Sharon has 21+ years of experience as a qualified Emergency Care Nurse registered with the Australian Health Practitioner Regulation Agency (APHRA) and 12+ years as a First Aid Trainer.
She takes pride in FirstAidPro making first aid training available, comprehensive and affordable to everybody.
What Is The Recovery Position?
It’s a hot, sunny day at the park, but an individual has collapsed. They are in no need of cardiopulmonary resuscitation (CPR), but are listless, slowly becoming less and less responsive and showing signs of heat stroke.
It’s a cold morning at the bus stop and 2 people have been involved in an accident. Both have serious injuries, but one has an airway obstruction and isn’t breathing.
A house party rages on into the windy night, but one of the attendants has been vomiting excessively. They are showing other signs of possible opioid toxicity and nearing loss of consciousness.
Absent of other life-threatening conditions or illnesses like cardiac arrest, putting someone in the recovery position is the safest way to support an unconscious person and monitor breathing until emergency help arrives to take over. A mainstay of first aid training, this technique keeps a vulnerable person’s airway open by supporting their head and neck. This is to let their stomach contents freely drain through the mouth without endangering the airway. It is low-risk, limits neck movement while not impairing breathing, and enables a first aid responder to easily move the casualty onto their back to apply CPR if their condition deteriorates.
How to Put Someone In The Recovery Position
Kneel beside the casualty and straighten their arms and legs, making sure to remove any bulky or dangerous objects from their immediate vicinity or their pockets. If they are wearing glasses or face coverings, as they could become obstacles, remove them.
Take the arm nearest to you and bend it diagonally across their chest, elbow bent, with the casualty’s hand pressed down, reaching towards their opposite shoulder.
The other arm should stretch out at a right angle, palm facing upwards. There is no need to bend this other arm, either.
With the leg closest to you, lift it at the knee and place their foot on the floor next to the far knee. Like this, the leg is bent in an upside-down ‘V’ shape, with the upper leg being at a 45-degree angle to their body.
When we roll the person, this knee will prevent the person from rolling onto their face.
The far leg should remain as is, with the far knee straight.
After positioning the arm and knee closest to you, gently support the casualty’s head and neck as you gently roll them onto their side. Keep their bent knee facing away from you and at an angle until their knee touches the ground.
You may use one hand on the top leg nearest to you to gently turn them.
Place the casualty’s arm closest to you so that their hand supports the cheek on the opposite side, positioning the person’s head slightly lower to enable free drainage in the event of regurgitated fluids. This is what will keep the airway clear.
Ensure there is no pressure on the chest and keep the far leg straight with the near leg at a right angle and both arms in place. The head should face downwards, and the airway should be open.
Listen to their breathing and monitor their condition until emergency aid arrives.
If you notice the patient having difficulties breathing, roll them — being careful with their head — and begin administering first aid with chest compressions.
The Recovery Position and CPR
The recovery position is for individuals who are NOT suffering from other life-threatening illnesses or conditions and who do NOT require CPR.
When learned properly, through practical first aid courses, the recovery position can be used on individuals having difficulty breathing or someone who has successfully resumed breathing after having been resuscitated, but not prior.
First Aid Scenarios: When to Use the Recovery Position
Heatstroke
If left untreated, heatstroke or heat exhaustion can lead to organ damage, eventual organ failure and even death.
The symptoms manifest as dizziness or weakness, shallow and rapid breathing, an elevated pulse, headaches, nausea (including vomiting) and fainting.
Heatstroke is a medical emergency, so if you suspect someone has become a casualty of it, you should call Triple Zero (000) for assistance. While you are waiting for medical help, you can begin efforts to bring their body temperature down by cooling them any way you can. This includes moving them to a shaded or cool place and employing the recovery position while giving them cool liquids.
An Unconscious Person
Lack of oxygen to the brain for any amount of time is serious, and the longer a person is unresponsive, the greater the long-term effects. Someone becoming unconscious is a medical emergency, so if you see someone has become unresponsive, call triple zero (000) and follow the operator’s instructions.
If the person has progressed to a stage of unconsciousness where they are not breathing, CPR will be necessary while waiting for medical assistance. Keeping your resuscitation skills current is crucial, so reinforce your first aid skills with a refresher course regularly.
