the victim returns to consciousness, he is carefully covered and given hot tea.

After the victim returns to consciousness, he is dressed in dry clothes and carefully covered. For additional warmth, use a heating pad. You can improve blood circulation with a hot drink, but alcohol is strictly prohibited.

To prevent repeated loss of consciousness, the victim is carefully monitored and ammonia is offered. Before paramedics arrive and provide primary care, they give you a sedative and help you move to a more comfortable place.

If the extremities are cold, they need to be rubbed.

Secondary drowning

Quite a dangerous phenomenon due to its non-obviousness. It usually occurs after the primary one and carries a hidden threat that can only be detected by careful observation. The mechanism by which this phenomenon occurs is quite simple. After removing water from the lungs, some fluid may remain inside in the form of droplets, which will interfere with the proper functioning of the respiratory system. This will lead to a depletion of oxygen in the body and a subsequent lack of oxygen in the brain. In adults, this problem is solved by the body itself, but for children it poses an increased danger, since the area of their lungs is relatively smaller and any violation will lead to prolonged oxygen starvation. The secondary type of drowning can be detected over a time period from an hour to a day.

Figure 6. If these symptoms appear after drowning, call an ambulance immediately

Symptoms to look out for (Figure 6):

Difficulty breathing;
Prolonged cough that does not go away for several hours;
Pain in the chest cavity;
A slight temperature deviation from the norm;
Sudden crippling fatigue accompanied by drowsiness;
Impaired thinking abilities and odd behavior;
Nausea and heaviness in the stomach.

When faced with these symptoms, it is necessary to call an ambulance, but it may not always arrive on time (Figure 7).

Figure 7. When calling an ambulance, do not rely only on its quick arrival, provide all possible CORRECT first aid

When you are pressed for time, do the following:

Sit down and ask your child to lie on your back, feet up;
Grab your hips with your hands and secure them on your shoulders;
Then stand up straight and ask the child to cough while shaking him.

Injuries associated with drowning

The most difficult first aid for drowning is provided in cases where the drowning person was injured while diving. The most common injuries are to the skull and cervical vertebrae. The presence of spinal cord damage can be determined by the lack of sensation in the limbs. The victim must be immediately placed on his back, on a flat and preferably hard surface. Under no circumstances should you turn your head. If there is a danger that a person will suffocate on vomit, one must carefully turn the whole body on its side, holding the head. In the supine position, the head is gently fixed with bolsters placed on the sides. No additional actions can be taken until the ambulance arrives.

How to save a drowning person?

No matter how different the types of drowning are, first aid for drowning should begin with ensuring the safety of the rescuer himself. A drowning person (if he is still conscious) can behave extremely inappropriately. That is why, when pulling a victim out of the water, you should be careful. Otherwise, the rescuer risks finding himself in the role of a drowning person.

Remember: you don’t need to get into the water if you’re not a good swimmer!

Carrying out artificial respiration

Typically, artificial respiration begins with exhalation. If the chest rises, then everything is normal and the air is passing through; you can make several blows, pressing on the stomach after each blow to help the air escape.

If the victim does not have a heartbeat, it is important to perform indirect cardiac massage in parallel with artificial respiration. To do this, you need to place your palm at a distance of two fingers from the base of the sternum and cover the second. Then press quite hard, using your body weight, 4-5 times and inflate. The speed of pressing should depend on the age of the victim. For infants, pressure is applied with two fingers at a speed of 120 pressures per minute, for children under 8 years old at a speed of 100 times per minute, and for adults - 60-70 times per minute. In this case, the sternum of an adult should bend by 4-5 centimeters, and in a child under 8 years old - 3-4 cm, in an infant - 1.5-2 cm.

It is necessary to carry out resuscitation until breathing and pulse are restored on their own or until undeniable signs of death appear, such as rigor or cadaveric spots. One of the most common mistakes when providing first aid is premature termination of resuscitation measures.

Usually, when performing artificial respiration, water is released from the respiratory tract, which got there during drowning. In such a situation, it is necessary to turn the victim’s head to the side so as to allow the water to flow out and continue resuscitation. If resuscitation is performed correctly, water will flow out of the lungs on its own, so squeezing it out or lifting the victim upside down makes no sense.

After the victim comes to his senses and breathing is restored, it is necessary to take him to the hospital, since deterioration of his condition after improvement is practically the norm for drowning. The victim should not be left unattended for a single minute, as swelling of the brain or lungs, respiratory and cardiac arrest can begin at any minute.

