The recovery position is a standard first aid technique designed to protect an unconscious person who is still breathing normally. This side-lying posture is a temporary measure intended to maintain the individual’s safety while emergency medical services are on the way. Its primary function is to prevent life-threatening airway obstruction that occurs when an unresponsive person is lying flat on their back.
Airway Protection and Aspiration Prevention
When an individual loses consciousness, the muscles throughout their body relax significantly, including those controlling the jaw and tongue. If the person is lying supine, the relaxed tongue can fall backward against the posterior pharyngeal wall, blocking the passage of air. The recovery position counters this by using gravity to pull the tongue forward, effectively moving it away from the back of the throat to keep the airway open and clear.
Placing the person on their side provides a downward path for fluids to exit the mouth. In an unconscious state, the reflexes that normally trigger coughing or swallowing are depressed, and the sphincter muscle at the top of the stomach relaxes. This relaxation can allow stomach contents, blood, or excessive saliva to passively flow up and out of the mouth.
Without the recovery position, these fluids can be inhaled into the lungs, a complication known as aspiration. Aspiration can lead to aspiration pneumonia, a serious respiratory infection. By ensuring the mouth is the lowest point, the side-lying position promotes drainage, significantly reducing the risk of a blocked airway and subsequent pulmonary complications.
Identifying the Need for the Recovery Position
The recovery position is specifically indicated for an individual who is unresponsive but confirmed to be breathing adequately. Before attempting to move anyone, a rescuer must first confirm that the person is unconscious and then check for normal, regular breathing. If the person is not breathing, or is breathing in gasps, immediate Cardiopulmonary Resuscitation (CPR) should be initiated instead.
Common scenarios that often necessitate this positioning include unconsciousness due to intoxication, fainting, or the period following a seizure when the individual remains unresponsive. This action is reserved for situations where the priority is maintaining an open airway, and there is no suspicion of a severe traumatic injury that movement would worsen.
Practical Steps for Safe Placement
To begin placing an individual into the recovery position, kneel beside them and ensure both of their legs are straight. Take the arm nearest to you and position it at a right angle to their body, with the elbow bent and the palm facing upward. This arm will ultimately help stabilize the person’s torso and reduce pressure on the side of their chest.
Next, bring the person’s far arm across their chest and place the back of that hand against the cheek closest to you. You must hold the hand in place against the cheek, as it will be used to cushion and support the head during the roll. Bend the leg farthest from you at the knee, so the foot is flat on the ground.
Using the bent knee as a lever, gently pull it toward you to roll the person onto their side. Adjust the bent leg so the hip and knee are at right angles; this stabilizes the body and prevents them from rolling onto their stomach or back. Finally, gently tilt the head back to ensure the airway remains open, and monitor breathing constantly until medical help arrives.
When to Modify or Avoid the Position
The recovery position should be avoided entirely if there is a suspicion of a spinal or neck injury, such as from a fall or car accident. In these cases, moving the person could cause further damage to the spinal cord, and movement should be minimized unless absolutely necessary to clear the airway. If the airway must be opened, the head and neck should be stabilized and moved as a single unit.
Specific populations require modification to the standard technique for safety reasons. Pregnant individuals who are unconscious must be positioned on their left side to prevent the uterus from compressing the vena cava, a major blood vessel that returns blood to the heart. For infants, the recovery position involves cradling them with their head lower than their chest, allowing fluids to drain out while providing continuous support to their head and neck.