Unresponsive but snoring: recovery position in a 60 cm kitchen gap
07:10 on a Monday at a small high-street bakery. You are the designated first aider opening up. A 22-year-old commis chef has been found lying on her back in the narrow galley between the prep counter and a fan oven; the gap is about 60 cm wide. She does not respond when you shout her name and does not react to a firm squeeze of her shoulders. Her chest is rising and falling about 14 times a minute, but there is a snoring noise and a small amount of vomit visible at the corner of her mouth. A hot tray at 200 °C is on the floor 30 cm from her head, and a pan of stock is simmering on the hob. Two colleagues are standing behind you. There is no first aid room; the ambulance is 9 minutes away. You have gloves, a torch, and the first aid kit by the door.
1. What do you do in the first 60 seconds, and how do you decide whether this casualty is 'breathing normally' or needs CPR?
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Hazards before hands. The 200 °C tray and the simmering pan are a risk to me and to her. I would move the tray clear with my foot or a cloth, take the pan off the heat, and ask the two colleagues to stay but give me room - I need one of them free to phone.
Response. Gloves on, shout her name, squeeze her shoulders. No response means she is unresponsive. I would send one colleague to call 999/112 on speakerphone and bring the kit (and the AED if the bakery has one), and note the time.
Airway and breathing. Head tilt, chin lift. I would remove the vomit only because I can see it and it is loose - no blind finger sweeps. Then look, listen and feel for no more than 10 seconds.
The judgement call. Fourteen breaths a minute with snoring is not normal breathing in an unresponsive casualty. Snoring means the tongue or vomit is partly blocking the airway. A casualty who is unresponsive and breathing - even noisily - is protected by the recovery position, not left flat on her back where she can inhale vomit. If, during the 10-second check, there is no breathing or only occasional gasps, the answer flips to CPR at 30:2. Gasps are not breathing.
2. Describe how you would position her given the confined space, and how you monitor her until the ambulance arrives.
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The gap is too narrow to kneel astride her, so I work from one side. I would have a colleague clear the floor on my side and roll her towards me so she ends up on her side facing the open kitchen.
- Kneel beside her; place the arm nearest me out at a right angle, elbow bent, palm uppermost.
- Bring the far arm across her chest and hold the back of that hand against her near cheek.
- With my other hand, pull the far knee up until the foot is flat on the floor.
- Pull on that knee to roll her towards me onto her side.
- Tilt the head back and lift the chin so the airway stays open; the upper leg stays bent at a right angle to stop her rolling onto her face.
- Check the mouth is lower than the throat so vomit drains, and that she is not against the oven or the hot tray.
Monitoring. Breathing, colour and response at least every minute; keep her warm with a coat or foil blanket; nothing by mouth; note times. If the snoring returns, re-tilt the head. If she stops breathing or only gasps, I roll her onto her back, start CPR and get the AED - 999 is already running.
3. The paramedics arrive and she is now conscious but confused. What do you hand over, and what do you record afterwards?
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Handover should be timed and factual: when she was found and when I arrived; that she was unresponsive to voice and to a shoulder squeeze; her breathing rate and the snoring; that there was vomit in the mouth; the time she went into the recovery position; any change in her breathing, colour or responsiveness; that nothing was given by mouth; the 999 call time and reference; and any information colleagues gave me (medical history, medication, whether she had eaten, whether this has happened before).
Recording. In the accident book or first aid record: date, time, location, her name and job, what I found, what I did and when, advice given, who took over and when, my name and signature. Facts and times, not opinions such as 'looked unwell' - write what I actually saw, for example 'lips grey, breathing 14 with snoring'. Note that she could not consent because she was unresponsive, and that the record is confidential and kept under data protection rules, released only to those who need it (the employer for health and safety purposes, or the treating clinician). If she is later off work for more than seven days, the employer - not me - considers reporting under RIDDOR.