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Introduction Despite evidence that immediate rescue and initiation of resuscitation plays a vital role in determining the outcome of a drowning person, research on lay rescuer interventions remains limited. We explored lay rescuer interventions in fatal drowning incidents in Canada and described the characteristics of lay rescuers who had a fatal outcome while attempting to rescue another person.Methods We reviewed all unintentional drowning deaths that occurred in Canada (2010–2019) identified by the Drowning Prevention Research Centre. We determined the adjusted OR of lay rescuer intervention for different drowning incident characteristics using multivariable logistic regression. Using descriptive statistics, we described incidents where a lay rescuer fatally drowned while attempting to perform a rescue.Results During the study period, 4535 people died as the result of unintentional drowning incidents in Canada. There was an attempted rescue in 2480 cases (54.7%) and most were by lay rescuers (n=1846, 74.4%). Lay rescuers frequently used a high-risk, contact rescue technique (n=895, 48.5%). Lay rescuers were more likely to respond when the drowning person was a child, was female, the drowning occurred in a pool, only one person was drowning and when there was no ice present in the body of water. 74 lay rescuers fatally drowned while attempting to save another person.Conclusions Lay rescuers frequently intervened on drowning incidents with a high-risk, contact rescue. Since characteristics differed between drowning incidents where a lay rescuer response occurred (vs not), further investigation into rescuer motivation may inform tailored interventions to reduce rescuer injury.