Recovery Position – what is it and why does it change?

Current research suggests 2,500 unconscious people die needlessly each year because those around them don’t know how to use the recovery position appropriately. And that’s just in the UK. That’s seven deaths a day which could have been prevented by reading this article and taking the following steps…..

What is the Recovery Position?

It’s really a collection of different ways of placing an unconscious person “3/4 on their side” – it’s also called the three-quarter prone position and the lateral recumbent position. The version now taught in most Canadian Red Cross courses is called the HAINES (High Arm in Endangered Spine) position. You don’t need to remember that, you just need to get this picture in your head.

Any person who is unconscious and on their back is at risk from choking on their tongue. You may have heard it said someone ‘swallowed their tongue’ – no, you can’t (unless it’s been cut off!), but it can go down far enough to block your windpipe & stop you breathing.

When we’re conscious but just asleep, we naturally stop this happening. When someone is unconscious (GCS<8) because of accident or injury, alcohol ingestion or whatever, they can’t always maintain their own airway so they choke and can die. This means unconscious people with non-life-threatening injury die just because they can’t breathe properly. And as you might be in a position to use the HAINES position help them, here’s what to do.

How to do the Recovery Position

There are several variations, here’s one (yes, the HAINES):

1. Start with the casualty lying on their back, arms by sides, legs together but not crossed.
2. Kneel next to their chest/shoulder
3. Lean across and raise their arm furthest away from you up and out above their head, on the floor.
4. The arm nearest to you can be moved across their chest so that fingers touch opposite shoulder
5. Bend their leg nearest to you, such that their foot comes flat to the floor, near their opposite knee.
6. Support their head with your hand, put your forearm under their (nearest to you) shoulder.
7. Using the knee & shoulder as leverage, roll them away from you.
8. Once on their side, catch them so they don’t go face down!
9. The knee you were using as a lever can now continue rolling away from you until it props them on the floor (see the picture).
10. Make sure they’re still breathing!

What’s the Point of using the Recovery Position?

To stop them choking and dying! But ILCOR lists these key points to a good recovery position:

• Place the person in as near a true lateral position as possible with his mouth dependant to enable free drainage of fluid.
• Ensure the position is stable.
• There should be no pressure on the chest that impairs breathing.
• It should be possible to turn the person onto his side and to return him back easily and safely, taking into consideration the possibility of cervical spine
• injury.
• The airway should be accessible and easily observed.
• Your positioning itself should not give rise to any injury to the casualty

Let’s quickly put that in English:

• On their side, mouth low enough for any blood/vomit to drain out and not choke them.
• Not about to fall face down
• It’s more difficult to breathe when you’re face down and/or have something on your chest
• If they stop breathing, you need to get them on their back quickly and be ready to do CPR
• You should be able to tell they’re breathing, and notice if they stop
• Don’t injure them while rolling. If they’re in recovery position for more than 30 min, roll them over onto the other side.

HAINES is new – Why does it change?

• Because people think about what they teach, and try to improve it?
• Well, there isn’t really a recovery position, just several key points you’re trying to meet?
• And then, real-life never matches the textbook/classroom?

There are several reasons it could have changed since last you were taught (so get to class and keep up to date!). The (HAINES) position I’ve described here is the one taught in Canadian Red Cross courses at the time of writing. It allows you to move the person on your own, but takes in to account the possibility of neck injury.

A previously taught version required you to pull the person towards you – this allows you to move a bigger/heavier person, but puts more of a twist in the neck & spine. In the end, it’s down to your judgement to do the best in the situation. Whatever that is, it’s going to be better than adding their name to that list of 2,500 people!