Hacker News Reader

I was a lifeguard in my youth. I am an incredibly good swimmer.

I just went white water rafting with a bunch of friends in Malaysia - and on the boat were 2 other folks that were not great swimmers. We were in pretty good rapids, and the odds were for us flipping at some point. We were all wearing lifejackets, but in the rapids at times it feels like you aren't floating much at all.

The first patch of rapids another boat flipped and a bunch of people clutched on to each other basically climbing the ladder on each other - we quickly got to them but they all had swallowed a lot of water.

I gave a big speech about how if someone is drowning their instinct is to grab you and pull you under - so make sure when helping others you can safely just grab them.

A few rapids later we flipped. I quickly grabbed on to the raft and was doing fine - until I saw one of the poor swimmers floating face down drinking a lot of water and heading towards more rapids. I swam over and grabbed on to her, flipped her on her back and told her to relax we were going to be fine. Then we hit some more rough water and all of a sudden she was pushing down on my shoulders and I was under water for about a minute as we passed through rapids and she was struggling to stay on top of me. I outweighed her by 50 pounds and still struggled to get out from under her while being tossed around in the water. I was comfortable for the first 30 seconds or so, but at that point I started to get the whole "Damnit, I am drowning" feeling. I finally separated myself from her, threw up a few times, and then held the top of her lifejacket from a behind.

My long winded story is intended to say one thing. If someone is drowning, their natural instinct will be to climb on top of you to get above water. It doesn't matter how much bigger you are - how much better of a swimmer. Even if you are really experienced it can still be difficult to rescue a drowning swimmer.

Spot on. I'm sorry to hear about your story but it really nails the point home. I was also a lifeguard and a competitive swimmer in my youth, and realized after some time that the single best training I ever had for escaping an active drowning victim was playing water polo! You really have to think of the victim as an adversary, keep a firm grip, and have practiced being extremely stable in the water to manage it.

No big deal - I was laughing about it a few minutes later.

I don't think I was ever seriously at risk with a life jacket on and plenty of other boats very close. But through the rapids - 10 feet away can mean you can't reach the person for a few minutes downstream.

Talking about it makes me want to do some more rapids - it was my first time and I really enjoyed it. It was class 4-5 so fairly difficult rapids even for a 6 man raft. Made for a lot of fun, especially when sitting in the front!

"The instinctive drowning response is a climbing response. What you see are twin splashes as the person's arms flail wide looking for something to grab on to. If they find it the automatic response is to grab it, climb up, and stand on top."

Reading this, I connected the dots on a childhood experience of mine. When I was very young, I was in a public pool that had a "big" deep end, about 5.5 feet. I couldn't swim, but I still went to the deep end. I sank to the bottom and jumped to the surface to get air, and slowly traveled wherever I wanted to go.

All of a sudden, WHAM! I got tackled from behind by a lifeguard and breathed a mouthful of water. He took me out and asked me if I was OK. Between hacking coughs I said I was. My mom brought my towel to me and asked me what I was supposed to say. I yelled and slapped his legs with my towel. I probably got punished for that later.

At the time I didn't understand why the lifeguard rescued me. I felt fine, and I was probably about a minute away from the edge of the pool at the rate I moved. But that's exactly what I looked like from the surface - both arms grabbing upwards and sideways to drive me to the surface

My now 8yo, then 3yo, almost drowned in a hotel pool while I was swimming just a couple of yards away from him. I reached him in seconds, and his reaction was to scale me like a tree, at which point I flung him onto the concrete. He had some scrapes and bruises, but he was alive.

I'm not a trained rescue professional, and I didn't know any of this information before you posted it. It's kind of amazing to look back and see how textbook his response was (and how terrifyingly unprepared I was).

Someone who may or may not be btilly posted exactly the above to Mario Vittone's blog, and got a response from Vittone saying, inter alia, "Your four points contain some good as well as some dangerous advice. There are often too many variables for lists of possible rescue techniques - but waiting for unconsciousness is a very (very) bad idea."

(Emphasis mine.)

