The Recovery position - an STCW refresher

Unconsciousness is a medical emergency as the person is very vulnerable and may not be able to manage their own airway effectively. We also need to think about the cause of unconsciousness. Is it a simple fainting episode due to illness? Is it a massive hemorrhage causing hypovolemic shock? Or is it due to some kind of external factor or injury? 

So, if we have a casualty who is unconscious, but who is breathing normally for themselves, and we’re not suspecting a serious injury, the recovery position is the best position to use while monitoring them. The recovery position keeps their airway open and makes sure that vomit or liquid won’t cause them to choke.

It’s an easy skill to use and even if you’re a small person and your casualty is much bigger, the technique used means you will still be able to roll them over. This video from the UKs NHS shows the best way to move someone into the recovery position:

• If they are on a hard or metal surface, they will lose heat quickly so putting a blanket under them as you roll them can help insulate them against heat loss. 

• If you’re on a moving vessel, you can pack cushions or blankets behind their back to help support them.

• If they wear glasses, you can put them in the casualty’s hand when you take them off their face. If they have visual problems and wake up unable to find their glasses, it can be extremely distressing.

• Make sure you keep them warm and keep monitoring them. 

One question we get asked a lot is how to manage the casualty if you suspect an injury, especially a spinal injury. Many people are unclear as to the best way to manage this situation and whether they should, or shouldn’t move the casualty. 

If you are suspecting an injury of any kind, then you need to handle the casualty gently. If a clot has formed internally or externally and is helping to manage a bleed, you don’t want to dislodge it. So if you have airway adjuncts to help manage the airway and you can stay with the casualty, leaving them on their back may be the best option.

The NHS recommends that if you think your casualty may have a spinal injury, you shouldn’t move them. However we may be in a situation onboard where we need to leave them and go for help, or the environment means they are safer in the recovery position.

Of course you still have the option of assigning one person to carry out a jaw thrust but using this technique means someone needs to stay in that position which can be surprisingly tiring. Remember that you can also use an Nasopharyngeal Airway and/or Oropharyngeal Airway to help maintain the airway. 

As a reminder, here’s the technique for a jaw thrust: (starts 1.15 mins into the film).

You should suspect a spinal injury if your casualty meets any of the following criteria:

• has been involved in an incident that's directly affected their spine, such as a fall from height or being struck directly in the back

• complains of severe pain in their neck or back

• is not able to move their neck

• feels weak, numb or unable to move (paralysed)

• has lost control of their limbs, bladder or bowels

If you do have to leave the casualty, maybe to raise the alarm, retrieve the medical kit or for another reason, there is a simple adaptation to the recovery position that makes it more suitable for those with suspected spinal injuries. This technique keeps the spine a little straighter when rolling the casualty over. You can see how it works HERE. 

We hope you’ve enjoyed this quick refresher on the recovery position, when, why and how it’s used. If you have any questions or suggestions for other topics we could cover in our blogs, please feel free to get in touch.

Other resources:  NHS Recovery Position