Recovery position
The recovery position is a standard first aid technique involving the lateral recumbent or side-lying placement of an unresponsive but normally breathing individual to maintain airway patency and prevent aspiration of fluids such as vomit, saliva, or blood.[1][2] This position facilitates the drainage of secretions away from the airway while allowing for ongoing monitoring of vital signs, and it is recommended by international consensus guidelines as of 2025 for non-traumatic scenarios in out-of-hospital settings where immediate resuscitation is not required.[2][3][4] Indicated primarily for adults and children with decreased consciousness of nontraumatic origin, the recovery position balances the need for airway protection against potential challenges in assessing signs of life, such as breathing adequacy or responsiveness.[2] Evidence from systematic reviews supports its use, demonstrating reduced rates of suspected aspiration pneumonia in poisoned patients (p<0.001) and lower hospital admission odds in pediatric cases (adjusted odds ratio 0.28, 95% CI 0.17–0.48, p<0.0001), though overall certainty remains very low due to limited observational studies and risks of bias.[5] Guidelines emphasize continuous reassessment or as needed, with repositioning to supine if the side-lying posture impairs monitoring or if the individual is found in prone positions associated with higher asphyxia risk.[2][5][3]Definition and Purpose
Definition
The recovery position is defined as a lateral recumbent body posture in first aid protocols, wherein an unconscious but breathing individual is placed on their side to facilitate airway patency.[2] In this configuration, the dependent (lower) arm is extended at a right angle to the body with the elbow bent and palm facing upward, the upper arm is draped across the torso with its hand positioned behind the head to support the cheek, and the upper leg is flexed at the knee with the foot planted flat on the surface for postural stability.[6] This arrangement ensures the body's alignment promotes drainage and ventilation without active intervention.[5] Commonly referred to by alternative names such as the semi-prone position, lateral recumbent position, side-lying position, or three-quarters prone position, these terms stem from established nomenclature in international first aid and resuscitation guidelines to denote variations of the side-oriented posture.[5] Unlike the prone position (fully face-down) or supine position (fully face-up), which are not standard for managing unconscious breathing casualties due to risks of airway compromise, the recovery position specifically incorporates lateral tilt and limb adjustments for optimal support.[2]Primary Purposes
The primary purposes of the recovery position in first aid are to safeguard the airway and breathing of an unresponsive but breathing individual, particularly in non-traumatic scenarios, until emergency medical services arrive. By positioning the person on their side, the recovery position prevents the tongue from falling back into the pharynx and obstructing the airway, thereby maintaining patency without the need for manual interventions.[2][7] A key objective is to minimize the risk of aspiration, where vomit, saliva, or other fluids can enter the lungs and cause potentially fatal complications such as pneumonia or airway blockage. In this lateral position, such fluids drain passively from the mouth and away from the airway, reducing the likelihood of pooling in the posterior oropharynx.[1][8] Additionally, the recovery position promotes stable breathing patterns in unconscious patients without trauma, facilitating ongoing oxygenation and ventilation without external support. This setup helps avoid the complications of supine positioning, such as restricted diaphragmatic movement, ensuring the individual maintains adequate respiratory function during the critical waiting period.[2][7] According to the 2025 ILCOR guidelines, the recovery position supports overall recovery by minimizing hypoxia risks through sustained airway openness and effective drainage, allowing the person to remain stable until professional help arrives.[8][3]Indications and Contraindications
Suitable Scenarios
The recovery position is recommended for adults and children over 1 year who are unresponsive but exhibiting normal or adequate breathing, following an initial assessment to confirm the absence of life-threatening conditions.[7] For infants under 1 year, use age-appropriate airway management techniques such as placing supine with slight head extension.[9] This intervention is particularly suitable after scenarios such as fainting (syncope), where the individual regains partial consciousness but remains at risk of airway compromise due to decreased alertness.[10] Prior to placement, rescuers must perform an ABCDE assessment—evaluating Airway, Breathing, Circulation, Disability, and Exposure—to verify stable vital signs and rule out the need for cardiopulmonary resuscitation (CPR).[7] Common indications include post-seizure recovery, where the person is unresponsive following tonic-clonic convulsions but breathes normally; in such cases, positioning helps prevent aspiration of saliva or vomit once the active seizure phase ends.[11] Similarly, it applies to alcohol intoxication or drug overdose, such as opioid-related incidents, when consciousness is impaired but breathing remains adequate and non-agonal.[7] According to the 2025 Resuscitation Council UK guidelines, the recovery position is appropriate for individuals with decreased responsiveness of nontraumatic etiology who do not meet CPR criteria, ensuring the airway stays open while awaiting professional medical help.[7] This approach aligns with international standards, emphasizing its use only after confirming normal breathing to avoid exacerbating potential issues like suspected spinal injury.[10]When to Avoid
The recovery position should be avoided in cases of suspected spinal or neck injuries to prevent further damage to the spinal cord; instead, maintain the person in a supine position or use a log-rolling technique with spinal immobilization if movement is necessary to secure the airway.[4][10] Similarly, it is contraindicated for individuals exhibiting agonal breathing, inadequate ventilation, or absent breathing, as these require immediate initiation of cardiopulmonary resuscitation (CPR) rather than positional management.[4][12] Precautions are necessary for pregnant individuals, particularly in the third trimester, where the position should be on the left side to avoid compression of the inferior vena cava and optimize circulation and fetal oxygenation.[13] According to the 2025 European Resuscitation Council (ERC) guidelines, the recovery position should not be maintained if post-placement monitoring detects signs of airway occlusion, at which point the person must be repositioned to supine to restore patency and reassess breathing.[4][8]Procedure
Step-by-Step Instructions
The standard recovery position is performed gently to minimize the risk of injury to the unconscious person, following protocols from the UK's National Health Service (NHS) and the American Red Cross as of 2025.[1][14]- Prepare the position: Ensure the person is lying flat on their back on a firm surface. Kneel beside them at hip level, and if necessary, gently straighten their arms and legs to align the body for safe rolling.[14]
- Position the arms: Extend the arm nearest you at a right angle to their body, with the elbow straight and the palm facing upward to provide support once rolled. Then, fold the farther arm across their body, placing the back of the hand against the cheek nearest you to secure the head during the roll.[14]
- Roll the person: Grasp the leg farther from you and bend the knee upward while keeping the foot flat on the ground. Use this bent knee as a lever to gently roll the person toward you onto their side, supporting their body to prevent abrupt movement.[14]
- Stabilize and open the airway: Once on their side, adjust the bent upper leg so the hip and knee form right angles for stability. Tilt the head back slightly with the jaw forward to open the airway, ensuring the mouth is downward to allow fluids to drain. Continue monitoring breathing and responsiveness until professional help arrives; if breathing stops, begin CPR immediately.[1]