It was not I who posted that there.

I fully agree that waiting for unconsciousness is a very bad idea. Obviously it is an option of last resort. However from my training, I believe it to be a better idea than getting killed. And in my training it was suggested as an option of last resort if we had no other options and didn't feel comfortable making a rescue.

And yes, there are a lot of variables that come into play. For example my instructor once saw 3 people drowning in a river. She rescued 2 and let the third drown because she was developing hypothermia. (The story is that one broke through thin ice, the other two tried to rescue the first. The one who died was one of the would-be rescuers.)

However in general if you have the knowledge and experience to properly judge those factors for yourself, you should know more about drowning than my brief blog post.

I grew up near a lake and always used to hearing those drowning stories. One of the guy I met told me about a similar story. He was trying to rescue a kid who was drowning and he started to grab/climb him as soon as he reached him. He said he had to punch him into unconscious then rescued him.

Obviously it is an option of last resort.

Not obviously, since you listed it third of four and fourth was roughly "swim where they can't grab you, and drag them back to shore while avoiding their grasp", which sounds pretty straightforward to an untrained reader.

It sounds pretty straightforward when you hear it, but execution is the real challenge. And if you execute it incorrectly, you run a serious risk of death.

To give an example of what can go wrong, your description suggests that you just hold the person where they can't reach you and drag them. But if you try that you'll find out the hard way that there is no good way to drag the person while they are still panicking without getting grabbed.

To give another problem, can you swim in place for a minute with your hands out of the water? Try it before confidently asserting that you can. And that is substantially easier than swimming in place, holding a struggling, panicked person up.

Those are among the reasons why I've so strongly recommended that untrained people avoid option #4. If you can stand on the bottom, fine. Otherwise, not so fine.

As a former lifeguard (certification has expired), I agree with btilly. Treading water without your hands was part of the test for this reason. Part of the training also involved being grabbed underwater by fellow trainees. Until you've actually been grabbed in a bear hug underwater, you can't really prepare yourself for what it feels like. And this is with someone who isn't panicking, and that you know will let go if you can't break their hold after a while.

Another important thing that they brought up in my training: the first thing to check for before going in to save someone (land or sea) is if the conditions are safe. As far as I know, every trained rescuer is told to put their own safety above the person or people they are trying to save. While I don't fault anyone that sacrifices themselves to save others, it doesn't make sense to add another death to what is already a tragedy.

I'm not a lifeguard -- I'm not even much of a swimmer -- but I am trained in First Aid. One of the things we were taught is not to just rush to be a hero when you come upon an apparent trouble situation. You first need to assess the situation and area with respect to the safety of yourself, and any bystanders.

Example scenario (based on a real life occurrence, as related by my instructor): You approach an indoor pool, and see what looks to be a child floating face down in the water, and an adult also floating similarly nearby. Your first instinct might be to dive in to save one or both of them, but a subtle clue is present: while the child is in swimming attire, the adult is in street clothes. In actual fact, a live wire has somehow come to be in contact with the water -- the adult had dived in to try to save the child, but was electrocuted.

What you said about people bear hugging you underwater reminds me of when I was on a swim team and we played a game called "Sharks and Minnows."

The lone shark starts at one end of a 25 meter pool, all the minnows at the other. The coach blows the whistle and all the minnows have to try to reach the other end without getting caught at the surface. Any minnows caught at the surface immediately become sharks. Repeat until there are no minnows.

I wasn't the fastest swimmer, but I could easily hold my breath from one end of the pool to the other, including wrestling underwater with sharks. If Sharks and Minnows were an Olympic sport I would have been competitive. Of course, that was when I was twelve ;-) At this point, I think I'd carefully consider how to approach an obviously drowning person.

I remember playing that.

My strategy was to breast-stroke as fast as I could while not quite scraping the bottom of the pool with my chest.

I usually came out pretty well in the end :)

We would also do exercises in the diving pool of treading water for a half hour+ at a time. Good times.

