Action Training Services Ltd

There are several variations of the recovery position, each with its own advantages. No single position is perfect for all victims. The position should be stable, near a true lateral position with the head dependent, and with no pressure on the chest to impair breathing.

The Resuscitation Council (UK) and Action Training Services Ltd recommends this sequence of actions to place a victim in the recovery position:

• Remove the victim’s spectacles.

• Kneel beside the victim and make sure that both his legs are straight.

• Place the arm nearest to you out at right angles to his body, elbow bent with the hand palm uppermost.

• Bring the far arm across the chest, and hold the back of the hand against the victim’s cheek nearest to you.

• With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground.

• Keeping his hand pressed against his cheek, pull on the far leg to roll the victim towards you onto his side.

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

• Tilt the head back to make sure the airway remains open.

• Adjust the hand under the cheek, if necessary, to keep the head tilted.

• Check breathing regularly.

If the victim has to be kept in the recovery position for more than 30 min turn him to the opposite side to relieve the pressure on the lower arm.

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Risk to the rescuer
The safety of both the rescuer and victim are paramount during a resuscitation attempt. There have been few incidents of rescuers suffering adverse effects from undertaking CPR, with only isolated reports of infections such as tuberculosis (TB) and severe acute respiratory distress syndrome (SARS). Transmission of HIV during CPR has never been reported. There have been no human studies to address the effectiveness of barrier devices during CPR; however, laboratory studies have shown that certain filters, or barrier devices with one-way valves, prevent oral bacteria transmission from the victim to the rescuer during mouth-to-mouth ventilation. Rescuers should take appropriate safety precautions where feasible, especially if the victim is known to have a serious infection, such as TB.

Initial rescue breaths
During the first few minutes after non-asphyxial cardiac arrest the blood oxygen content remains high. Ventilation is, therefore, less important than chest compression at this time.

It is well recognised that skill acquisition and retention are aided by simplification of the BLS sequence of actions. It is also recognised that rescuers are frequently unwilling to carry out mouth-to-mouth ventilation for a variety of reasons, including fear of infection and distaste for the procedure. For these reasons, and to emphasise the priority of chest compressions, it is recommended that, in most adults, CPR should start with chest compressions rather than initial ventilations.

Jaw thrust
The jaw thrust technique is not recommended for lay rescuers because it is difficult to learn and perform. Therefore, the lay rescuer should open the airway using a head-tilt-chin-lift manoeuvre.

Agonal gasps
Agonal gasps are present in up to 40% of cardiac arrest victims. Laypeople should, therefore, be taught to begin CPR if the victim is unconscious
(unresponsive) and not breathing normally. It should be emphasised during training that agonal gasps occur commonly in the first few minutes after sudden cardiac arrest. They are an indication for starting CPR immediately and should not be confused with normal breathing.

Mouth-to-nose ventilation
Mouth-to-nose ventilation is an effective alternative to mouth-to-mouth ventilation. It may be considered if the victim’s mouth is seriously injured or cannot be opened, the rescuer is assisting a victim in the water, or a mouth-to-mouth seal is difficult to achieve.

Manual Handling Assessment Chart (MAC) Tool
Under the Manual Handling Operations Regulations 1992 (as amended), the College must ensure that any manual handling task that cannot be eliminated and that is likely to be a risk to health and safety is examined and assessed. Such tasks would include moving large pieces of equipment or materials in a workshop. A risk assessment should be conducted in order to assess these risks and to produce control measures to reduce the risk of injury.

The Manual Handling Assessment Chart (MAC) tool was developed by the HSE and can be used to assess common risk factors in lifting, lowering, carrying and team handling operations. The HSE website contains a section on the MAC tool including case studies and worked examples. The MAC tool is designed to help users understand, interpret and categorise the level of risk of the various known risk factors associated with manual handling activities. It incorporates a numerical and a colour coding scoring system to highlight high-risk manual handling activities.

It uses a combination of colour coding 'traffic light' (green/amber/red/purple) approach to highlight the level of risk as well as scoring and considers the following three types of operations: single lift, single carry and team handling.

For each type of assessment there is a guide and a flow chart to help you. The flow chart guides you, step by step, through each element of the operation enabling you to evaluate and grade the level of risk. To enable you to calculate the risk for the load and frequency of the operation, a graph is supplied with the flowchart which indicates the appropriate colour band and numerical value to be entered into the score sheet.

Each of the three types of assessment has a score sheet to be filled in. The score sheet will provide a total score and along with the colour banding, determine which elements of the task require attention (i.e. controls put in place to reduce risk)

An interactive version of the score sheet is available on the HSE website which totals the respective scores from the colour bands.

The MAC tool cannot be used to assess the risks associated with pulling or pushing: the risk assessment checklist should be used to evaluate such tasks