Management of the Unconscious Casualty: Recognizing and Placing in Recovery Position

The Condition

A casualty is considered to be unconscious when he/she does not speak, does not respond to questions and does not move when asked but is breathing normally.

In the case of loss of consciousness, there is a risk of respiratory or circulatory arrest. A casualty who has lost consciousness and who is left on his/her back is always exposed to breathing problems due to congestion or obstruction of the airway by: fluids present in the throat (saliva, blood, vomit, gastric juices); the tongue falling back.

The Glasgow Coma Scale (GCS)

In this video, we explain the Glasgow Coma Scale (GCS). As the implementation and response strategies of this essential tool will be described, we'll specifically focus on its application in providing immediate assistance to road accident survivors. Understanding the Glasgow Coma Scale is not only vital for medical professionals but also for anyone who may find themselves in a position to offer first aid.

Recognition

Decreased level of consciousness (LOC)-Consciousness refers to the level of awareness one has of themselves and their surroundings. There are different levels of consciousness ranging from completely conscious to completely unconscious. Many injuries/illnesses can cause changes in a casualty’s level of consciousness, including:

• A breathing emergency

• A heart attack

• A head injury

• Poisoning

• Shock

• Alcohol or drug abuse

• Medical condition (epilepsy, diabetes, etc.)

-Semi-consciousness and unconsciousness are breathing emergencies for casualties lying on their back, because the tongue may fall to the back of the throat and block the airway. Saliva and other fluids can also pool at the back of the throat and choke the person.

-A progressive loss of consciousness means the casualty’s condition is getting worse. Always monitor a casualty’s level of consciousness and note any changes.

-A first aider can use the acronym AVPU (alert, verbal, pain, unresponsive) to assess and describe levels of consciousness. Decreased consciousness is always an urgent situation. The person can quickly become unconscious, and this is a breathing emergency. When you recognize decreased consciousness, get medical help as quickly as possible.

Recovery Position Method

• Position arm and straighten legs Kneel beside the casualty.

• Remove any spectacles and any bulky objects (such as mobile phones or large bunches of keys) from the pockets.

• Straighten the casualty's legs. Place the arm nearest to you at right angles to the casualty's body, with the elbow bent and the palm facing upwards (see picture 4).

• Position far arm, hand and knee Place yourself in a stable kneeling or tripod position beside the casualty.

• Bring the arm that is farthest from you across the casualty's chest and hold the back of his/her hand against the ear nearest to you.

• Keep the casualty's hand pressed against his/her ear, palms together. Using your other hand, grasp the far leg just above the knee and pull it up until the foot is flat on the floor.

• Roll casualty towards you. Place yourself at a sufficient distance from the casualty next to his/her chest, so that you can roll him/her. Keeping the casualty's hand pressed against his/her ear, pull on the far leg and roll him towards you and on to his/her side.

• Carefully remove your hand from under the casualty's head while supporting his/her elbow with your other hand.

• Adjust the upper leg so that both the hip and knee are bent at right angles .

• Open the casualty's mouth with one hand, using the thumb and index finger, without moving the head, so as to allow fluids to drain out.

• Monitor and record vital signs.

• Call the emergency services If there is a bystander, ask him/her to make the call while you wait with the casualty.

• Continue monitoring and recording vital signs.

What to do

• Assess the situation and make sure that there is no risk for you, the casualty(ies) and the bystanders; check the casualty for unresponsiveness; check response by asking the casualty simple questions like "How do you feel?" or "Can you hear me?”. Speak loudly and clearly to the casualty; gently touch (shake) the casualty's shoulder. If he/she does not respond, take the following actions. If you are alone, summon help

• Lay the casualty down on his/her back if not already in this position.

• Open the airway-Kneel by the casualty's head; place one hand on his/her forehead; gently tilt his/her head back. As you do this, the mouth will fall open so that you can look for any obvious obstruction to the airway (if there is something to be removed, do so); place the fingers of your other hand under the point of the casualty's chin and lift the chin.

• Check breathing -With the airway open, you can check if the casualty is breathing; do this by putting your head down close to his/her mouth and nose for 10 seconds; look for chest movement; listen for sounds of breathing; feel for the flow of air exhaled through the nose and mouth; do this for no more than ten seconds. The chest rises, the casualty's breathing is observed: the casualty is breathing normally.

• Place the casualty in the recovery position.

• Call the emergency services.

• Protect the casualty against cold, heat and inclement weather.