(I was also around 12)

I absolutely love the mechanics of that game. First of all it's a blast. But the cool part is that the game mechanics themselves ensure that everybody is safe. The minnows want to stay underwater to win the game, which is a secondary goal to wanting to breathe. And the sharks want to get the minnows to the surface to win the game. So fight it out as much as you want, but the minnows have to TRY to not breathe.

As a former Bronze Cross I also agree with btilly. I practiced swimming for thousands (training, competitively, and pleasure) of hours before having to save my first drowning victim. If you don't have the experience you are going to put yourself and the other person at great risk.

"Another important thing that they brought up in my training: the first thing to check for before going in to save someone (land or sea) is if the conditions are safe. As far as I know, every trained rescuer is told to put their own safety above the person or people they are trying to save."

Absolutely.

NOLS and the Sierra Club tell you the same thing, as well -- if you lead a hike for the Sierra Club and someone gets hurt, the FIRST thing you do is make sure the situation is safe. It doesn't do anyone any good if someone gets hurt and you get yourself hurt trying to get to them -- because now there are TWO victims.

I understand it once explained, I just said you should watch yourself before calling it obvious in future, because as someone untrained in lifeguarding or swimming - it isn't.

Or more specifically, watch yourself before deciding not to mention it because it's "obvious".

Why isn't it obvious that you don't really want to let someone drown almost to death? In any case I really didn't want to put too big a warning against #3 because I don't want to scare people away from that option if it is a choice between that and #4. Seriously, I don't.

As for you understanding the risks of #4 when explained, if you had understand it when it was first explained you shouldn't have responded as you did. Go back and re-read my original post. I said not once, but twice, that this was for trained people only. I further gave as two reasons the inability of untrained people to properly support a struggling person in the water, and the speed with which a mistake gets you killed. Yet your reaction was that #4 didn't look so bad.

I described #4 in the amount of detail I did because I thought people would be curious about it. But if people are going to misread my attempt to satisfy curiosity as a howto, it would have been much better for me to say no more than that going after a person drowning in water over your head is a recipe for suicide unless you have specialized training.

> which sounds pretty straightforward to an untrained reader.

Precisely why 3 was before 4. 4 is only an option if you know you're capable of it, and know why. If you think you are, you're wrong.

4 is an option until you know why it's not as simple as it looks, then it's not. It becomes an option again when you know you're capable of it.

Unskilled and unaware of it. Deadly unk-unks.

If you are in the middle of a lake and not a fairly well trained swimmer - it is really dangerous advice to try to drag them to shore and avoid their grasp. The swimmer could easily grab on to you and drown you both.

Don't underestimate a drowning swimmers ability to grab and hold you under the water - they are fighting for their life. It sounds ridiculous, but I have seen a small child do so to a large adult many times.

Don't think of this as lifeguard training,but you've basically got to get them over one shoulder or under an arm, then across the torso, while using your hip and a strong kick to basically pin them against your side so they have the least possible leverage to twist around and hug/climb you. Then you have to figure out how to swim them back with one arm. Sometimes it takes a couple tries. While a passive victim is closer to death the situation is usually safer for the rescuer, especially if inexperienced or untrained.

Waiting for unconsciousness is neither a bad idea nor should it be considered a last resort. Thinking of it as such is exactly how you get yourself in trouble yourself. It's amazing how quickly you can get incapacitated in the water, you might think you can hold your breath for 30 seconds with no problem, but that doesn't work when you start with empty lungs and a kick to the stomach. Then you're oxygen deprived from the very beginning and within 15 seconds your survival instincts have taken over. Now there are two drowning people which means the next person who wants to try and make the rescue will have two people jumping on him. No one in his right mind is going to try that so the only option is to wait for unconsciousness. Unfortunately by the time the second person is unconscious the first person may well be dead.

As btilly points out very aptly the first step to the rescue always has to be getting the person to calm down. However the moment they start to climb you, you need to go under to get them off. If you do manage to get a grip behind them and they start to struggle their sometimes lifeguards will arch their backs pulling both the rescuer and the victim's heads under water, this hopefully gets them to calm down.

