Rescuers who drown sacrifice their lives so that another might live; these drowning deaths are a particular challenge to prevent. In this research from Australia and the literature, we dissect and discuss the elements of “rescue altruism.” This 18-year critical incident population study identified 103 victims who drowned while attempting a rescue. In 74% of cases the primary “victim” (rescuee) survived, 50% of rescuers were visitors not familiar with the water hazard; 67% of the drowned rescuers were related to the primary victim. None were professionally trained in aquatic rescue. We propose that rescue altruism is composed of (a) an ethos based on the Good Samaritan or Golden Rule ethic; (b) a subjective identity of the rescuer with the victim, intensified by a perceived duty-of-care relationship; (c) perception of risk in which the potential of rescue-resuscitation success is greater than zero; and (d) personal courage that ignores degree of risk. The unmet challenge therefore is to ensure all members of the public are equipped with lifesaving drills and skills to ensure their safety and those in their care.