If someone is unconscious, you put them in the recovery position.
That’s one of the first things many of us remember from first aid training.
But is it always the right thing to do?
No.
The recovery position is an important first aid technique that can help maintain an open airway and reduce the risk of someone choking on vomit or other fluids. However, there are circumstances where automatically rolling a casualty onto their side may not be appropriate.
More importantly, there is one situation where putting someone into the recovery position could delay the treatment they desperately need: cardiac arrest.
Knowing when NOT to put someone in the recovery position is therefore just as important as knowing how to perform it.
In this guide, we’ll look at when the recovery position should be used, when it shouldn’t, and what first aiders should do instead.
What Is the Recovery Position?
The recovery position involves placing an unresponsive casualty onto their side in a stable position while maintaining an open airway.
The NHS advises that if someone is unconscious but breathing and has no other life-threatening conditions, they should be placed in the recovery position.
The position helps to:
- keep the airway open
- allow vomit or other fluids to drain from the mouth
- reduce the risk of airway obstruction
- allow the casualty’s breathing to be monitored
But the important words here are:
Unresponsive and breathing normally.
The recovery position should not simply be the automatic response whenever somebody collapses.
You need to assess the casualty first.
1. Do NOT Use the Recovery Position If They Are Not Breathing Normally
This is perhaps the most important message in this entire article.
If someone is unresponsive and not breathing normally, they may be in cardiac arrest.
They need CPR, not the recovery position.
Current Resuscitation Council UK guidance states that if a person is unresponsive with abnormal breathing, cardiac arrest should be assumed and chest compressions started as soon as possible.
If you find someone unresponsive:
Call 999 and assess their breathing.
If they’re not breathing normally:
- start CPR
- send someone for an AED if one is available
- follow the instructions given by the ambulance service
- attach the AED as soon as possible
- Continue CPR as instructed
Do not put them onto their side and wait for an ambulance.
Every minute matters during cardiac arrest.
2. Be Extremely Careful Not to Mistake Agonal Breathing for Normal Breathing
This is something we regularly discuss during first aid training at HMB Training Services.
A casualty in cardiac arrest does not necessarily look completely still and silent.
They may appear to be breathing.
They might:
- gasp
- snort
- make strange breathing noises
- take occasional breaths
- appear to gulp for air
- breathe irregularly
These abnormal respiratory movements are sometimes known as agonal breathing.
They are not normal breathing.
This can create a dangerous situation.
Someone sees the casualty gasp and thinks:
“They’re breathing.”
They then put them into the recovery position. But the casualty may actually be in cardiac arrest and require immediate CPR.
The Resuscitation Council UK specifically states that someone with agonal breathing should not be moved into the recovery position.
If someone is unresponsive and their breathing is abnormal, irregular or you’re unsure whether it’s normal, call 999 and follow the call handler’s instructions. The ambulance service can help you determine whether the person’s breathing is normal.
3. Do NOT Automatically Use the Recovery Position Following Major Trauma
This is another important area where first aid guidance needs to be understood rather than simply remembered as:
“Unconscious + breathing = recovery position.”
Current Resuscitation Council UK first aid guidance states:
In cases of trauma, do not move the person into the recovery position.
Trauma could include situations such as:
- a fall from height
- a serious road traffic collision
- being struck by a vehicle
- a significant blow to the head, neck or back
- a crush injury
- an accident involving significant force
There may be injuries to the casualty’s spine, pelvis, head, chest or other parts of their body.
Unnecessary movement could potentially worsen an injury.
If the casualty is breathing normally and their airway can be maintained without moving them, keep them as still as possible, call 999 and continually monitor them.
However, there is an extremely important exception.
4. Airway and Breathing Still Take Priority
People can understandably become frightened of moving someone when they suspect a spinal injury.
But preserving life takes priority.
If you suspect a spinal injury and the casualty cannot maintain an open airway, you may need to move them.
St John Ambulance advises that where a spinal injury is suspected but an open airway cannot be maintained, the casualty needs to be placed into a spinal recovery position.
If there are other people available, they may be able to help keep the casualty’s head, neck and spine aligned while the person is turned.
For a first aider, the priority remains:
Airway. Breathing. Circulation.
A spinal injury is serious.
But an obstructed airway can kill within minutes.
This is why good first aid training is about understanding priorities rather than simply memorising a series of movements.
5. Do NOT Put Someone in the Recovery Position During a Convulsive Seizure
If someone is actively having a seizure with convulsive movements, don’t attempt to force them into the recovery position.
