The recovery position is a straightforward first aid technique involving placing an unconscious person on their side. This lateral posture’s primary goal is to maintain an open airway that an unresponsive person cannot protect. Positioning the person on their side uses gravity to prevent the tongue from blocking the throat, a common obstruction in unconscious individuals. The position also facilitates the drainage of fluids, such as saliva, blood, or vomit, away from the mouth, reducing the risk of aspiration into the lungs.
When to Use the Recovery Position: Assessment Criteria
The decision to use the recovery position hinges on two simultaneous criteria: the person must be unresponsive, and they must be breathing normally. Unresponsiveness is checked by attempting to rouse the person, typically by shouting their name and gently tapping their shoulders. If there is no response, the person is deemed unconscious.
Normal breathing must be confirmed immediately. A first responder checks for breathing using the “look, listen, and feel” technique for no more than ten seconds. This involves looking for chest movement, listening for breath sounds, and feeling for air on the cheek. If the person is not breathing, or if breathing is irregular, shallow, or characterized by gasping (agonal breathing), the recovery position should not be used. This state indicates a possible cardiac arrest, and the priority shifts immediately to starting cardiopulmonary resuscitation (CPR).
Understanding the Risks: Trauma and Spinal Injury
A primary contraindication for using the recovery position is the suspicion of a severe spinal injury, particularly involving the head, neck, or back. Moving a person with an unstable spinal fracture risks causing displacement, which can lead to permanent neurological damage. If the mechanism of injury suggests trauma, such as a serious fall or car accident, the person should not be moved.
However, maintaining an open airway always takes precedence over a suspected spinal injury. If an individual with potential spinal trauma is actively vomiting or their airway is obstructed, they must be moved immediately. In such high-risk scenarios, a modified technique called a “log roll” is required. This involves multiple rescuers supporting the head, neck, and torso to minimize twisting motion and keep the spine as straight as possible while turning the person onto their side.
Step-by-Step Procedure for Placement
Once the decision is made, kneel beside the person and ensure both legs are straight.
- The arm nearest to the rescuer is placed out at a right angle to the body, with the elbow bent and the palm facing upward. This arm acts as a cushion for the head.
- The person’s far arm is brought across their chest, and the back of that hand is held against the cheek nearest to the rescuer.
- The far leg is lifted at the knee so the foot is flat on the ground, creating a stable lever.
- While holding the hand pressed against the cheek, pull on the bent knee to gently roll the person toward you onto their side.
- The bent knee acts as a prop to stabilize the final position and prevent rolling onto the stomach.
- Gently tilt the head back to ensure the airway remains open and the mouth is downward to allow fluid drainage.
Monitoring the Patient After Placement
Continuous monitoring is required until professional medical help arrives. The rescuer must observe the person’s breathing rate and quality to ensure it remains normal and effective. The person should also be covered with a blanket or coat to prevent hypothermia, as an unconscious person cannot regulate body temperature effectively.
If the person remains in the recovery position for an extended period, they should be carefully rolled to the opposite side approximately every 30 minutes. This rotation helps prevent pressure injuries and circulatory issues from prolonged pressure on the underside arm and leg. Any change in condition, particularly if breathing becomes abnormal or stops, requires an immediate return to the back to initiate CPR.