Positioning the Ill or Injured – Updated

Generally, an ill or injured person should not need to be moved. This is especially important if you suspect, from the person’s position or the nature of the injury, that the person may have a pelvic or spine injury. There are times, however, when the person should be moved:

If the area is unsafe for the first aid provider or the person, move to a safe location if possible. (Class I, LOE C-EO)

If a person is unresponsive and breathing normally, it may be reasonable to place him or her in a lateral side-lying recovery position. (Class IIb, LOE C-LD)

There is evidence that this position will help increase total airway volume1 and decrease stridor severity.2 Extend one of the person’s arms above the head and roll the body to the side so that the person’s head rests on the extended arm. Once the person is on his or her side, bend both legs to stabilize the body. There is little evidence to suggest an alternative optimal recovery position.3 If a person is unresponsive and not breathing normally, proceed with basic life support guidelines (see “Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality”).

If a person has been injured and the nature of the injury suggests a neck, back, hip, or pelvic injury, the person should not be rolled onto his or her side and instead should be left in the position in which they were found, to avoid potential further injury. (Class I, LOE C-EO)

If leaving the person in the position found is causing the person’s airway to be blocked, or if the area is unsafe, move the person only as needed to open the airway and to reach a safe location. (Class I, LOE C-EO)

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  1. Litman RS, Wake N, Chan LM, McDonough JM, Sin S, Mahboubi S, Arens R. Effect of lateral positioning on upper airway size and morphol- ogy in sedated children. Anesthesiology. 2005;103:484–488.
  2. Arai YC, Fukunaga K, Hirota S, Fujimoto S. The effects of chin lift and jaw thrust while in the lateral position on stridor score in anesthetized chil- dren with adenotonsillar hypertrophy. Anesth Analg. 2004;99:1638–1641, table of contents. doi: 10.1213/01.ANE.0000135637.95853.1C.
  3. Singletary EM, Zideman DA, De Buck EDJ, Chang WT, Jensen JL, Swain JM, Woodin JA, Blanchard IE, Herrington RA, Pellegrino JL, Hood NA, Lojero-Wheatley LF, Markenson DS, Yang HJ; on behalf of the First Aid Chapter Collaborators. Part 9: first aid: 2015 International Consensus on First Aid Science With Treatment Recommendations. Circulation. 2015;132(suppl 1):S269–S311. doi: 10.1161/CIR.0000000000000278.
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Positioning the Ill or Injured – Updated