The recovery position

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Scene 1 · Opening

The end of dinner at your aunt's. She gets up to go to bed, says her head is spinning.

She takes two steps, leans on the back of the armchair, and slides to the floor. Nobody else in the flat.

Scene 2 · Does she answer?

She is on her back, eyes closed. Her eyelids are not moving.

Nothing says she can hear you.

What do you do?

• Right move : I speak to her loudly and ask her to open her eyes, and I shake her shoulders gently.
  She does not answer: she is unconscious : A plain question, a hand on each shoulder. No answer, no reaction: now you know what you are dealing with, and what comes next is a precise chain of actions.
• Mistake : I slide a cushion under her head so she is more comfortable.
  The cushion folds her neck and closes her throat : The guidance asks for the exact opposite: you tilt the head BACK and lift the chin, to pull the tongue off the back of the throat. A cushion drops the chin onto the chest.
• Mistake : I sit her up against the armchair.
  Sitting up, she slumps and her tongue falls back : In an unconscious person the muscles go slack: the tongue falls to the back of the throat and blocks the airway. You do not sit her up. You open her throat, then you roll her onto her side.

Scene 3 · Is she breathing?

You are down at floor level, right beside her. This is the question that governs all the rest.

How do you check that she is breathing?

• Right move : One hand on her forehead, I tilt her head back, I lift her chin, and I put my cheek near her mouth for ten seconds.
  She is breathing : You watch whether the chest rises, you listen for the sound with your ear near her mouth, you feel the breath on your cheek. Ten seconds, not two. And never press under the chin: that would get in the way of her breathing.
• Mistake : I feel for her pulse at the wrist.
  The pulse is not what you are looking for : A pulse at the wrist is hard to find, and your own fingers have a beat too. What the guidance asks you to look at is BREATHING: the chest, the sound, the breath on your cheek.
• Not the best choice : I hold my phone screen near her mouth to see if it mists up.
  Mostly you saw your own reflection : Your cheek is a far better sensor, you already have it with you, and it does not switch off after thirty seconds. Put that away and lean in.

Scene 4 · Onto her side

She is unconscious, she is breathing, and she is on her back. This is exactly the situation where you roll someone over.

How do you roll her?

• Right move : Her hand against her ear, I take hold of her far knee, I roll her towards me, then I open her mouth towards the floor.
  That is the recovery position : The back of her hand against her ear, palm against palm, and you pull on the leg until the knee touches the floor. Hip and knee at right angles. Then you open her mouth towards the floor, so that fluids drain out.
• Mistake : I pull her by the arm and the belt, in one go, it is quicker.
  Her head goes back on its own : The hand pressed against her ear is there precisely to carry her head through the roll. Without it, the neck turns by itself. You free your hand by holding her elbow, to avoid moving her head at all.
• Mistake : I leave her on her back, she is breathing, and I wait for help like that.
  On her back, her throat closes again at any moment : That is the whole point of the recovery position: keeping the upper airway clear and letting fluids drain out. An unconscious person on her back has neither of those protections.

Scene 5 · The alert

The dispatcher : “Samu, go ahead.”

Timer: 35 seconds.

What do you say?

• Right move : “9 place Saint-Étienne in Nevers, fourth floor, right-hand door, the entry code is 1204. A woman of 74, unconscious and breathing, I have put her on her side.”
  The place, her condition, what you have already done : The address with the code and the floor, then what has happened, then what you have already done. The dispatcher knows he is sending a crew to an unconscious person whose throat is already protected.
• Mistake : “My aunt has fallen asleep on the floor, I think she ate too much, I am calling just in case.”
  An unconscious person is not asleep : The word you use changes how urgent it sounds at the other end of the line. She answers neither to your voice nor to your touch: that is loss of consciousness, and that is what you call it.
• Mistake : “She is breathing, it will be fine, I will call back if she gets worse.”
  You have hung up on an unconscious person : You do not hang up before the person on the line asks you to: the doctor on the line may need more information or may give you instructions. And breathing can change in a minute.

Scene 6 · The wait

The dispatcher asks you to stay next to her and not to put her back on her back.

What do you do for the next six minutes?

• Right move : I stay beside her and keep checking that her breathing is normal.
  Watching is an action : Checking regularly that breathing stays normal is the last link in the chain, and the longest. If it stops, you will know within seconds, and so will the dispatcher.
• Mistake : I put her back on her back so I can see her chest rise more easily.
  You have just undone the one useful thing you did tonight : The recovery position keeps the airway clear and lets fluids drain out. You keep it until help arrives. Her chest is perfectly visible from the side.
• Mistake : I go down to the street to wait for the crew and let them in faster.
  Nobody is watching her breathing any more : You gave them the entry code and the floor: they will come up. What nobody can do in your place is stay in the room and see her breathing change.

Scene 7 · The crew

Blue light turns across the living room ceiling. Two crews arrive, one behind the other.

They ask you how long she has been like this, whether she spoke, and what position you found her in. You answer all three.

She stayed on her side, she breathed the whole time, and somebody watched her breathe. That was the entire job.