The primary danger for any person who is unconscious or heavily sedated and begins to vomit is aspiration. This occurs when stomach contents are inhaled into the lungs, which can lead to serious complications like aspiration pneumonia or complete airway blockage. An individual who is not fully conscious lacks the protective reflexes—such as coughing or swallowing—necessary to clear their airway effectively. Therefore, rapidly placing the person into a specific posture is the most immediate and effective first-aid measure to prevent obstruction. This specialized position uses gravity to ensure that any fluids drain safely out of the mouth, keeping the airway clear.
The Standard Recovery Position
The standard recovery position is a stable, side-lying posture designed for unconscious but breathing individuals. To begin, kneel beside the person and ensure their legs are straight. Take the arm nearest to you and place it out to the side at a right angle to their body, keeping the elbow bent with the palm facing up. This arm acts as a stabilizing support when the person is rolled onto their side.
Next, bring the person’s other arm across their chest and hold the back of their hand against the cheek nearest you, maintaining this hold throughout the roll. Use your other hand to grasp the knee farthest from you and pull it up so the foot is flat on the floor. This bent leg serves as a lever for rolling and stabilizes the final position.
Carefully pull on the bent knee to roll the person gently toward you onto their side. Ensure the hand tucked under the cheek remains in place to cushion the head. Once the roll is complete, adjust the top leg so both the hip and knee are bent at right angles, which prevents the person from rolling onto their stomach or back. Finally, gently tilt the head back slightly to open the airway and direct the mouth toward the ground, allowing for drainage.
Why Proper Positioning Prevents Aspiration
The side-lying posture prevents aspiration by utilizing the force of gravity to redirect fluids away from the trachea. In an unconscious person lying on their back, the relaxed tongue can fall backward, physically obstructing the airway. This supine position also allows vomit or other fluids to pool at the back of the throat, increasing the likelihood of inhalation into the lungs.
When the person is positioned on their side with the head tilted slightly backward and facing downward, the tongue naturally falls forward, maintaining an open passage for air. This orientation ensures that any stomach contents will flow out of the mouth rather than being drawn back into the pharynx. The recovery position thus keeps the airway clear by preventing tongue blockage and promoting continuous drainage.
Positioning for Special Populations and Circumstances
The standard technique requires modification for certain individuals, such as infants and those with suspected spinal injuries. For children older than one year, the recovery position is generally the same as for adults, though their smaller size requires close attention to the head tilt. Infants under one year old should not be placed in the adult recovery position due to their anatomical differences.
Infants and Children
Instead, a modified infant recovery position involves cradling the baby on their side or stomach across your forearm, with the head supported and held slightly lower than the rest of the body. This head-down orientation allows any fluids to drain immediately from the mouth.
Suspected Spinal Injuries
If a head, neck, or back injury is suspected, the absolute priority is minimizing movement to prevent further spinal cord damage. In cases of suspected spinal injury, the person must be rolled as a single unit, often requiring a maneuver known as the log roll. If alone, the rescuer must still prioritize rolling the person onto their side to prevent choking, but without tilting the head back. The goal is to roll the person just enough to allow drainage, while keeping the head, neck, and torso aligned as much as possible during the movement.