What is Recovery position: A guide to correctly position an unconscious patient

The recovery position is a specific body position used in first aid to place an unconscious or unresponsive person who is breathing but not fully alert. It is designed to maintain an open airway, facilitate drainage of fluids, and prevent complications that arises from a compromised airway. When applied correctly, the recovery position significantly reduces the risk of complications and improve the chances of a positive outcome in emergency situations. This guide will help you how to put a patient in a recovery position.

Putting someone in the recovery position is a crucial skill in first aid that helps maintain an open airway and prevent complications. Follow these step-by-step instructions to correctly position an unconscious patient in the recovery position:

1. Check for danger
2. Assess Responsiveness
3. Call for Help
4. Open the Airway using head tilt, chin lift technique
5. Extend the person's arm that is closest to you
6. On the same side as the extended arm, bend the person's knee, keeping the foot flat on the ground.
7. Roll the person onto their side by gently pulling their hip and shoulder towards you.
8. Ensure the head is tilted back slightly to maintain an open airway.
9. Observe the person's chest to confirm that they are breathing normally.
10. Stay with the person and monitor their vital signs until medical professionals take over.

Step 1: Check for Danger

Before approaching the person, ensure the area is safe for both you and the unconscious individual. Look out for potential hazards like traffic, fire, or unstable structures. If any danger is present, ensure it's addressed or move the person to a safer location if possible. Scan the surroundings thoroughly and assess if there are any immediate risks to yourself or the casualty. Ensure that you do not put yourself in harm's way while attempting to help the person.

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Step 2: Assess Responsiveness

Tap the person gently and shout loudly to check if they respond. If there is no response, assume they are unconscious and in need of assistance. Check for any signs of breathing or movement. If they are unresponsive, proceed with the following steps. Look for any visible signs of injuries or trauma that requires immediate attention.

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Step 3: Call for Help

If you're alone, call for emergency medical help immediately before proceeding with any first aid. Even if you're not alone, it's crucial to ensure that someone calls for help or activates emergency services while you administer aid. Provide clear and concise information about the situation to the emergency dispatcher, including the person's condition and location.

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Step 4: Open the Airway

Gently tilt the person's head back and lift their chin upward to open the airway. This helps ensure that the tongue is not blocking the air passage, allowing for easier breathing. Ensure that the neck is not twisted or bent excessively. If there is suspected trauma to the neck or spine, be cautious when tilting the head back and consider stabilizing the head and neck in a neutral position.

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Step 5: Extend the Arm

On the side that is facing upward, extend the person's arm that is closest to you. Bend their elbow at a right angle, with the palm facing upward. This position helps stabilize the body and prevents them from rolling onto their stomach. Ensure that the arm is not bent or positioned in a way that obstructs blood flow or causes discomfort.

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Step 6: Cross the Leg

On the same side as the extended arm, bend the person's knee, keeping the foot flat on the ground. This will help stabilize the body in the recovery position and prevent them from rolling over onto their stomach or back. Ensure that the leg is not crossed over the body or placed in a position that causes strain or discomfort.

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Step 7: Roll the Person

Carefully roll the person onto their side by gently pulling their hip and shoulder towards you. The top arm is used to support their head. The person's head should rest on the extended arm, and their top leg should be bent at the right angle to keep them stable. Ensure that the head, neck, and spine are aligned during the rolling process. Use smooth and controlled movements to avoid causing any further injury.

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Step 8: Adjust the Head Position

Ensure the head is tilted back slightly to maintain an open airway. Check again for any obstructions in the mouth or throat and remove them if possible without causing further harm. If there are any concerns about the person's airway, consider repositioning the head or using techniques such as the chin lift or jaw thrust to ensure adequate airflow.

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Step 9: Check for Breathing

Observe the person's chest to confirm that they are breathing normally. Look, listen, and feel for any signs of breathing for at least 10 seconds. If they are not breathing or having difficulty breathing, start CPR immediately and continue until medical help arrives. If there are any abnormalities in breathing, such as gasping or shallow breaths, provide appropriate assistance based on the person's condition and level of training.

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Step 10: Monitor Vital Signs

Stay with the person and monitor their vital signs until medical professionals take over. Note any changes in their condition, such as changes in breathing pattern, skin color, or responsiveness, and communicate these observations to the arriving medical personnel for appropriate care. Continuously reassess the person's condition and provide any necessary interventions to ensure their safety and well-being until help arrives. 

Remember, the recovery position is appropriate for individuals who are unconscious but breathing normally. If there is any doubt about the person's condition or if they are not breathing, call for emergency medical help and begin CPR as necessary.

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Importance of Recovery Position

Recent research has shed light on the significant benefits of the recovery position for individuals experiencing reduced responsiveness. Through a comprehensive review spanning multiple databases, researchers uncovered compelling evidence supporting the effectiveness of positioning individuals on their side or in a slightly upright posture, particularly in cases of poisoning. This simple intervention has been shown to reduce the risk of inhaling harmful substances and lower the likelihood of hospital admission, particularly among pediatric patients.

