# Recovery Position



## CPRinProgress (Apr 30, 2014)

I work as a lifeguard but I am also an EMT.  We were training where I work as a lifeguard and my supervisor asked me a question out of a lifeguarding book.  Here is the question.

You are working as a lifeguard and you walk into a maintenance room and find a maintenance worker laying supine on the ground unresponsive but breathing. He is laying at the base of a ladder.  You must leave to get help.  What should you do?

The two answers I was between were 

Leave him how he is and get help

Place him in recovery position and then leave to get help.

I picked to leave him how he was but my supervisor said the right answer was to place him in recovery to keep his airway open. I thought that since he was laying at the bottom of the ladder, he may have a spinal injury and since he was breathing on his own, I thought it would be best to leave him and then come back and administer care.  Am I right in my thinking or am I wrong?


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## UnkiEMT (Apr 30, 2014)

I'd side with you, the fact that he's at the base of the ladder at least raises the possibility of a trauma MOI, and thus I wouldn't go moving him about.

I was going to say that it's a matter of scope and training, that lifeguards don't deal with spinal precautions and thus wouldn't be tested on it, but back when I did my lifeguard, we totally covered what to do if someone dives headlong into the bottom, did you?

Of course, the real answer is grab your cell phone and call 911, get a truck rolling for a man down, put the operator on speakerphone and do a rapid assessment to see if you can give them a bit better information.


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## CPRinProgress (Apr 30, 2014)

Yes. We are only trained to deal with spibak injuries that occur in the water and they teach us how to do a standing takedown. We do not, however, learn how to log roll if someone is laying on the ground. We are supposed to call EMS and let them handle that.  I figured it wasa scope of practice thing I was just surprised that they would put the whole thing with the ladder in if they didn't seem to care about the possible trauma.


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## rmabrey (Apr 30, 2014)

You're supervisors logic is this: ABC C-spine

My phone is dyingg or id go into more detail but someone will be along to do it.


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## CPRinProgress (Apr 30, 2014)

rmabrey said:


> You're supervisors logic is this: ABC C-spine
> 
> My phone is dyingg or id go into more detail but someone will be along to do it.



I understand that airway trumps spinal but  the question stated they were breathing so the airway is open.  I guess it is possible for it to close but in the time it would take to leave and tell someone to call 911 and return, that doesn't seem like it would affect the pt.


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## teedubbyaw (Apr 30, 2014)

That's a pretty silly question. Is he not maintaining his airway? Snoring resps? Gurgling? Then leave it be for the 30 seconds it takes you to get help.


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## Ewok Jerky (Apr 30, 2014)

Can't you put someone in recovery position with their arm supporting their head thus "maintaining" c spine? Modified recovery or lateral recumbant or something?

As for test questions ALWAYS remember A>B>C, always always always, even when it don't make sense.


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## CPRinProgress (Apr 30, 2014)

teedubbyaw said:


> That's a pretty silly question. Is he not maintaining his airway? Snoring resps? Gurgling? Then leave it be for the 30 seconds it takes you to get help.



It is from a LG book so it didn't go into that much detail but I'm assuming when they say he is breathing, they mean adequately.


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## OnceAnEMT (Apr 30, 2014)

beano said:


> As for test questions ALWAYS remember A>B>C, always always always, even when it don't make sense.



I've actually been hearing a lot of C(spine)>A>B>C lately, as C-spine positioning literally makes or breaks your airway.

My cell phone would be on the deck with 911 dialing on speaker.


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## CPRinProgress (Apr 30, 2014)

beano said:


> Can't you put someone in recovery position with their arm supporting their head thus "maintaining" c spine? Modified recovery or lateral recumbant or something?
> 
> As for test questions ALWAYS remember A>B>C, always always always, even when it don't make sense.



I'm not sure about the recovery position that maintains c spine. My point is that if they are maintaining their own airway at that time, then why compromise cspine unnecessarily.


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## mycrofft (Apr 30, 2014)

HAINES position.*

If someone can't get out of supine position (unconscious, spine board, paralyzed) you need to protect their airway.