One point that isn't mentioned is that this is an entirely different situation if you have a flotation device buoyant enough to hold both of you. Lifeguard tubes are ideal for of course ideal but fun noodles or kickboards can be used in a pinch. With such a device, your goal is to get a hold of the person without losing your float. With Lifeguard tubes you want to approach the person (ideally from behind) with the tube across your chest underneath your arms and grab them underneath their arms once you have them try to get as much of their weight onto the tube. If the tube is supporting their weight then they can't put any unexpected pressure on you, and they'll calm down very quickly when they feel the stability.

How throwing them the noodle, without getting close enough to endanger yourself? Or can't they climb the noodle?

Edit: Having read the article--a noodle probably won't help somebody who's past aquatic distress and has started drowning.

It sounds cold, but if you are not a trained professional, they are in deep water, and you cannot throw them something, you run the very (very) real risk of having you BOTH drown and die if you try to save them while conscious. In case you didn't read the article, if they get a hand on you they will climb you like a tree and have the strength of a million doses of adrenaline.

What solution do you propose instead?

It's not unprecedented either. In CPR training, you are taught the Heimlich. You are also taught that you have to ask someone who is choking if they want help (or you will be sued, regardless if you save them). If they say no, they don't want help, you can either leave them to die, do it anyway and get sued for all you are worth (don't count on mercy, the law is 1000% against you), or wait until they pass out and then do it anyway (you are then protected by the Good Samaritan law)

Unless you are a medical professional (and you are acting in that capacity (a 3 hour CPR course doesn't count)), you don't need to obtain "consent to treat." And even if you are a medical professional, Implied Consent would be a pretty easy argument to make in the case of a non-verbal patient.

Good Samaritan laws are 1000% in favor of the rescuer (especially if that rescuer is a lay person).

TL;DR; If you are familiar with the Heimlich Maneuver, and you see someone who is choking (can't speak or cough, clutching their throat, etc), _please_ don't hesitate to act.

If someone can say no, they do not need the Heimlich -- at worst, they have a partially occluded airway, in which case using a finger to try to sweep the object out, or turning the person face down so the object falls out, is the correct course of action. (of course, if someone is non-verbally communicating no, then what you say applies, but I'd still be getting into position, and gesturing either sweep the mouth themselves, or use a convenient chair to do it.)

I was referring to when they are using non-verbal communication. Of course you do not do the Heimlich when they can still talk, that is Heimlich 101.

I was under the impression that you were taught to ask if they wanted help to determine if they were legitimately choking to death or not. Is it possible for someone who is truly choking to respond to a question about if they want help or not?

That's part of it -- if they're able to respond, or if they're coughing, they're still breathing.

My wife was taught in her lifeguard training to swim towards the person but as you get closer extend your feet towards them as if you were sitting in a lazy-boy facing them. Then if they try to pull you under you can kick them in the face and knock them out.

Is this common advice?

Kicking someone in the face will damage them, might stun them and keep them off you, but probably won't knock them out. Knockouts come from moving the brain within the skull, and a blow to the face isn't the best way to do it (too soft).

I recently took the PADI Rescue Diver certification, had been a lifeguard in my youth and currently participate in long distance swimming events (1 - 2 miles) and triathlons. I can tell you that according to the Rescue diving course the correct order of btilly's recommendations would be 2, 1, 4 and possibly 3 (while implementing 4).

It should go without saying, but your immediate course of action is to call for help and/or designate someone to do so in case of an actual drowning situation.

Your preferred choice of action is to stay out of the water entirely. Do not get in the water unless you must. Use any means at your disposal from lines to poles to thrown floatation devices to safely assist the victim. Keep eyes on the victim, assign someone to do so as well - in case you need to gather emergency equipment (above or swimming aides like mask/fins if they are available and if you are going in).

Next would be a wading assist, again, waist/chest deep wade into the water with a line/pole/floatation device.