First aid

If there are signs of “dry drowning,” resuscitation measures must begin immediately. In other cases, you should try to remove water from the lungs first.
To remove water from a drowned person, first clean the mouth with fingers wrapped in a cloth. The victim should be placed face down on the rescuer's knee so that the head is below the pelvis, and apply strong pressure to the chest area. You can try to induce vomiting by pressing your fingers on the root of the tongue.
If the process has started, great, the more water comes out, the better. But if nothing works within 1-2 minutes, stop trying and start resuscitation.
The victim is placed on his back on a flat surface with his head slightly thrown back and mouth-to-mouth artificial respiration is started. If you cannot unclench your convulsively clenched jaws, you can breathe air into the victim’s nose. When inhaling into your mouth, be sure to pinch your nose, and when inhaling into your nose, close your mouth so that the air does not escape.
If the drowned person’s pulse cannot be felt, artificial respiration must be combined with chest compressions. To do this, the rescuer stands to the left of the victim and places his palms crosswise on the heart area. The movements are performed strongly; between pushes, the arms cannot be removed from the sternum. 60-70 pushes should be made per minute. Artificial respiration is performed every 5 movements. Activities are carried out until spontaneous breathing occurs and the heartbeat is restored, or until professional rescuers and doctors arrive.
Be careful when performing chest compressions, especially when rescuing a child: overdoing it can cause the person being rescued to break the ribs.
Even if the rescued person has regained consciousness and can navigate in space, move and speak independently, do not allow him to leave until the doctors arrive. After drowning, hospitalization is necessary, since after some time a sharp deterioration in the victim’s condition is possible, up to secondary cardiac arrest. In addition, after drowning, pneumonia, cardiac problems and other complications may occur.

Sinking or not?

A drowning person quickly spends the energy that is not enough to scream for help, just to stay on the water.

Signs that a person is drowning:

screams for help for a minute or more;
during “wet” drowning, flails his arms randomly for a short time;
stays in place when trying to swim;
tries to raise his face above the surface of the water, turning over on his back and throwing his head back;
often hides under water for 2-3 minutes.

Appearance of the victim

Different types of drowning have certain differences in clinical manifestations.

If the victim was conscious at the time of immersion in water, the scenario for the development of events looks something like this. A man tries to escape by swallowing water. Breathing becomes impossible, the body experiences hypoxia, as a result of which a characteristic bluish coloration of the skin appears. Dilatation of the veins of the neck is often observed. Pink foam comes out of the mouth. If a person is removed from the water during the agony stage, breathing and cardiac activity may still persist.

If drowning was preceded by depression of central nervous system functions (drunkenness, poisoning, intoxication), laryngospasm often occurs. The lungs do not fill with water, but death also occurs as a result of asphyxia. The skin acquires a bluish tint.

Causes of drowning

Drowning is a form of suffocation that occurs due to the closure of the respiratory tract with water, silt, sand, mud, etc. Drowning can be caused by inability to swim, alcohol intoxication, swimming in unfamiliar places, bathing children without supervision, inability to use equipment for individual scuba diving. Cases of drowning also occur in small amounts of water. This can happen in a puddle, in the bathroom, during an epileptic seizure, etc. A tired person does not drown immediately; first, in a panic, he makes uncoordinated movements and, exhausted, plunges into the water, holding his breath. The accumulation of carbon dioxide in the blood leads to involuntary inhalation under water, and it enters the lungs. Then involuntary shallow breathing movements appear in the lungs, as a result of which foam is formed from water, mucus and remaining air. The cessation of cardiac activity during drowning occurs due to the fact that the fibers of the heart muscles begin to contract unevenly, which leads to cessation of blood circulation. As a result of drowning in fresh water, a large amount of liquid enters the bloodstream through the lungs, which thins the blood and disrupts its ionic balance. In combination with a lack of oxygen, all this leads to cardiac arrest, which occurs earlier than the cessation of respiratory activity. When drowning in sea water, water does not enter the blood from the lungs (due to the high salt content in it), and cardiac activity stops later than breathing stops. 1-1.5 minutes after breathing stops, brain cells are affected and the person loses consciousness. And after another 1.5-2 minutes the heart stops. In cases of blockage of the respiratory tract with water, the skin and mucous membranes of the victim are sharply bluish, the ears, lips and fingertips are purple-blue. Visible veins of the head and neck are sharply swollen. The face becomes puffy. A lot of foam mixed with blood is released from the nose and mouth. In some cases, a life-threatening condition does not develop due to the filling of the airways with water, but as a result of reflex paralysis of the heart. It occurs from sudden irritation of the nerve endings of the skin and larynx by cold water. The same thing can happen with emotional shock from fright. This condition is also called “dry drowning” because due to spasm of the muscles of the larynx, water does not enter the lungs. The skin and mucous membranes of those who drowned due to reflex paralysis of the heart are deathly pale, in contrast to those who choked, whose skin is bluish.

Signs of drowning

A drowning person looks completely different from what the vast majority of people are used to thinking. He cannot wave his arms to attract attention, he cannot shout, and besides, the whole process happens very quickly and rarely takes more than one minute. So, the most likely signs of drowning are the following:

In order to inhale, a person leans back strangely, throwing back his head or trying to roll over onto his back;
Breathing is uneven, it can be shallow, when it happens - convulsive, sharp breaths;
The rest of the time the head is low in the water and the mouth is submerged;
The gaze is empty, the eyes are not focused, the person seems to be looking into the distance, sometimes the eyes may be closed;
A person is vertical in the water, cannot push off with his feet, at best he moves his feet in the water, as if climbing a ladder;
Hair hanging down can cover the eyes, but the person makes no attempt to remove it.

The external signs of drowning themselves are not characteristic of this particular condition. A person may breathe intermittently if he has just surfaced or swam at a fast pace, he may lean back, wanting to change position, etc. But it should be taken into account that if a person is really drowning, then there is practically no time for reflection; death can occur at any moment. Therefore, if you notice the behavior of a person on the water that alarms you, do not think about whether you see true signs of drowning or whether it seemed to you that you need to quickly swim up to the person and call out to him. Failure to respond will be a signal for emergency action.