AOS below “Pattons Run” to a group of “Fast Rivers” rafting guests who appeared to be in distress. The father and a group of bystanders advised that a 12 YO Mal3e had been rescued from the water (freshwater 55*) after being submerged for an unknown amount of time. Per the bystanders the patient was pulseless, apneic and cyanotic. One of the bystanders immediately started CPR with respirations and notified 911. 3 rounds of CPR were performed before the patient began vomiting water/frothy sputum from his mouth. Per the bystanders patient was rolled into the recovery position and pulses were checked. ROSC confirmed. Per the bystanders the patient was kept in recovery position for 5 minutes and then was moved into an upright/tripod position as he became more alert. **Patient information redacted** Additional NOC guides arrived on scene and began assisting with warming the patient while I updated 911. Via bystanders cell phone 911 was advised of our updated location and the best place to access us from. 911 advised that it had been 30 minutes since the first call was placed. A plan was devised that used the walking path access from the put-in. The patient was ambulatory and walked 20 yards from the river to the walking path. During this walk the patient presented with audible gurgling/rales which stopped when he came to a rest again. ** Patient information redacted ** Nantahala FD first responders arrived on scene and provided a space blanket and began assesing vitals. Macon County EMS arrived on scene and received a full patient report and passdown. No further assistance needed per Macon County EMS.