Finally, if you must enter the water remember that YOUR SAFETY is above that of the victim. If you allow the victim to overpower you, you will become a victim yourself. The most powerful tool at your disposal at this stage is your voice. Talk to the victim, reassure them, let them know you are there for them and everything will be ok. Reel them back from the edge of panic. After that, the next powerful tool at your disposal if you are overtaken by a panicked swimmer is to dive and push the victim away from you while under water - the victim will not follow you down. Rinse repeat until the victim calms down, you get a hold on them from behind, or they pass out. Having the victim pass out is not the worst thing that can happen. It may require rescue breaths and/or cpr once you get the victim to shore/boat.

I read this comment out loud to my girlfriend, who noted that toddlers sometimes drown by stumbling into a bucket of water. It occurred to me then that instinctive responses are a lot like code--you can hope it'll cover most of the cases most of the time, but so much code I've written does the equivalent of walking into a bucket, falling in head first, and flailing desperately when it reaches an edge case.

While your advice seems researched and correct, the general advice passed down by Boy Scouts is reach, throw, row, go.

First, try and reach something out to the victim for him to grab hold of. If that won't work, try to throw something for him to hang on to. If that fails, go to them in some kind of boat (though a surfboard may work too). If, and only if, all those things do not work, swim out to rescue them.

[Edit: after having read the article, I realize that this is advice in what to do for someone experiencing aquatic distress, not someone who is drowning. My apologies.

In regard to 3... How do you know when the drowning person is unconscious... that would be when they dip under and don't come back up? They're lungs would be full of water then? So you would have to swim down to them, pull them to dry land (they won't float) and resuscitate them? I understand sometimes that could be the only option... but seems like a heavy responsibility.

How do you know when the drowning person is unconscious

Wait for their hands to stop moving.

that would be when they dip under and don't come back up? They're lungs would be full of water then? So you would have to swim down to them, pull them to dry land (they won't float) and resuscitate them?

They won't sink at this point, they'll just float with their face in the water. (There is a reason why the dead man's float is called that. See http://www.ehow.com/how_6582_survival-float.html for a description.)

And yes, at this point they'll have water in their lungs, and may need CPR.

I understand sometimes that could be the only option... but seems like a heavy responsibility.

If you're not trained, then getting in over your head (literally!) is an easy way to commit suicide. I had multiple years of lessons before any instructor gave me any instruction on how to go after someone in the water beyond, "Don't."

Now one thing that I didn't talk about was how you can tow someone in the water. If you have any swimming training you may be familiar with the elementary backstroke. (If not, hopefully you know the breaststroke, basically it is a version of that except on your back.) If you continuously do the kick from that, you get the whipkick. (Well to get it right you need to keep the knees a little closer together than many people's breaststroke, but close enough.) It turns out that the kick is enough.

Now what you do is lay the person with their head on your chest, your arms coming under their shoulders and crossing their chest, and just do that kick as fast as you can. You won't move very fast, but you can keep both your face and theirs in the air as you go. If you get them early enough, there is a good chance they will start breathing on their own as you tow them. At which point you get them to land and your job is done. If not, you'll get to land alive without having done further damage and can start CPR. (A life skill that I firmly believe everyone should have.)

They'll only float if their lungs are fully inflated with air (from your link and my own experience). If they've been choking on water and are now drowned (as opposed to drowning) I would assume that's no longer the case.

That helps, but fat is lighter than water, so if they have some degree of it they'll float anyway.

I've experimented with this. If I exhale, I sink. My body fat percentage is somewhere around 20%. I estimate that I need at least 1/3 to 1/2 a lung-full of air to have even neutral buoyancy. I understand that I might be unusual in this.

My body fat percentage is somewhat lower than yours, but my experience is similar. Actually, I have to swim moderately vigorously to keep my face out of the water, even with full lungs. A pool activity I enjoy is laying on the floor with swim goggles, watching the water surface from below.

Ever tried blowing bubble rings? It's not too hard, but it takes a bit of work to make good ones (and good capacity & patience, swirling water destroys them).

What's the technique?

I love doing this.

Same here, and I suspect your upvotes are from others who can sink.

