Resuscitation:
Get to know your A,B,C
Renu Warnasuriya continues our series on first aid
The recovery position is the best way to keep an unconscious person. The position prevents the tongue from blocking the airway and also reduces the risk of the casualty inhaling stomach contents.

Before placing the casualty in this position however, it is essential to make sure that the A,B and C of resuscitation, are functioning properly. A, is the airway which must be open so that oxygen can enter the body. To open the airway carefully tilt the casualty's head backwards by placing two fingers under the point of the chin and lifting the jaw while placing the other hand on the forehead and gently tilting the head back. It is important to handle the head carefully, in case there are head or neck injuries. Once the airway is open, also check if any foreign object is blocking it.

B, which is for breathing, should be checked according to the LLF rule. Place your face close to the casualty's mouth with your ear towards his nose and your face turned towards his body. This way you are able to Look at the chest for signs of movement, which indicate breathing, Listen for sounds of breathing and Feel the exhaling air on your cheek. Do this for at least ten seconds and once you are sure that the casualty is breathing properly move on to C, the circulation. For this check for the Carotid pulse, which can be felt by placing two fingers in the hollow between the windpipe and the large neck muscle for up to ten seconds.

It is only once these three vital factors have been confirmed that you should proceed to get the casualty into the recovery position. It is also advisable to check for signs of injury or bleeding so as to avoid further injury.

Before putting the casualty in position, remove any bulky objects from the pockets and loosen any tight items of clothing like belts or ties so as to help the circulation. If there are any injuries that can be treated immediately, do so before putting the casualty into position. While treating however, it is essential to keep the head tilted back at all times. If however, the treatment will take time, it is better to first place the casualty in the position and then see to the injuries as the position will secure the ABC until the casualty can be given proper medical attention. If any fractures or other injuries are noticed it is better to try not to put too much weight on it and not to move it too much.

Once the casualty is fully checked begin putting him into position. First tilt back the head (according to the method explained above) and keep the airway open. Straighten the legs and place the arm nearest to you at right angles with the casualty's body, palm upward. Take the other arm across the chest and hold the back of that hand against the casualty's nearer cheek. Using your other hand lift the casualty's leg (on the same side of the body) just above the knee, while keeping the foot flat against the ground. With the casualty's hand still pressed against the cheek pull him towards you, so that he will be on his side. Once in position the casualty's head must always be kept tilted so that the airway does not get blocked. Once in position adjust the hand under the cheek and the upper leg so that the hip and the knee are bent at right angles.

An unconscious person in this position is well balanced and won't move around easily. Since it is a relaxed and natural position it helps with the circulation. The bent leg will prevent the body from moving forward. Placing the back of the hand against the cheek and the palm against the ground will prevent any damage to the back of the hand and will also support the head, keeping it tilted. Once in position the casualty can be left unattended while you get help.

Since there is no particular side that the casualty must be laid, it could be done in a way to avoid any further injury. If for instance, there is some kind of injury, like a fracture on the right arm, it is better to lay the person down on the left arm so that there would not be any added weight on the injured arm.

If there is a penetrating chest wound however, the situation is different, whether the wound has been dressed or not. In this case, the patient should be laid down with the wounded side pressing against the ground. This is because the lung on the wounded side is likely to be damaged and unable to function properly. Thus it is important for the other lung to be allowed to function well enough to provide the oxygen the body needs. If the good lung is pressed against the ground it will not have enough room to expand and get the necessary oxygen. This way, both lungs will not be functioning properly and there will be other problems.

This recovery position however, is unsuitable for casualties with spinal problems. The modifications that need to be made in such cases will be discussed at a later date. The above steps explain how to place a casualty found on his back, in to the recovery position. If the casualty is found in some other position, it will be necessary to apply the same steps accordingly.

(Information provided by St. John Ambulance Association and Brigade of Sri Lanka)