Introduction – Each year, accidental drownings cause approximately 1,000 deaths in France. This article presents an analysis, based on data from the 2018 and 2021 NOYADES surveys, of risk factors for severe drowning outcomes and the characteristics of victims, a better understanding of which could improve prevention efforts. Method – The 2018 and 2021 NOYADES surveys collected data, via a standardized questionnaire, on drowning incidents handled by emergency services in France during the summer. The “severity level” variable for drowning was constructed primarily based on a four-level severity scale completed by emergency services, with the fourth level defined as severe drowning. Risk factors and excess risks of severity in drowning cases were established using a robust variance Poisson regression. Results – Among the 2,866 drowning cases analyzed, severe drownings were more common among men and adults (with the proportion of severe drownings increasing with age). Among the variables included in the multivariate model, the primary risk factor for drowning severity was age, with individuals aged 65 and older having a threefold higher risk of a severe drowning compared to those aged 0–5 years. Other risk factors included being male, residing abroad, the drowning occurring in a private family pool or in a river/body of water rather than in the sea, the drowning occurring in the Southwest, the Northwest, the Interior, and overseas territories rather than in the Southeast, when rescue efforts occurred in the morning, and in cases of sudden illness (incidence rate ratio – IRR – ranging from 1.14 to 1.77). After stratification by age, alcohol consumption was also a risk factor for severity in drowning among adults. Discussion – This study identifies, for the first time, risk factors for severity in drowning in France, for all ages and by age group. It defines priority target populations for prevention.