*I am seeing two versions. The one I teach at ARC has both knees bent on completion. All the non ARC stuff I see has only the upper leg bent. The deal is holed the head while turning from supine to semi-prpone and wind up with the head held in approximate alignment with shoulders on top of the lower humerus.
Here's one:
http://www.youtube.com/watch?v=WUHSBsxNJ-Y


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## CPRinProgress (Apr 30, 2014)

mycrofft said:


> HAINES position.
> 
> If someone can't get out of supine position (unconscious, spine board, paralyzed) you need to protect their airway.



Thank you mycrofft.  I don't remember that from EMT class. The question was after I had taken my recert for LG but I didn't take the first aid portion of the class because they let me skip it since I am an EMT. I guess I should have attended it. Haha


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## mycrofft (Apr 30, 2014)

I edited the comment as you posted.
It is basic ARC first aid.


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## CPRinProgress (Apr 30, 2014)

mycrofft said:


> I edited the comment as you posted.
> It is basic ARC first aid.



Do you know if this has been recently started to be used or am I just being forgetful?


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## mycrofft (Apr 30, 2014)

Long time

http://en.wikipedia.org/wiki/Recovery_position


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## cprted (Apr 30, 2014)

What if your patient has a head injury and starts vomiting while you're gone?

Life over limb.  Being able to breath is far more important than being able to feel your toes.  Roll to recovery if you have to leave.


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## CPRinProgress (Apr 30, 2014)

mycrofft said:


> Long time



OK. Well thank you for the quick reply. I thought it was weird that the question would include the part of the ladder if they just expected lifeguards to disregard the possible spinal injury.


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## cprted (Apr 30, 2014)

CPRinProgress said:


> OK. Well thank you for the quick reply. I thought it was weird that the question would include the part of the ladder if they just expected lifeguards to disregard the possible spinal injury.


You're not "disregarding" the possibility of spinal injuries.  You're expected to consider spinal injury and prioritize appropriately.


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## mycrofft (Apr 30, 2014)

zsstop and read all replies. I'll stop editing mine!


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## Christopher (May 1, 2014)

CPRinProgress said:


> I work as a lifeguard but I am also an EMT.  We were training where I work as a lifeguard and my supervisor asked me a question out of a lifeguarding book.  Here is the question.
> 
> You are working as a lifeguard and you walk into a maintenance room and find a maintenance worker laying supine on the ground unresponsive but breathing. He is laying at the base of a ladder.  You must leave to get help.  What should you do?
> 
> ...



The recovery position, or HAINES position, is fine for any patient. Lateral "immobilization" is common in places that actually read good and stuff. Supine is unnatural, impairs pulmonary function, and opens your patient up to the risk of aspiration.

We've got some sick fetish whereby we lay everybody down supine who is sick or injured...can I get some head elevation please? Won't anybody think of the side sleepers?!


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## mycrofft (May 1, 2014)

Christopher said:


> The recovery position, or HAINES position, is fine for any patient. Lateral "immobilization" is common in places that actually read good and stuff. Supine is unnatural, impairs pulmonary function, and opens your patient up to the risk of aspiration.
> 
> We've got some sick fetish whereby we lay everybody down supine who is sick or injured...can I get some head elevation please? Won't anybody think of the side sleepers?!



Yes!! Time and again I've see patients shut down because we tip 'em like turtles.

We flip em on their back and resp shuts down. Some people it does that without insult! ANd then we have to roll them back onto their side because we didn't check quickly for trauma, pain tenderness or deformity on the back or flanks before rolling them.


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## MedicDelta (Sep 26, 2014)

By the sound of it you have higher training than your LifeGuard instructor who I'm guessing is only First Aid qualified. Airway/breathing only comes before c-spine if the patient is actually suffering from an airway problem, having breathing difficulties or goes into cardiac arrest. Don't take any crap from someone who has lower level medical training than you, wether he's your supervisor or not. When an emergency actually happens you should technically have seniority.


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