Recovery position

When someone is unconscious, their muscles lose tension. That includes the tongue and the muscles in the throat. Lying on the back, the tongue can therefore sink backwards and block the airway. In addition, protective reflexes such as coughing and swallowing, which would otherwise stop things from entering the windpipe, can be missing in unconsciousness.

In the recovery position gravity works for the person. Because the head is tilted slightly back, the throat stays open. Because the mouth is the lowest point, saliva, blood or vomit drain outwards. You do not have to hold the head the whole time – the position keeps the airway open on its own.

The bent limbs have a clear job. The upper leg, bent at hip and knee at roughly right angles, props the body up at the front. The hand under the cheek keeps the head at the right tilt. Together they stop the person from rolling onto their front or back onto their back.

The recovery position is meant for one very specific situation: the person does not respond but is breathing normally. That is why the breathing check always comes before the recovery position. If you put someone on their side without checking breathing first, you might miss a cardiac arrest.

If the person is not breathing normally – or only gasping – the recovery position is wrong. Then they need resuscitation at once, as described in the entry on the unresponsive person, and the dispatcher guides you. Someone who is awake and can speak, on the other hand, usually finds a comfortable position themselves; you do not need to put them in the recovery position.

After falls or traffic accidents there may be an injury to the head, neck or spine. Then you move the person as little as possible and ask the dispatcher. An open airway always takes priority, however – if the airway cannot be kept open any other way, breathing comes first.

Before turning, you remove glasses and bulky things from their pockets so nothing presses. While turning, the person's hand stays at their cheek – that way the head ends up resting correctly on the hand. You roll the person towards you, not away from you; that way you keep control.

At the end you check two things: is the head tilted slightly back, and is the mouth pointing downwards? A common mistake is letting the head drop forward onto the chest. Then the airway kinks like a garden hose, and the position loses its purpose.

Afterwards you cover the person, ideally underneath too against the ground cold, because someone lying still on cold ground cools down quickly. If the emergency call has not been made yet, do it now. And then you stay and check regularly that they keep breathing normally.

An unconscious person's breathing can deteriorate at any time. That is why the recovery position is not a moment to walk away but a moment to watch. In the recovery position breathing is harder to see than on the back – look and listen closely.

If the person stops breathing normally, you turn them onto their back at once, inform the dispatcher and start resuscitation. If help takes a long time, some courses recommend turning the person onto the other side after a while to relieve the lower arm. Have this shown to you on a course and ask the dispatcher.

With heavy or injured people turning is difficult. Then get help from other bystanders. If disposable gloves are available, put them on, especially when blood or vomit is involved.

The recovery position is part of almost every basic first-aid course, and it is easy to learn. It is best to practise it several times on different practice partners – a tall, heavy person feels completely different from a small, light one. That way you notice how much strength you need and where to take hold.

In other countries and courses the position has a slightly different name and is sometimes performed slightly differently. Do not let that unsettle you: what always matters is an open airway, a mouth pointing downwards and continuous monitoring of breathing.

After the course you can calmly rehearse the sequence of movements with a family member. That does not replace the course, but it helps you remember it. In a real emergency: a not-quite-perfect recovery position with an open airway is better than none at all.