There's a few points and questions that I have:
1) Regulator Failure. The exhaust diagphram can tear or misalign. This can mean that the 2nd stage allows water to flood in. You cannot spot this via the SPG. It has nothing to do with a 2st stage failure (that is fail-safe). The way to confirm that your second stage is sealed is to attempt to draw a breath without the air turned on. If you can suck air in... then it isn't sealed. The emergency reaction should be to immediately seek an AAS (your buddy, or even your own octopus).
2) Inhalation. As taught on the Open Water course; always maintain airway control. When first descending, after taking the regulator out of your mouth, or in any event that you suspect water is in your regulator; use your tongue as a splash-guard and inhale slowly and cautiously. If you inhale water into the lungs, it will lead to serious medical issues (as illustrated in this thread). If your mouth is full of water, you can exhale the water or even swallow it... so that your mouth is clear for further breathing.
3) Oxygen. Oxygen is critical for any near-drowning or DCS emergency. It can literally be the difference between life and death. Any dive boat that doesn't have an
adequate (dictated by the time it takes to get to emergency care) supply of oxygen is breaking every industry standard applicable. Local/national laws may not dictate that O2 has to be carried - but a responsible dive operator should nonetheless respect their safety obligation to the customer. If a dive operator chooses
not to bother with carrying O2... then you
must not dive with them. Be sure to
tell them why you choose not to dive with them - if enough potential customers do this, then eventually they'll get the hint and adopt more responsible business practices.
4) Near Drowning. Any inhalation of water into the lungs is a critical medical emergency and must be treated as such from the very start. Even if the casualty apparently 'recovers' there is a high risk of
secondary drowning and infection. Another issue that can present, even if only a tiny amount of water spray is inhaled, is
Salt Water Aspiration Syndrome. Any of these is potentially life threatening. Be aware of these issues!