Approximately 360,000 deaths globally are attributed to drowning every year. Drowning often affects young victims and can have dire personal, emotional, and financial consequences for patients, families, and society. The goal of these practice guidelines is to reduce the burden of drowning through improvements in treatment and prevention. We present accepted drowning terminology as part of a review and evaluation of literature regarding acute care for the drowning patient, in both out-of-hospital and emergency medical care settings, with particular focus on the wilderness context. The authors relied upon the experience and knowledge of a panel of wilderness and emergency medicine practitioners to make recommendations where little or unreliable evidence is available. This is the first update of the original publication from 2016.