However, if the casualty is still breathing, placing them in the recovery position can keep them stable enough until assistance arrives.
Poisoning (such as alcohol poisoning) or Opioid Toxicity
In just one of the many design quirks of the human body, the opening of the esophagus (food pipe) is right next to the trachea (windpipe) in the throat. As such, matter that re-emerges from the esophagus can enter the trachea and cause issues.
Large enough amounts of matter like vomit entering the trachea can result in consequences ranging from infection of the lungs called aspiration pneumonia to choking or even drowning.
An unresponsive person who is vomiting needs to be stabilised in a way that keeps their airway open to minimise the risk of choking, and placing them in the recovery position accomplishes this.
Post-Seizure
You should call triple zero (000) if: a seizure lasts more than 5 minutes, if a second one follows the first quickly, if the person remains unresponsive even after the seizure has ended, if an injury has resulted, if you are aware the person who has had the seizure also has diabetes or is pregnant, if there is an airway blockage or if, to your knowledge, this is the person’s first seizure.
During a seizure, do not attempt to restrain the person or (unless in the event of immediate danger) move them. You can help prevent them from injuring themselves by removing obstacles around them or placing something soft under their head.
Once the seizure has ended, you can place them in the recovery position and remain with them until they have recovered enough.
Special Considerations for the Recovery Position
What if the person has a Spinal Injury?
Serious complications and even permanent paralysis can occur if an individual with a spinal injury is moved suddenly. Call triple zero (000) and follow all instructions.
For placing someone in the recovery position when a suspected injury to the spine is suspected, extra care is required during the rolling phase. It is recommended you do NOT move a person with a suspected spinal injury, but if it becomes necessary to place them in the recovery position, do NOT do it alone. Having an additional person to assist you will make it easier to keep the spine straight during the manoeuvre, and lessen the risk of long-term consequences.
For Pregnant Individuals
When someone who is heavily pregnant (typically second or third trimester) needs to be put in the recovery position, there is a risk when they are not placed on their left side. Lying a pregnant person in the recovery position on their right side can cause uterine pressure that may compress the inferior vena cava.
The inferior vena cava runs down the right side of the vertebral column in the abdominal cavity. The uterus, with its passenger, can place pressure on this vein. For this reason, it’s best to place pregnant individuals on their left side when placing them in the recovery position
For Children under 1 year of age
For infants, the recovery position needs to be different to accommodate their small, fragile bodies.
This is done by laying the infant face-down along the length of your arm. The baby’s head can then be supported by your hand, and you can easily monitor their condition or apply first aid.
Lateral Recumbent Position
Lateral recumbent position is when a patient about to undergo surgery is positioned on their side (lateral) while lying down (recumbent) with the operative side facing upwards. The patient may be fixed in place with pillows or foam padding around their chest and legs to prevent them from moving. The name of the position is often confused with or used interchangeably with the recovery position.
Why is the recovery position on the left side?
As aforementioned, there is a strong case for the positioning of a pregnant casualty on their left side when it is necessary to place them in the recovery position to alleviate uterine pressure on the inferior vena cava. However, for most other patients, there is no academic consensus on whether one side is more beneficial than another.
The left is the most frequently suggested side and the most generally instructed.
One reason for the left side’s popularity points to the shape and position of the stomach, which curves to the left. Supposedly, lying on the left gives stomach contents an additional curve to overcome, reducing the possibility of regurgitation and lowering the risk of aspiration.
Another reason points to the right lung being larger and having 3 lobes. Positioning the casualty with the head slightly lower and the more productive lung on top with the least amount of airway pressure would surely be the lesser risk.
Remember that the best position is the one that allows you to best protect, manage and monitor their airway until emergency help arrives, regardless of side, the only exception being persons who are pregnant.
Final Thoughts
The recovery position is a helpful first aid technique for first responders to ensure an unresponsive, but breathing person’s airways are protected.
It can safely be done on people of all ages, including infants and pregnant people, but special considerations should be taken for certain circumstances like the possibility of a spinal injury.
It is useful for monitoring breathing and makes it easy to move a person onto their back in the event of cardiac arrest where CPR may be necessary.
Taking a first aid course to practise placing people in this position and other first aid techniques could one day make the ultimate difference in someone else’s life.
