Recovery Position: Guide to Correctly Position an Unconscious Patient

The recovery position is 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 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.

How to Put Someone in 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 Responsiveness and Breathing: Ensure the person is unconscious but breathing normally. If they are not breathing or have irregular breaths, start CPR instead of the recovery position.
2. Position the Arm Nearest to You: Kneel beside the person and place the arm closest to you at a right angle to their body, with the elbow bent and palm facing up.‍
3. Position the Far Arm Across Their Chest: Take their other arm and gently place it across their chest, so the back of their hand is against the cheek closest to you. Hold the hand in place to support their head.‍
4. Bend the Far Knee: Lift their far leg at the knee and pull it up so their foot is flat on the ground, creating a stable base to roll them over.‍
5. Roll the Person Onto Their Side: Carefully pull on the bent knee while supporting the head, rolling the person towards you onto their side. Adjust their head to ensure the airway is open and supported.‍
6. Tilt the Head and Adjust the Face: Tilt their head slightly back to keep the airway open, making sure their mouth points downward to allow any fluids to drain.‍
7. Monitor Breathing: Keep an eye on their breathing and stay with them until professional help arrives. If their condition changes, be ready to act, including returning to CPR if necessary.

The recovery position helps prevent choking by allowing fluids to drain from the mouth, making it ideal for unconscious but breathing individuals.

1. Check for Responsiveness and Breathing

Before proceeding, confirm whether the person is responsive and breathing. This initial check helps you determine whether to begin CPR or proceed with the recovery position. Gently shake the person by the shoulders and speak loudly, saying something like, "Are you okay?" Lean down to listen for breath sounds, feel for breath on your cheek, and watch their chest to see if it’s rising and falling. If they do not respond but are breathing, proceed with the recovery position.

This step ensures that you’re only using the recovery position when the person is breathing but unconscious. If they aren’t breathing, CPR is essential as it is life-saving. Distinguishing between faint, irregular breathing and no breathing at all is challenging. If there’s any uncertainty about their breathing, begin CPR. Irregular or gasping breaths (agonal breathing) indicate an emergency that requires CPR rather than the recovery position.

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2. Position the Arm Nearest to You

Take the arm closest to you and straighten it out from the body. Bend it at the elbow to form an “L” shape, with the hand pointing upward, palm facing up. This acts as a support arm once the person is rolled onto their side. Positioning the arm this way keeps the person from rolling too far onto their stomach, providing stability once they’re in the recovery position.

Sometimes the arm is stiff, unresponsive, or difficult to move into the correct position. If the arm is difficult to position, leave it as close to the body as possible and proceed to roll the person slowly, being cautious not to put weight on the arm as you turn them.

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3. Position the Far Arm Across Their Chest

‍Take the arm farthest from you and gently place it across the chest. Position the back of the person’s hand on the cheek closest to you. This will support the head as you roll them and help prevent neck strain. Positioning the arm across the chest with the hand on the cheek prevents excessive head movement, protecting the neck and spine during the roll.

The hand may not stay in place on the cheek during the roll, especially if the person is larger or if their muscles are tense. You need to keep a gentle hold on their hand to stabilize the head, especially if they’re in a precarious position or there’s a concern about spinal alignment.

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4. Bend the Far Knee

Bending the leg furthest from you helps create a stable, locked position for rolling the person onto their side without risking a backward roll. Grasp the knee of the far leg and bend it so the foot is flat on the ground. This bent leg will help create leverage and keep the person stable once they’re in position. The bent knee provides leverage to help roll the person smoothly onto their side. It stabilizes them, so they don’t accidentally roll back onto their back.

Sometimes the leg is hard to bend, possibly due to stiffness, injury, or unconscious muscle resistance. If bending the knee isn’t feasible, roll the person carefully without bending the leg, but you’ll need to take extra care to keep them balanced on their side.

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5. Roll the Person Onto Their Side

This step is the actual roll, where you move the person onto their side to prevent choking or airway blockage.

• Place your hand on their bent knee and gently pull it toward you while holding their hand against their cheek for head support.
• Roll them onto their side in a controlled motion until they’re fully on their side, using the arm and leg as supports.
• Rolling them onto their side allows fluids, such as saliva or vomit, to drain out of the mouth,  reducing the risk of aspiration.

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Rolling someone who is larger or in a cramped space is challenging. If the person is too heavy, seek additional help if available. In a confined space, you need to adjust the angle, tilting them as much as possible to promote drainage even if a full side roll isn’t possible.

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6. Tilt the Head and Adjust the Face

Tilting the head back and adjusting the face downward promotes an open airway and facilitates drainage of fluids. Gently tilt the person’s head slightly back by lifting the chin and ensure the mouth is angled downward. If available, support the head with a soft object like a rolled-up piece of cloth or the person’s hand.