However, it's essential to note a potential downside: an increased risk of sudden unexpected death among individuals with epilepsy when in the prone position. Despite certain study limitations, such as potential biases, the importance of quick responsiveness checks, CPR intervention, and ongoing patient monitoring cannot be overstated. These findings emphasize the critical role of incorporating the recovery position into first aid training programs, ensuring better emergency response outcomes and improved patient care.

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In what situations is the recovery position used?

• When someone is unconscious and breathing, but you cannot wake them up or they do not respond to stimuli, the recovery position is appropriate.
• The person must be breathing normally on their own. If someone is not breathing or is having difficulty breathing, immediate CPR (Cardiopulmonary Resuscitation) is required instead.
• The recovery position is generally suitable for individuals without suspected spinal injuries. If there is a possibility of a spinal injury or neck inury, it's essential to follow appropriate protocols for spinal immobilization.

On which side should an unconscious person be placed in the recovery position?

The recommended side is the left lateral recumbent position. In this position, the person is lying on their left side with the left arm extended, and the left leg bent at a right angle to provide stability. However, there are instances where the right lateral recumbent position might be used instead. The decision depends on factors such as the person's physical condition, injury, or other considerations. Generally, though, the left lateral recumbent position is the preferred choice when placing an unconscious individual in the recovery position.

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Why the Left Side: Understanding the Preference for the Left Lateral Recumbent Position

When placing an unconscious person in the recovery position, the left lateral recumbent position is often recommended. This preference is rooted in several physiological and practical considerations:

1. Reduced Pressure on the Heart: Lying on the left side reduces the amount of pressure the unconscious person's organs exert on the heart. This is particularly beneficial for individuals with heart conditions or when heart health is a concern.
2. Optimal Blood Flow: The left-side position facilitates better blood flow throughout the body, including critical blood flow to the heart and brain. This is crucial in emergency situations where maintaining optimal circulation is a priority.
3. Digestive Advantages: The stomach is positioned slightly to the left of the body. Placing a person on their left side aids in preventing regurgitation and aspiration, which is the inhalation of stomach contents into the lungs – a significant risk in unconscious individuals.
4. General Medical Practice: In many medical scenarios, the left side positioning is a standard practice. This consistency helps in emergency situations, ensuring a familiar and widely understood approach.

Right vs. Left Lateral Position: Comparing the Two Positions in Emergency First Aid

While the left lateral position is generally preferred, there are situations where the right lateral position might be more suitable:

• Injury Considerations: If the person has injuries on the left side of their body, such as fractures or wounds, placing them on their right side is more appropriate to avoid exacerbating these injuries.
• Medical Devices or Conditions: Certain medical conditions or the presence of medical devices (like a feeding tube on the left side) might necessitate placing the person on their right side.
• Assessment and Comfort: The decision depend on the responder's assessment of the situation and the unconscious person's comfort. For instance, if the person is found lying on their right side and appears stable, it might be safer to maintain that position.
• Flexibility in Emergency Situations: Ultimately, the most important factor in an emergency is to ensure the person is in a stable lateral position that keeps the airway open and allows for fluid drainage. Whether this is on the left or right side is secondary to these immediate concerns.

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The Purpose of the Recovery Position in Emergency Situations

1. Airway Management: The primary purpose of the recovery position is to ensure that the person's airway remains open and unobstructed. When unconscious, the muscles in the throat relaxes, causing the tongue to fall back and block the airway. The recovery position helps to prevent this, allowing air to flow freely in and out of the lungs.
2. Preventing Aspiration: Placing someone in the recovery position helps to reduce the risk of aspiration. Aspiration occurs when stomach contents or other fluids are inhaled into the lungs, leading to respiratory distress and potential complications like pneumonia.
3. Drainage of Fluids: If a person is vomiting or has blood in their mouth, the recovery position enables any fluids to drain away from the airway, minimizing the risk of choking or inhaling those substances.
4. Comfort and Stability: The recovery position ensures that the person is lying on their side, providing a stable and secure position while reducing the likelihood of them rolling onto their back or stomach, which could obstruct their airway.

