The question of when to use the recovery position often arises from a misunderstanding of what defines a life-threatening emergency. Cardiac arrest is the abrupt and unexpected cessation of the heart’s function, leading to unresponsiveness and the absence of normal breathing or circulation. This state requires immediate intervention, specifically cardiopulmonary resuscitation (CPR) and defibrillation, to restore a heartbeat and blood flow. The recovery position, by contrast, is a specific posture for an unconscious person who is breathing normally. Its purpose is to maintain an open airway and prevent the aspiration of fluids or vomit.
Immediate Action for an Unresponsive Person
The first step upon encountering an unresponsive person is to quickly assess the situation. Check for responsiveness by gently shaking the person and shouting to them, asking if they are okay. Once unresponsiveness is confirmed, immediately call emergency medical services (911 or the local equivalent) and then check for breathing.
An individual in cardiac arrest will not be breathing normally, manifesting as no breathing or only occasional, ineffective gasping breaths. If the person is not breathing normally, the priority shifts to initiating chest compressions and preparing an automated external defibrillator (AED) if available. The recovery position must be avoided for anyone suspected of being in cardiac arrest, as lying flat on the back is required for effective chest compressions. Focus must remain on restoring circulation through CPR until emergency responders arrive.
The Criteria for Using the Recovery Position
The decision to use the recovery position is based on two simultaneous conditions: the person must be unconscious or unresponsive, and they must be breathing normally. The position is designed for individuals who cannot protect their own airway due to loss of consciousness, such as from intoxication, a seizure, or a head injury. When a person lies flat on their back unconscious, the relaxed tongue muscle can fall backward and obstruct the airway.
Placing the person onto their side allows gravity to help the tongue fall forward and enables fluids, such as saliva or stomach contents, to drain out of the mouth. This drainage prevents aspiration, which can cause severe lung injury or pneumonia. By maintaining a clear airway, the recovery position stabilizes the unconscious person and helps prevent secondary cardiac arrest. It is also appropriate for a person who has received successful CPR and has started breathing normally while awaiting medical care.
Step-by-Step Guide to Placing Someone in the Recovery Position
Once you have confirmed the person is unconscious but breathing normally, you can begin placing them into the recovery position. Kneel beside the person and ensure both of their legs are straight. Take the arm closest to you and extend it straight out from their body at a right angle, with the palm facing upward.
Next, take the person’s other arm and bring it across their chest, placing the back of their hand against the cheek closest to you. Hold this hand in place to support the head as you move them. With your other hand, grasp the far leg just above the knee and bend it, ensuring the foot remains flat on the ground.
To roll the person, pull steadily on the bent knee toward you, using it as leverage to gently roll them onto their side. The bent leg acts as a stabilizer, preventing the person from rolling onto their stomach. Once they are resting on their side, adjust the top leg so the hip and knee are bent at right angles to maintain stability. Finally, gently tilt the head back slightly to ensure the chin is lifted and the airway is fully open, and continue to monitor their breathing until medical help arrives.
Situations Where the Recovery Position Must Be Avoided
While the recovery position is a valuable technique for an unconscious, breathing person, moving the individual could cause more harm in specific circumstances. The position must be avoided if there is any suspicion of a severe head, neck, or spinal injury, such as from a major fall or car accident. Any unnecessary movement risks shifting the spine, which could lead to irreversible damage to the spinal cord.
If a spinal injury is suspected, the person should not be moved unless there is an immediate, life-threatening danger, such as a fire, or if the airway is blocked and requires clearing. If movement is necessary, attempt to keep the head, neck, and torso aligned as a single unit to minimize spinal manipulation. If a person in the recovery position stops breathing, they must be immediately rolled back onto their back to allow for the commencement of CPR and chest compressions.