Immediate resuscitation if indicated 
Assess need for CPR but do not delay removal from water
Ventilation is a higher priority in drowning victims in cardiac arrest than in other situations requiring CPR
Deliver two rescue breaths immediately upon reaching shallow water or a stable surface; early breaths have been associated with improved survival 
If no response to rescue breaths with chest rise, continue to standard CPR algorithm
Administer high flow O2 and intubate apneic patients
Do not routinely immobilize c-spine without suspicion based on mechanism or clinical signs 
Supportive care based on presentation is cornerstone of management
Consider CPAP if inadequate tidal volume with high flow O2
OG tube for gastric distension
Indications for intubation:
Comatose or unable to protect airway
Hypoxemia or hypercapnia on ABG despite high flow O2 (PaO2 below 60, PaCO2 above 50)
Continue resuscitation efforts in hypothermic patients until core temperature rises to at least 30 C (not dead until warm and dead) 
Routine antibiotics in ED are not necessary, but broad spectrum coverage may be indicated for<unk>  in heavily contaminated water
Comatose or unable to protect airway
Hypoxemia or hypercapnia on ABG despite high flow O2 (PaO2 below 60, PaCO2 above 50)
Submersion injury
Hypothermia
Blast injury
Immersion pulmonary edema
Stingray injury
Marine toxins, envenomations, and bites
High-pressure injection injury
Scuba diving emergencies