Managing an unresponsive casualty who is breathing (recovery position)
This domain tests the safe positioning and monitoring of a casualty who is unresponsive but breathing normally. The exam expects you to protect the airway, place the casualty in the recovery position, and reassess continuously. It also tests when the recovery position may need modifying.
Core rules and concepts
- Confirm breathing first. Use look, listen, and feel for up to 10 seconds. If breathing is absent or abnormal, start CPR, not the recovery position.
- Call 999. An unresponsive casualty who is breathing still needs urgent professional assessment.
- Use the recovery position to keep the airway open and allow fluid to drain. It reduces the risk of aspiration if the casualty vomits.
- Technique: kneel beside the casualty, place the near arm at a right angle, bring the far hand across the chest with the back against the near cheek, bend the far knee, and roll the casualty towards you. Tilt the head back, open the mouth, and check the airway.
- Monitor continuously. Check breathing regularly and note any change. Do not leave the casualty alone.
- Do not give food or drink. An unresponsive casualty cannot safely swallow.
- Special situations: if pregnancy is visible, place the casualty on their left side if possible. If a spinal injury is suspected but the airway is at risk, the recovery position may still be necessary; use manual airway support if trained and help is delayed.
Worked example
A diabetic colleague becomes drowsy and then unresponsive but is breathing normally. The first aider calls 999, places them in the recovery position, and checks breathing every few minutes. They do not try to give sugar by mouth because the casualty cannot swallow safely. When the casualty becomes more alert, the first aider keeps them lying down and waits for the ambulance. Reasoning: airway protection comes first; oral treatment is unsafe until consciousness and swallowing are regained.
Traps that cost marks
- Placing a casualty who is not breathing normally in the recovery position.
- Leaving the casualty alone after positioning.
- Putting fingers or objects into the mouth to “clear” the airway.
- Giving drinks or food to an unresponsive casualty.
- Failing to reassess breathing and responsiveness.