Information - The Unresponsive Casualty

Background information for Key Stage 3 and parents.

The importance of breathing

When we carry out an initial assessment of a casualty we need to go to the quietest casualties first. We do this because we do not know whether a quite casualty is breathing or if the airway is closed. Along with the head position, the position of
casualty is important as it could be restricting the movement of the chest. The restriction could be caused by an object pressing on the chest or us laying on our front making our own breathing difficult. This is because we breathe by expanding
our chest, which creates space for air to be drawn in and we breath out by relaxing our chest so the weight of our ribs forces air out. If a casualty has pressure on the chest, it will make it more difficult for them to breath. Take a look at
the video for more information on how we breathe or look on youtube for a huge range of videos aimed at different age groups.

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Approaching a casualty

As we covered in the session 'Information - Initial Assessment', we approach the casualty by following DRABC. Once we have identified a casualty is unresponsive and breathing, we need to put them in a safe position to maintain an open airway which
is known as the recovery position. The key points to remember of a recovery position is the casualty is on their side, their head is back and low. This position will ensure fluid can drain out of the mouth and not build up in the back of the mouth,
as well as ensuring the tongue does not drop back to block the airway.

Recovery position

These are the steps to put someone in the recovery position.

  1. Remove a casualty's glasses, putting them somewhere safe and ensure the casualties legs are straight.
  2. Move the arm nearest to you into the stop position. Allow the arm to rest naturally and do not force it into a position.
  3. Bring the arm furthest from you across their body and place the back of their hand against their face. Keep hold of the hand.
  4. Grasp the outside of the knee on the leg furthest from you and raise it up, so the foot is flat on the floor.
  5. Sit up high on your knees with your back straight. While supporting the casualties head, sit back, pulling on the casualties knee to roll the casualty towards you.
  6. Adjust the knee, so it at 90o to the body, but do not force it and allow settle where comfortable for the casualty.
  7. Ensure the casualty is on their side and will not roll backwards or totally onto their front.
  8. Check the casualty's head is back and low, to ensure the airway is open and fluid can drain away.
  9. Ensure the casualty is covered and warm.
  10. Monitor the casualty for any changes and to ensure breathing is maintained.

Things to consider

While the casualty is in the recovery position, you should monitor the following:
  • Their breathing
  • Any signs of the casualty getting worse, for example, changes in their skin colour, level of response, speed of breathing
  • They are kept warm and are not getting cold
You should consider how long a casualty is on their side. If the ambulance is delayed and they are there more than 30 minutes, turn them onto their other side, if injury and space allow.
If a casualty is wearing rings with studs on the hand
going against the face, turn the rings so the studs are not against the face.

Common questions

  • Does it matter which side you place them?
    The important thing is to manage a casualties airway and keep them breathing by getting them on the side, so do not spend time worrying which way to turn them. In an ideal situation, if the casualty
    has a chest injury, the injury should be next to the ground to allow drainage of blood away from the uninjured lung.
  • What if a casualty has a suspected spinal injury?
    It is important to keep a person with a suspected spinal injury still, but you need to remember our priorities of first aid, DRABC. The airway is at the top of our priorities before breaks.
    We need to ensure we manage the airway so they stay breathing and they are alive when the emergency services arrive to deal with any potential broken bones.
    If a casualty is unresponsive and you cannot guarantee an airway, they need to
    go on their side (recovery position). If there is a group of you and you know the 'log roll' technique, you should utilise this technique.