The document discusses guidelines for in-water resuscitation (IWR) for drowning victims. It describes the process used to develop evidence-based recommendations called Consensus on Science and Treatment Recommendations (CoSTR). CoSTR reviewed available evidence and established that ventilating or performing CPR on unconscious victims in water is generally safe and effective if done before removal from the water. The recommendations provide that rescuers bring victims face up, check breathing, ventilate if needed, and remove promptly to shore for further care. Cervical immobilization is not routinely needed unless trauma is suspected.