Instead:
- protect them from nearby hazards
- remove dangerous objects where possible
- cushion their head
- note what time the seizure started
- do not restrain them
- do not put anything into their mouth
Once the jerking or convulsive movements have stopped, assess their airway and breathing.
If they’re breathing normally but remain unresponsive, they can then be placed into the recovery position where appropriate.
If they are not breathing normally, call 999 and start CPR.
There are also circumstances where an ambulance should be called for a seizure, including a seizure lasting longer than five minutes, repeated seizures without recovery, a first seizure, significant injury or abnormal breathing.
6. A Conscious Casualty Doesn’t Automatically Need the Recovery Position
The recovery position is primarily used for someone with a decreased level of responsiveness who does not require CPR.
If someone is conscious and able to respond, the most appropriate position depends upon their condition.
For example, forcing someone who is struggling to breathe to lie down may make them more uncomfortable.
Instead, they may naturally adopt a position that makes breathing easier.
Listen to the casualty.
Unless there is a specific first aid reason to move them, allow a conscious casualty to adopt a comfortable position while you assess them and arrange appropriate help.
7. What About Someone Having a Heart Attack?
A heart attack and cardiac arrest are not the same thing.
Someone experiencing a heart attack may still be:
- conscious
- talking
- breathing normally
- experiencing chest pain or discomfort
- feeling sick
- sweating
- feeling weak or light-headed
If they are conscious, you would not normally put them into the recovery position simply because you suspect a heart attack.
Help them into a comfortable position and call 999.
However, a heart attack can lead to cardiac arrest.
If the casualty suddenly becomes unresponsive, call 999 immediately and assess their breathing.
If they are not breathing normally, start CPR and use an AED as soon as possible.
8. What If Someone Has Fainted?
Fainting is another situation where people sometimes automatically think of the recovery position.
Someone who has fainted usually loses consciousness briefly because there has been a temporary reduction in blood flow to the brain.
If they quickly regain consciousness and are breathing normally, they may not need to be placed into the recovery position.
However, don’t automatically assume that every collapse is “just a faint”.
If someone remains unresponsive, call 999 and assess their breathing.
If they’re breathing normally and there is no trauma or other reason not to move them, the recovery position may be appropriate.
If they’re not breathing normally, treat it as a potential cardiac arrest.
9. What If the Casualty Is Vomiting?
This demonstrates why first aid isn’t always black and white.
One of the main purposes of the recovery position is to help protect an unresponsive casualty’s airway.
If an unresponsive person vomits while lying flat on their back, there is a risk that vomit could enter or obstruct their airway.
Turning the casualty onto their side can allow fluids to drain from the mouth.
But what if you also suspect a spinal injury?
This is where priorities matter.
If the airway is threatened, maintaining the airway takes priority.
Call 999 and follow the instructions you’re given.
10. What About Pregnancy?
If a pregnant casualty becomes unresponsive but is breathing normally, their pregnancy should be considered when positioning them.
Particularly during later pregnancy, lying completely flat on the back can cause the uterus to compress major blood vessels.
Where an unresponsive pregnant casualty needs to be positioned on their side, the left side is generally preferred.
As with any unresponsive casualty, call 999 and continually monitor their breathing.
The Recovery Position Is Not a Treatment for Unconsciousness
This is an important point.
Putting someone into the recovery position doesn’t mean your job as a first aider is finished.
The recovery position helps maintain the airway while further help is arranged.
You still need to:
- call for appropriate emergency assistance
- continually monitor the casualty
- keep checking their breathing
- look for changes in their condition
- keep them warm where appropriate
- be prepared to start CPR
Someone’s condition can change very quickly.
A casualty who was breathing normally when you first assessed them could subsequently stop breathing normally.
If that happens, you need to respond immediately.
Keep Checking Their Breathing
Once someone is in the recovery position, don’t walk away and assume they’re safe.
Stay with them.
Monitor their level of response and breathing while waiting for help.
If their breathing becomes abnormal or stops being normal, they need to be moved onto their back onto a firm surface so CPR can begin.
Call 999 if this hasn’t already been done and use an AED as soon as one becomes available.
So, When SHOULD You Use the Recovery Position?
Current Resuscitation Council UK guidance recommends a lateral, side-lying recovery position for adults and children with a decreased level of responsiveness who do not meet the criteria for CPR, particularly where the decreased responsiveness is due to medical illness or non-physical trauma.
In simple terms, the recovery position may be appropriate when someone is:
Unresponsive + breathing normally + does not require CPR + does not have trauma that means unnecessary movement should be avoided.