Tilting the head back helps to keep the airway open while positioning the face downward to prevent choking if fluids drain from the mouth. If the head tends to fall forward, place the hand under the cheek or use a soft item to maintain the tilt without force, ensuring the airway remains open.

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7. Monitor Breathing

After the person is in the recovery position, it’s essential to continuously monitor their breathing and responsiveness. Observe the chest for steady rising and falling. Listen closely for breath sounds and watch for any signs of change in their condition. Stay close so you can respond quickly if necessary. Monitor their breathing rate, depth of breaths, and level of consciousness. Watch for any changes, such as slowed or labored breathing or loss of consciousness, as these indicates a need for further intervention or a transition back to CPR if breathing stops.

Monitoring helps ensure the person’s breathing remains stable, and you’ll be able to act immediately if there’s any indication of breathing difficulties or changes in consciousness. Stay alert and prepared to resume CPR if breathing becomes weak or stops. You need to adjust the recovery position if you notice shallow breathing or other distress signs.

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Why is the Recovery Position Important in First Aid?

Recent research has shed light on the significant importance 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.

In what situations is the recovery position used?

The recovery position is used in the following situations:

• 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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What is the Purpose of Recovery Position in Emergency Situations?

The purpose of the recovery position is to maintain an open airway and prevent complications in unconscious individuals. When a person is unconscious, the muscles in their throat relax, which causes the tongue to fall back and block the airway. The recovery position helps prevent this by positioning the person on their side, ensuring that air flows freely in and out of the lungs. It reduces the risk of aspiration, where stomach contents or other fluids are inhaled into the lungs, which lead sto respiratory distress and potentially life-threatening complications like pneumonia.

Additionally, if the person is vomiting or has blood in their mouth, the recovery position allows fluids to drain away from the airway, lowering the risk of choking or inhaling those substances. This position provides comfort and stability, as it keeps the person securely on their side and minimizes the chance of them rolling onto their back or stomach, which could obstruct the airway.

What are the 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, 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 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 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 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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How does the recovery position aid in preventing aspiration?

The recovery position helps prevent aspiration by positioning a person on their side, allowing any vomit, saliva, or blood to drain out of the mouth rather than entering the lungs. This reduces the risk of choking and protects the airway from obstruction, a critical factor in preventing respiratory issues during emergency care.

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What are the risks of not using the recovery position when necessary?

Failing to use the recovery position when appropriate leads to aspiration, where vomit or other fluids enter the lungs, increasing the risk of choking, pneumonia, and respiratory failure. Additionally, airway obstruction may occur, which deprives the brain of oxygen, leading to potential brain damage or death if not promptly addressed.

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How long should someone remain in the recovery position?

Keep the person in the recovery position until medical professionals arrive or the individual regains full consciousness. Regularly monitor their breathing and responsiveness, and ensure they stay stable. If they become fully alert, assist them into a more comfortable sitting position if appropriate.

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Are there modifications to the recovery position for different injuries?

Yes, modifications are necessary for certain injuries. For suspected spinal injuries, try to avoid moving the neck and spine. Keep the spine as aligned as possible and roll the person with gentle, minimal movement to avoid further spinal damage. For head injuries, the recovery position helps prevent additional pressure on the skull, but caution is essential to avoid any jerky or rapid movements.

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What are the signs that someone is stable enough for the recovery position?

Signs that someone is ready for the recovery position include spontaneous breathing, a stable pulse, and a return of basic reflexes, such as coughing or swallowing. Once they are breathing adequately on their own but are still unconscious, transitioning them into the recovery position is generally safe and beneficial.

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Can the recovery position be used on all age groups?

Yes. The recovery position can be used for all age groups but requires adjustments for infants and young children. For infants, the recovery position involves placing them on their side with their head tilted slightly downward to prevent choking. Be gentle and support the head carefully when positioning them to ensure they don’t roll onto their back.

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What Does CPR Select Recommends if the person is too heavy or in a confined space?

If the person is too heavy or in a confined space, CPR Select recommends a few adjustments to safely place someone in the recovery position while ensuring their airway remains open:

• Assess the Situation: Look at the space and the person’s condition. If the space is too tight, avoid forcing the person into the recovery position.
• Get Help: If possible, ask someone nearby to assist. This makes it easier to move the person and keep their airway open.
• Position for Airway Protection: If you can’t turn the person fully, position their head lower than their chest. Tilt the head to one side to keep the airway clear.
• Monitor the Person: Keep checking their breathing and responsiveness. If the space is tight, stay with the person until emergency help arrives.

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How does the recovery position fit into the chain of survival?

The recovery position is part of the “early intervention” step in the chain of survival, aimed at preserving life and preventing worsening of the condition. It buys time and stabilizes the individual while emergency services arrive, making it a vital link in ensuring that a breathing, unconscious person remains safe, especially in cases where CPR is not needed.

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

To learn the correct recovery position, enroll in 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 demonstrates your ability to respond effectively to emergencies and 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.