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Resuscitation. 2014 Sep;85(9):1149-52. doi: 10.1016/j.resuscitation.2014.05.034. Epub 2014 Jun 7.

Creating a drowning chain of survival.

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Sociedade Brasileira de Salvamento Aquatico, Sobrasa, Miguel Couto Hospital - Research Center, Brazil. Electronic address:
Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand. Electronic address:
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA. Electronic address:
van Heurnlaan 10, 5261 EW VUGHT, Netherlands. Electronic address:
Ocean Rescue Captain at Miami-Dade Fire Rescue, Miami, USA. Electronic address:
Bowling Green State University, Kinesiology-HMSLS, Bowling Green, OH, USA; BGSU, BG Perspective: 21st Century Liberal Studies, Bowling Green, OH, USA. Electronic address:
Postgraduate Family Practice Residency Program at The University of British Columbia, Canada. Electronic address:
Research Center for Emergency Medicine at Aarhus University Hospital, Aarhus, Denmark. Electronic address:


All nations would benefit from a simple, clear Drowning Chain of Survival. In high income nations this tool will refine prevention and the call for action. In low and middle income nations this tool is a guide for policy making, resource allocation and priority setting in drowning prevention. A best evidence approach was utilized to create a universal Drowning Chain of Survival. Education on how to prevent drowning and to how react when a drowning incident occurs has not always been guided by good levels of evidence, or high levels of specialized training in drowning process recognition and management. The Drowning Chain of Survival refers to a series of steps that when enacted, attempts to reduce mortality associated with drowning and attempted aquatic rescue. The term "chain of survival" has provided a useful metaphor for the elements of the emergency cardiac care system for sudden cardiac arrest, however interventions and patient management in drowning involves principles and actions that are specific to these situations. The result is a unique and universal Drowning Chain of Survival comprised of five links guiding the important life-saving steps for lay and professional rescuers. This may significantly improve chances of prevention, survival and recovery from drowning. The steps of the chain are: Prevent drowning, Recognize distress, Provide flotation, Remove from water, and Provide care as needed.


Chain of survival; Drowning; First aid and CPR; Lifeguarding; Lifesaving; Rescue and safety equipment

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