But first aiders must continue to monitor them.
When Should You NOT Put Someone in the Recovery Position?
As a quick reminder:
Do not automatically use the recovery position if:
- the casualty is not breathing normally
- the casualty appears to have agonal breathing
- CPR is required
- the casualty has suffered significant trauma and their airway can be maintained without moving them
- a spinal injury is suspected and their airway can be maintained in their current position
- they are actively convulsing during a seizure
- they are conscious and another position is more appropriate for their condition
There will always be situations where priorities change.
For example, if someone’s airway cannot be maintained, protecting their airway takes priority over concerns about moving them.
A Simple First Aid Rule to Remember
Instead of remembering:
“Unconscious = recovery position”
think:
“Unresponsive? Call 999 and check their breathing.”
If they’re not breathing normally, think:
CPR + AED
If they’re breathing normally, consider:
Do they need to be moved into the recovery position, or is there trauma that means I should avoid unnecessary movement?
That simple thought process could make an enormous difference in an emergency.
Why Practical First Aid Training Matters
Watching a video showing how to perform the recovery position is useful.
But first aid is about much more than learning a sequence of movements.
A real casualty isn’t a training manikin.
They may have fallen down stairs.
They may be bleeding.
They may be gasping.
They may have had a seizure.
They may have hit their head.
Or what initially looks like someone who has simply fainted could actually be a cardiac arrest.
That’s why good first aid training teaches people to assess the situation and make appropriate decisions, rather than simply memorising procedures.
At HMB Training Services, our first aid courses are practical, informative and designed to help learners build the confidence to respond when a real emergency happens.
We deliver a range of training including:
- Emergency First Aid at Work
- First Aid at Work
- Paediatric First Aid
- Emergency Paediatric First Aid
- workplace first aid training
- bespoke first aid training for organisations
Our courses give learners the opportunity to practise essential skills including CPR, AED use, casualty assessment and the recovery position while understanding why, when and when not to use them.
Because in an emergency, knowing what to do is important.
Knowing why you’re doing it is even better.
Need First Aid Training for Your Workplace?
Whether you need to train a new group of first aiders, renew existing qualifications or make sure your organisation has appropriate first aid provision, HMB Training Services can help.
We provide practical first aid training for businesses, schools, nurseries and organisations across the West Midlands, Staffordshire and surrounding areas.
Get in touch with HMB Training Services to discuss your first aid training requirements and find the right course for your team.
Frequently Asked Questions
Should you always put an unconscious person in the recovery position?
No. First assess whether they are breathing normally. If they are unresponsive and not breathing normally, call 999, start CPR and use an AED as soon as possible. The recovery position is not appropriate for someone in cardiac arrest.
Should someone who is gasping be put in the recovery position?
No. Gasping or agonal breathing can occur during cardiac arrest and should not be mistaken for normal breathing. An unresponsive casualty with abnormal breathing should be treated as a potential cardiac arrest.
Can you put someone with a suspected spinal injury in the recovery position?
Avoid unnecessary movement if spinal injury is suspected and the casualty’s airway can be maintained. However, if their airway cannot be maintained, airway management takes priority and it may be necessary to move them.
Do you put someone in the recovery position during a seizure?
Do not attempt to force someone into the recovery position while they are actively convulsing. Protect them from injury. Once the convulsions have stopped, assess their breathing. If they’re breathing normally but remain unresponsive, use the recovery position where appropriate.
Why does the recovery position help?
It helps keep the airway open and allows fluids such as vomit to drain from the mouth rather than potentially obstructing the airway.
Should you leave someone alone once they’re in the recovery position?
No. Continue monitoring their breathing and level of response while waiting for help. If their breathing becomes abnormal, be prepared to start CPR.
Train with HMB Training
At HMB Training, we believe that everyone should have the confidence to act when someone needs help. Our accredited first aid courses combine practical, hands-on learning with realistic scenarios, giving learners the skills to deal with emergencies such as fainting, unconscious casualties, CPR, choking, severe bleeding and much more.
Whether you’re a business, school, nursery, sports club or community organisation, our experienced trainers deliver engaging, supportive training that leaves participants feeling confident and prepared.
If you’d like to learn more about our first aid courses, learn what to do when someone faints or arrange training for your team, get in touch with HMB Training today. Because when an emergency happens, the right knowledge really can save a life.
01543 453338 / 07506 906641
info@hmbtrainingservices.co.uk
This article provides general first aid information and does not replace practical first aid training or advice from emergency medical professionals. In an emergency, call 999 and follow the instructions given by the ambulance service.
