Recover!

The Recovery Position—sometimes overlooked with fatal consequences.

Dubrokva Theater, Moscow, Russia, October 23, 2002. 912 people held hostage. The siege was ended on 26 Oct when a Fentanyl-based gas was pumped into the theater, incapacitating both the hostages and the terrorists. Ultimately, 130 hostages perished. Most suffocated from blocked airways as they had been brought out of the theater and laid flat on their backs, unable to protect their airways. In later evaluations of the actions, medical officials stated that if the unconscious hostages had been placed in recovery position and medical response on scene notified of the condition of the hostages, more lives could’ve been saved.
I recently utilized the recovery position to open the airway on a student who had passed out during one of my classes and had great success with this easy maneuver and it was recognized as such by the students who witnessed the incident.
The recovery position is quite simple and effective in many ways. First, it utilizes gravity to pull the tongue of the unconscious person forward and off of the back of the airway. This allows the victim who has spontaneous respiration but the inability to protect their airway the ability to breathe. Second, it allows any blood, vomit or other fluid to drain forward and out rather than aspirate back down the airway. Aspiration can cause a chemical pneumonia which has close to a 50% mortality rate. Third, it keeps the head/neck in a somewhat “neutral” position when the arm on the “down” side of the victim is outstretched underneath the victim’s head. While not as effective as a c-collar, it does offer some stability. (We should emphasize that at this point, it’s more important to keep the victim’s airway open than focus on c-spine if there are multiple patients to attend to.) Fourth, it allows the responder to assess multiple victims.
How do you perform the recovery position?
1. Extend the victim's arm that is farther from you above the victim's head.
2. Position the victim's other arm across the chest.
3. Bend the victim's nearer leg at the knee.
4. Put your forearm under the victim's shoulder with your hand around the back of the neck to support the head and neck.
5. Carefully roll the victim away from you by pushing on the victim's flexed knee and lifting with your forearm while your hand stabilizes the head and neck. The victim's head is now supported on the raised arm.

6. While continuing to support the head and neck, position the victim's hand palm down with fingers under the armpit of the raised arm, with forearm flat on the surface at 90 degrees to the body.
7. Keep the top leg flexed so that it acts like a “kickstand” and the victim's position is stabilized.
8. With the victim now in position, open the mouth to allow drainage and monitor breathing.
As they’re placed into the recovery position, you can also, simultaneously, place an emergency blanket under them and around them to keep them warm. You can also do a quick assessment of the posterior aspect of the body and check for and treat any injuries.
Like the old saying goes, “It’s the little things that mean the most.” This is especially true with the recovery position. Not a lot of effort and a whole lot of benefit.
Step back, check your own pulse first. Assess your scene for safety and take care of one thing at a time. Keep it simple. Keep it safe.

Proper recovery position