The Recovery Position – When? When Not?

The Recovery Position

Having dealt with a number of first aid emergencies over the years, we’ve noticed that the recovery position is often viewed as a “fix all” by untrained onlookers. On countless occasions, when faced with an unconscious casualty lying on their back, we’ve been told by a panicking bystander to “put him (or her) in the recovery position!” as if the recovery position will solve any and every medical emergency. However, this is not always the case! In this article, we will explain why that is.

First, check for breathing

Before contemplating the recovery position, we first need to check whether the casualty is breathing. To check for breathing, we open the casualty’s airway – place one hand on their forehead, two fingers under their chin, and tilt the head back. Then, placing our face close to their nose and mouth we listen and feel for breaths, being careful not to confuse “agonal gasps” with normal breathing. Looking down the casualty’s body, we also look to see if their chest is rising (approximately 2-3 times in 10 seconds). If not, we must immediately begin CPR. To perform CPR, we need the casualty to be on their back, not in the recovery position!

Unconscious, but breathing – Is the recovery position always necessary?

If the casualty is unconscious but breathing, should they immediately be placed into the recovery position? Not necessarily. True, while laying on their back, there is a risk that the casualty’s tongue could fall back in their throat and obstruct their airway. However, to move a person straight into the recovery position could cause more harm than good. For example, we think of the casualty with a spinal injury. We might ascertain from the surroundings that the casualty has fallen from a height, perhaps from a ladder. When this is the case, we should suspect a spinal injury and be very careful when it comes to moving the casualty, if indeed we move them at all. If the person is on their back, we might be able to carefully open their airway and monitor their breathing without the need to place them in the recovery position. Remember, when it comes to moving people with spinal injuries, it’s not just the possibility of causing paralysis that we need to consider. Damage to the spinal column, particularly at the 3rd to 5th cervical vertebrae can cause breathing difficulties, or even cause a casualty to stop person breathing altogether. In a case like this, moving the casualty into the recovery position could be what kills them! The key with spinal injuries is to never move a casualty unless you absolutely have to. When might this be?

Vomiting – when the recovery position becomes necessary

Let’s imagine that our casualty vomits. Their airway is now compromised. We may be able to remove the obstruction with our gloved finger, but if not, we will need to get the casualty onto their side in order to drain the vomit. If there are a number of bystanders available to help, we could use a technique called Manual In-Line Stabilisation or M.I.L.S. This is a manoeuvre where, working as a team, 4 people move a casualty onto their side while keeping their spine in alignment. If we’re on our own, we might use the recovery position to move the person to the extent necessary to drain their airway and allow for unobstructed breathing.

Leaving the casualty to get help

Imagine a situation where we are on our own and we need to leave an unconscious casualty to get help. In this scenario, we need to place the person into the recovery position in order to maintain an open airway in our absence. But before doing so, we first want to check for injuries by carrying out a “head to toe” survey of the casualty. This will allow us to decide whether we can safely move the casualty into the recovery position, and if so, how careful we need to be.

To move or not to move – that is the question

When faced with a casualty having spinal injuries it can be difficult to decide whether to move them into the recovery position or leave them on their back. Moving a person with a spinal injury might cause paralysis, or even stop them breathing altogether. But a casualty who is left to choke on their tongue or vomit is most likely going to be a dead casualty. Airway and Breathing trump everything else. So do whatever it takes to keep the person alive, whether that be moving them, or keeping them still.