The steps to perform a basic rescue of a drowning patient in open water follow the age-old mantra: “Reach, Throw, Row, Go (Don’t Go).” This simple saying highlights the importance of keeping a safe distance from a patient to ensure rescuer
safety. A panicking patient can easily take themselves and the rescuer underwater in an attempt to keep their airway above the surface. By keeping a safe distance from the patient, utilizing communication and buoyant or long-reaching objects from the surrounding environment, the rescuer can have the best chance of avoiding injury.

Reach: A rescuer should scan the surrounding environment for any object which can be used to reach the patient. This may include a pole, branch, rope, or clothing. While doing so, the rescuer should maintain communication with the patient, giving simple directions and instilling confidence. The benefit of this technique is that it keeps the rescuer out of the water, maximizing safety. The weakness of this technique is that it requires close proximity to the patient, which often isn’t possible in an open water environment and a conscious and coherent patient who is able to remain calm and follow directions.

Throw: If the patient is too far from the rescuer or there are no objects to be used for reaching, the next option is to throw a buoyant object to the patient. This may include a specifically designed rescue apparatus (ring, buoy, etc.), cooler, beach ball, or raft. For farther distances, equipment like throw bags are designed to be easily deployed, although these often require at least basic training in their use. The benefit of this technique is that it allows access to a patient who is farther from the rescuer. Similar to reaching, the weakness is that it requires a patient who is conscious and coherent enough to follow directions and grasp an object.

Row: If reachable or throwable objects are not available, or if a patient is too far from the rescuer, the next option is to “row” a craft to the patient. In this context, the term “row” can represent any means to pilot a buoyant craft to the patient, whether that be row a boat, paddle a surfboard, or drive a motorized boat. With the latter, extreme caution must be used in piloting a motorized boat to a patient (see Chapter 28), as the patient may not have the physical or mental capacity to avoid the craft or motor in the event that a wave or current brings it too close to the patient. The benefit of this option is that it brings a relatively stable and buoyant surface to the patient and allows for the rescue of those who may not have the strength or mental clarity to grasp an object that has been reached or thrown to them. The weakness is that the skills necessary for this technique can border on advanced; a panicking patient can capsize a small boat or surfboard leaving the rescuer vulnerable. In addition, the act of safely lifting a tired or unconscious swimmer onto a craft requires experience and training. It is best to only “row” to a patient if you have sufficient manpower to assist and a large enough craft to minimize the chance of capsizing, or if the patient is conscious and coherent enough to hold on to the side of the craft and not require lifting into it.

Go (Don’t Go): This phrase highlights the importance of avoiding contact rescues with a drowning patient without proper training and experience. If the previous options don’t work, and would-be rescuers lack the proper training for advanced techniques, or the environment is unsafe for your experience or equipment, the safest step is to contact local advanced rescue personnel. However, this stage becomes “Go” for trained providers, as a final personal resort. As discussed in Chapters 16 and 26, some systems add “Helo” as a final system resort, but this is more often used for swiftwater than open water rescue, with the exception of flood disasters.

Advanced procedures can be classified into two categories: noncontact and contact. Noncontact rescues include those techniques in which the rescuer does not make direct contact with a patient, usually using a buoyant rescue apparatus (buoy, ring, etc.). Contact rescues include those in which the rescuer is forced to make direct contact with the patient, either through holding their body or grasping an extremity, piece of clothing, or hair. Rescuers with the proper training and equipment may attempt these rescues as long as the open water environment and number of patients are deemed safe for the rescuer’s experience and physical capabilities. These rescue techniques vary greatly based on training, available equipment, water condition, and local protocols. This section will cover the basic principles and common techniques.

Although the decision to perform an advanced rescue has been made, steps to ensure rescuer safety must still take place. As the patient is approached, verbal communication should be used in an attempt to direct and calm the patient. Often, just by talking to a patient and letting them know that someone is there to help, they can gain enough confidence to calmly swim toward safety under the guidance of the rescuer. If available, a buoyant rescue apparatus should always be taken by the rescuer, as this can improve rescue effectiveness and provide a measure of safety for both the rescuer and the patient. If a patient is unable to swim but conscious enough to grasp the apparatus, the rescuer should keep a safe distance from the patient and advance the apparatus to them, instructing them to grasp it and rest. The rescuer can then either pull/push the patient toward safety or call to shore for more assistance. During the remainder of the rescue, it is important for the rescuer to maintain visual and verbal contact with the patient to ensure they are able to hold on and to instill confidence. This is also an opportunity to question the patient about additional persons who may be submerged.