Emergency Services were called to the Shoalhaven Heads boat ramp at about 5.50pm on Saturday afternoon after reports of a swimmer in distress.
A man, believed to be approximately 61 years of age was found in the Shoalhaven River after he suffered a medical episode.
NSW Ambulance responded as well as police from Shoalhaven LAC, who tasked water resources.
The patient was airlifted by Toll Air Ambulance to Wollongong Hospital, his condition remains unknown at this stage.
The South Coast Register understands the man, who was staying at the nearby caravan park, decided to go for a swim in the river before two fishers found him in distress.
An 11-year-old boy and a 22-year-old man were fishing from a kayak when they saw the man jump off the jetty to go for a swim.
When the pair made their way to the beach they saw the man face down and appeared to be suffering from a fit. They alerted emergency services.