This one is probably for Rule. Years ago moving a patient into the Coma Position meant rolling them towards you, controlling the roll, clearing the airway and watching them. Then the name got changed to the Recovery Position. And sometime or other the method got changed to rolling the patient away from you. I’ve checked the Aust Resusc Council and they seem to roll away. The European one, on the other hand, seems to still roll towards. I’m very uncomfortable about rolling the patient away from me. I don’t have the control of their body and I can’t see their face if they are facing away from me for monitoring. I’m happy to be corrected, but I can’t find any reason anywhere for changing the method. What is the rationale for rolling the patient away from you? The rationale for rolling towards is that the patient rolls onto your thighs (you are kneeling) and you can gently place their arms and legs from there (you are not leaning over them). They are also facing you, so you can monitor their breathing status and consciousness. And talk to them if they come around.

Ambulance Victoria roll towards.

The only good reason I can see to role away is in case the patient vomits.

Most people seem to have adopted the HAINES recovery position, which is (claimed to be) the creation of one of ex Amb Vic MICA flight paramedics, John Haines, because it reduces sideways movement of the neck.

Note that it can be difficult to get the head to actually balance / stay on the raised arm, so the other hand might need to be put in position to support, or the raised arm might need to be bent / moved.

There are better recovery / coma / lateral / stable side (call it what you will) positions for infants and pregnant women.

Yuck…so if they do vomit I’m leaning over them to clear it and getting a facefull of the smell. If they are facing me I can sort of sweep it away from me.

Anyway, if I have to do it, I’ll just use the oldfashioned one.

One of the reasons I quit being a first aid trainer was because of how simplified it had all become. You didn’t even have to do any real testing in the end (for general first aid and senior first aid). This recovery position was probably the best change though. However, we did not put the arm above the head as in rule’s video link, it went out at a 90 deg angle, though I notice that the link was for suspected spinal injury. You would still need to support the head well.

There’s been a few changes recently. Stiffneck collars are out, tourniquets are in, raising the legs is out for hypovoleaemic shock, proximal pressure points to control bleeding are out, haemostatic dressings are in, Aspirin for cardiac is in, pulse oximetres are in before O2 therapy, pelvic binders are in… and so on.

ARC & ANZCOR have no strong feeling on whether the Pt is facing toward or away but I think people who are used to patients being on beds & gurneys/stretchers tend to want them facing toward, but if they’re on the floor or in the litter, rescue tend to want them facing away. I always rig a stokes litter bridle with an adjustor to tilt the patient away for vomiting. It’s not about the vomit being yukky and messy – it’s a simple cross-infection control technique that reduces your exposure to vomit, blood, saliva & mucus.

But, but, but…..we still haven’t found where the research came from that instigated the change. Surely there must be something. It couldn’t have just been a random idea. Could it?

buffy said:

It couldn’t have just been a random idea. Could it?

It might have been. There’s a couple of other reasons it might be better:

1. With the patient on their back, it is extremely difficult for a single person to roll them onto their side (facing toward) without significant twisting of the spine and manage the head.

2. With the patient on their front, how do you roll them so they end up facing toward you?

Rule 303 said:

buffy said:

It couldn’t have just been a random idea. Could it?

It might have been. There’s a couple of other reasons it might be better:

1. With the patient on their back, it is extremely difficult for a single person to roll them onto their side (facing toward) without significant twisting of the spine and manage the head.

2. With the patient on their front, how do you roll them so they end up facing toward you?

1. I never found that difficult when we were teaching it. We quite specifically demonstrated with a small person rolling a large person – and the large person, being Mr buffy, offered no help at all. After placing the limbs, you are controlling the entire area from shoulder downwards, and once they are onto your thighs, you adjust the head.

2. You don’t, you just place them into position with the knee and hand under the chin, to channel the vomit.

So we still don’t actually have any research except the Haines stuff, which was specific to spinal injuries. I wonder if I should shoot an email to the Council and ask. I’m really curious now I’ve thought of it.