One of the ways I have fun in the water is to breathe a good amount of my lungs out, and sit on the bottom as long as I can. Sit, not hold-by-swimming. It's an incredibly effective way of learning how to control your heartrate & panic response to holding your breath, because it's hardly possible without control, and then it's pretty darned easy.

Hehe, that's I game I loved to play when I was a kid (ok, I admit, I still like it today). Never occurred to me that bodyfat could have something to do with it. And I agree it's an amazing feeling, maybe we could start an underwater meditation club? ;-)

Seems it'd be hard to do mantras.

"Ommmblblblubublbubublublb"

I've done this many times -- fun, or maybe pleasant is a better word.

Enjoyable? That covers both, and for me the experience roughly covers both. It's relaxing and, yes, fun.

> but seems like a heavy responsibility.

When in a dangerous situation, your first responsibility is to yourself. Rescuing someone else can be risky, and getting yourself into the same situation as the person in trouble helps no one, and increases the burden on any other would-be rescuers, whether professional (lifeguard, fire fighter, etc.) or another Good Samaritan like yourself.

But I agree that it seems like waiting for the drowning person to become unconscious dramatically increases the chance that they won't survive. That's gotta be a tough decision to make.

[My First Aid training tells me that] although brain death occurs in just a few minutes once the brain ceases to get oxygen supplied to it, if CPR is applied to a casualty, and the casualty can get in an ambulance and into a hospital within an hour or so (the "Golden Hour"), he or she stands a decent chance of surviving. The CPR would provide some oxygen to the brain and the rest of the body (while the ambulance makes its way to the scene), so if you can bring the casualty to shore within 2 or 3 minutes of them going unconscious, there's still reason for optimism.

As such, I would say it's not unreasonable to wait for the drowning person to lose consciousness if you aren't confident you could prevent or deal with him or her dragging you down.

The "Golden Hour" refers to the time it should take to get a trauma patient to a surgical table. The odds of a (non-hypothermic) cardiac arrest patient being viable after an hour are slim to none.

However, the good news is that drownings are one of the few times where Hollywood-style CPR "Do a couple rounds and they wake up" can occur. Their heart stopped beating because it stopped getting oxygen, not due to some other type of damage. So if you do CPR for a little while and get their heart oxygenated again, it can start back up in its own (most pools nowadays have an AED as well)

I was always taught to "Reach, Throw, Go":

First, try to reach them with a pole or something from outside the water

Second, if that doesn't work, throw something that floats like a vest or life preserver. Hope they grab on to it.

Only as a last resort, actually swim out to a drowning person. Your objective should be to put the thing you just threw at them in their hands, not to drag them back to safety.

The complete list is: talk, reach, throw, row, go, tow, carry which lists the things you try and their order in terms of hazard to the lifesaver.

That's a crappy list. It's long and it mostly rhymes, making it very easy to miss or misplace a stage.

It rhymes because it's a mnemonic and since we got quizzed on it about a million times I still remember it 25 years later. Seems like a good list to me.

It's amazing that there aren't many tools for drowning response, and any new technology recieves major pushback from the ineffective incumbents in the space. Check out http://life-safer.com/ they make a throwable, bouyant, foam disk that is significantly more effective than anything else available.

When I was in lifeguard training, they taught us how to deal with a struggling victim. It was a bit like aikido in the water, except that a panicking victim is probably stronger.

The following year they changed the "rules" and the instructor (who was also a teacher in my high school) said that we were now to keep an eye on a struggling victim, and attempt a rescue only after they stopped struggling. I think they'd had too many lifeguards end up in need of rescue themselves when they went after a panicked victim and got yanked underwater.

This is incredibly useful information, thank you for posting it. In emergency situations (like drowning) I tend to try to rescue people who might be in danger (as long as it's safe, of course). This I did not know and it could have had dire consequences for me.

A rescuer just died near Carmel, CA on Sunday. http://www.montereyherald.com/ci_15449083

I have been in a position where I felt like I was drowning and I was able to call for help. But I'd agree that if it had been worse, the results might have been as described.