If a patient is unconscious and laid on their back, the airway can be in danger from vomit or the tongue falling back.

A patient who has not been injured can simply be turned into the recovery position to protect the airway, but if spinal injuries are suspected, great care must be taken not to move the spine.

If a patient is already on their side (not on their back) you may not have to move them at all. Is the airway in danger from vomit or the tongue falling back? If not, the patient can be kept still in the position you find them.

If you can continually monitor that the patient is breathing normally, you may be able to keep them still until the ambulance arrives, even if they are on their back.

If the tongue begins to fall back or the patient vomits, however, immediate action will be needed to protect the airway.

Jaw thrust

• If the patient is breathing but the tongue is starting to obstruct the airway (usually makes snoring type noises) the jaw thrust technique can be used to keep the airway open.
• Kneel above the head of the patient, knees apart to give you balance.
• With your elbows resting on your legs (or the floor) for support, hold the patient’s head with your hands to keep their head and neck in line with the body.
• Place your middle and index fingers under the jaw line of the patient (under their ears).
• Keeping the head still, lift the jaw upwards with your fingers (see fig.2). This gently lifts the tongue from the back of the throat.

Do not attempt the jaw thrust technique during (just tilt the head to open the airway instead).

Log roll

If you have to leave the casualty, if they begin to vomit, or if you are concerned about their airway in any way, the patient will have to be turned onto their side. The head, neck and upper body must be kept in line as you turn the patient.

The best method of turning a spinal injury patient is the log roll technique, but you will need at least three helpers to roll the patient.

• Support the head of the patient, keeping the head, neck and upper body in line.
• Your helpers should kneel along one side of the patient.
• Get them to gently straighten the patient’s legs and arms.
• Making sure that everyone works together, the helpers should roll the patient towards them on your count. You gently move the head to follow the body as the patient is rolled.
• Keep the head, neck, body and legs in line at all times. If you can, keep the patient in this position until the ambulance arrives.

Recovery position

If the patient has to be turned onto their side and you don’t have three helpers, you will need to use the recovery position method when turning the patient. Keep the head, neck and body in line as best as you can as you roll the patient over. Have some padding (e.g. a folded coat) to support the patient’s head when they are on their side.

If you have one or two helpers, you can support the head as your helper(s) turn the patient.

Start by supporting the head of the patient, keeping the head, neck and upper body in line.

• Get your helper(s) to gently move the patient’s arms and legs into position, ready to turn the patient into the recovery position.
• Making sure that everyone works together, the helper(s) should roll the patient into the recovery position. The helper(s) should pull equally on the patient’s far leg and shoulder as they turn the patient, keeping the spine in line.
• You gently move the head to keep it in line with the body as the patient is moved.