A foreign national male in his 30s presented to our hospital after falling overboard. He appeared to have had a rope around his neck during the fall;however, no witnesses observed this. The patient was agitated in the emergency room and was walking around incessantly. He exhibited a cervical cord scar and hoarseness at the beginning of the examination and developed dyspnea and bloody phlegm 40 minutes after arrival. Sudden respiratory deterioration occurred, and oral intubation was performed under sedation with 30 mg midazolam. Chest computed tomography( CT) revealed bilateral pneumothorax and complete transection of the cervical trachea, with tube deviation into the mediastinum. After bilateral drainage of the thoracic cavity, a tracheostomy was performed in the emergency room. The patient underwent tracheoplasty in the operating room 4 hours after arrival. He was extubated on postoperative day( POD) 10;however, bilateral recurrent nerve palsy persisted. The patient was discharged on POD 16.