Physiological Benefits of Recovery Position

The recovery position ensures the safety and well-being of an unconscious person who is breathing and has a pulse. Below are the benefits and advantages of placing someone in the recovery position:

• Airway Management: The foremost advantage of the recovery position is the maintenance of a clear and open airway. When a person is unconscious, muscle relaxation causes the tongue to block the air passage. Side positioning helps keep the airway open, ensuring that the person breathes without obstruction.
• Prevention of Aspiration: In an unconscious state, there's a risk of vomiting or regurgitation, which leads to aspiration – where stomach contents are inhaled into the lungs. This causes choking or serious lung infections like aspiration pneumonia. The recovery position, by keeping the person on their side, allows fluids to drain out of the mouth, significantly reducing this risk.
• Enhanced Circulation: Lying on the side helps maintain better blood circulation throughout the body. This is particularly important in emergency situations where circulation is compromised. It ensures that vital organs, especially the brain and heart, continue to receive an adequate blood supply.
• Reduced Pressure on Organs: Side positioning relieves pressure on the internal organs. When lying on the back, the weight of these organs compress against each other, potentially affecting their function. The side position alleviates this pressure.
• Safety and Comfort: For an unconscious person, the recovery position is safer than lying on the back or stomach. It prevents them from rolling into a position that could obstruct the airway or cause injury. Additionally, it provides a degree of comfort and dignity, avoiding the risks associated with lying face down.
• Ease of Monitoring: In the recovery position, it's easier for first responders or bystanders to monitor the person's breathing and overall condition. This position allows for clear observation of the chest and abdomen, making it simpler to detect any changes or distress.
• Flexibility in Emergency Response: The recovery position is adapted based on the individual's specific needs, injuries, or medical conditions. This flexibility makes it a universally applicable technique in a wide range of emergency scenarios.

What are the signs that indicate the need for using the recovery position?

A person needs to be placed in the recovery position if they exhibit the following signs:

• Unconsciousness but breathing normally: The person is unresponsive but shows regular breathing patterns.
• No suspected spinal injury: There is no indication of a neck or spinal injury, which could be exacerbated by moving the person.
• No serious injuries preventing movement: The person does not have injuries that would be worsened by placing them in this position.

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What are the risks or complications associated with the recovery position?

While generally safe, there are some risks and complications associated with the recovery position. Moving a person with an undiagnosed spinal injury could potentially cause further harm, making it crucial to ensure that no spinal injury is present before positioning them. Additionally, if the person is not placed correctly, their airway might still become obstructed. There is also a risk of pressure sores or nerve damage if the person remains in the same position for too long, especially if they are lying on hard surfaces.

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How does the recovery position differ for children compared to adults?

When placing a child in the recovery position, certain adjustments need to be made. Loss of consciousness (LOC) is common in children, yet little is known about caregivers' responses to this situation, particularly regarding the use of the recovery position to protect the airway. Due to their smaller size, movements should be gentler and more controlled. Supporting the head is crucial to ensure it does not overextend, which happens more easily in children. Ensuring the child’s body is aligned properly is also important to prevent strain and to maintain a clear airway. Overall, care must be taken to handle children more delicately, considering their physical differences from adults.

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How often should you check on a person in the recovery position?

A person in the recovery position should be monitored frequently, ideally every few minutes. This involves checking for any changes in their breathing pattern to ensure they continue to breathe normally. Observing for signs of responsiveness is also important, as any change in their level of consciousness could indicate a change in their condition.

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What should you do if a person in the recovery position vomits?

If a person in the recovery position vomits, it is crucial to ensure that their airway remains clear to prevent choking. This is done by making sure the vomit drains out of their mouth. If necessary, adjust their position slightly to maintain an open airway. After vomiting, continue to monitor the person closely, observing their breathing and overall condition to ensure they remain stable and do not develop further complications.

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Through which first aid courses can one learn the correct recovery position?

To learn the correct recovery position, enroll in various first aid courses and training programs. These courses are offered by reputable organizations such as the American Red Cross, the American Heart Association, St. John Ambulance, and others. These programs cover essential first aid techniques, including the proper way to place an unconscious person in the recovery position.

For those who prefer online learning, platforms like CPR Select offer comprehensive first aid courses that provide theoretical knowledge. Online courses are a cost-effective solution that offers flexibility and convenience, allowing you to learn at your own pace from the comfort of your home. Completing first aid certification through these programs not only demonstrates your ability to respond effectively to emergencies but also ensures that you properly execute the recovery position and other life-saving techniques.

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Sources:

Douma MJ, Handley AJ, MacKenzie E, Raitt J, Orkin A, Berry D, Bendall J, O'Dochartaigh D, Picard C, Carlson JN, Djärv T, Zideman DA, Singletary EM. The recovery position for maintenance of adequate ventilation and the prevention of cardiac arrest: A systematic review. Resusc Plus. 2022 Apr 29;10:100236. doi: 10.1016/j.resplu.2022.100236. PMID: 35515010; PMCID: PMC9065878.

Julliand S, Desmarest M, Gonzalez L, Ballestero Y, Martinez A, Moretti R, Rivas A, Lacroix L, Biver A, Lejay E, Kanagarajah L, Portillo N, Crichiutti G, Stefani C, Da Dalt L, Spiri D, Van De Voorde P, Titomanlio L. Recovery position significantly associated with a reduced admission rate of children with loss of consciousness. Arch Dis Child. 2016 Jun;101(6):521-526. doi: 10.1136/archdischild-2015-308857. Epub 2016 Jan 25. PMID: 26811367.