Recovery position

The recovery position or more technically known as the lateral recumbent position is a first aid technique recommended for assisting people who are unconscious, or nearly so, but are still breathing. It is frequently taught as part of classes in CPR (cardiopulmonary resuscitation) or first aid.

When an unconscious person is lying face upwards, there are two main risk factors which can lead to suffocation:

Fluids, possibly blood but particularly vomit, can collect in the back of the throat, causing the person to drown. When a person is lying face up, the esophagus tilts down slightly from the stomach toward the throat. This, combined with loss of muscular control, can lead to the stomach contents flowing into the throat, called "passive regurgitation". As well as obstructing the airway, fluid which collects in the back of the throat can also then flow down into the lungs; stomach acid can attack the inner lining of the lungs and cause a condition known as aspiration pneumonia.

Many fatalities occur where the original injury or illness which caused unconsciousness is not itself inherently fatal, but where the unconscious person suffocates for one of these reasons. This is a common cause of death following unconsciousness due to excessive consumption of alcohol.

To a limited extent, it is possible to protect against risks to the airway by tilting the head back and lifting the jaw. However, an unconscious person will not remain in this position unless held constantly, and crucially it does not safeguard against risks due to fluids. If the person is placed in the recovery position, the action of gravity will allow any fluids to drain. Also the chest is raised above the ground, which helps to make breathing easier.

When to use the Recovery Position

The recovery position is recommended for unconscious people, those who are too inebriated to assure their own continued breathing, victims of drowning, and also for victims of suspected poisoning (who are liable to become unconscious). It is suitable for any unconscious person who does not need CPR.

Putting a victim in the Recovery Position

Before using the Recovery Position, perform the preliminary first aid steps. First assess whether the scene is safe for the rescuer. If not, leave. Assess whether the person is responsive to your voice by asking something like "hey, buddy, are you OK?". If not, assess whether the person responds to painful stimulus by rubbing their sternum with your knuckles (this is not accepted practice in some countries). Assess whether the victim has an open airway, is breathing and has a pulse ("airway, breathing, and circulation" or "ABC"). If the victim is alert and an adult, obtain consent before performing first aid. For children, attempt to obtain consent from a parent, guardian, or other responsible caregiver. If the victim is not alert, and is not breathing, check for a pulse. If there is no pulse, perform cardiopulmonary resuscitation. If there is circulation, perform rescue breathing. The initial assessment should be done quickly, in a minute or less. Next, alert trained emergency medical personnel. Call the emergency telephone number or other emergency services.

If no spinal or neck injury is indicated

The correct position is called the "lateral recovery position." [http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-115] Start with the victim lying on the back and with the legs straight out. Kneel on one side of the victim, facing the victim. Move the arm closest to you so it is perpendicular to the body, with the elbow flexed (perpendicular). Move the farthest arm across the body so that the hand is resting across the torso.

Bend the leg farthest from you so the knee is elevated. Reach inside the knee to pull the thigh toward you. Use the other arm to pull the shoulder that is farthest from you. Roll the body toward you. Leave the upper leg in a flexed position to stabilize the body.

Victims who are left in this position for long periods may experience nerve compression. Still, that is a more desirable outcome for the victim than choking to death.

If spinal or neck injuries are possible

When the injury is apparently the result of an accidental fall, collision or other trauma, the risk of spinal or neck injuries should be assumed. Normally, only trained medical personnel should attempt to move a victim with neck or spinal injuries. [http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-115] Such movements run the risk of causing permanent paralysis or other injuries.

Movement of spinal-injured victims should be minimized. Such victims should only be moved to a recovery position when it is necessary to drain vomit from the airway.

In such instances, the correct position is called the "HAINES modified recovery position." HAINES is an acronym of High Arm IN Endangered Spine. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. [http://www.australianfirstaid.com/hains.html] [http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-115]

There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage. [http://www.medscape.com/medline/abstract/10172477]

First Aider Notes

If an individual has suffered a fall or injuries that suggest damage to the spine, as a first aider the priority is to keep the airway open.If breathing, position should not be changed.If breathing has stopped, regardless of possible injury to the person, perform standard checks: DR & ABC (Danger, Response, Airway, Breathing, Circulation)and then move them into the recovery position to open the airway.If they do not start breathing, begin CPR. If they begin to breathe, keep them in that position.

Additional note for pregnant victims

A pregnant woman should always rest on her left side, as lying on the right side may cause the uterus to compress the Inferior vena cava, possibly resulting in death.

Additional note for victims with torso wounds

A victim with torso wounds should be placed with the wounds closest to the ground to minimize the possibility of blood affecting both lungs, resulting in asphyxiation.

External links

* [http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=901 NHS Direct – The recovery position]
* [http://www.health.harvard.edu/fhg/firstaid/recovery.shtml The Recovery Position] – step-by-step description with diagrams, from Harvard Medical School
* [http://www.sja.org.uk/firstaid/info/recoveryPosition.asp The Recovery Position] – step-by-step description with diagrams, from St. John Ambulance.
* [http://www.ast-services.co.uk/recovery-position.html Recovery Position] – extensive text description of how to move a victim into the recovery position.