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Casualty according to their response can be broadly classified into two types conscious and Unconcious. An Unconcious casualty takes precedence over all other things in first aid.


The unconscious casualty must be:

  1. Handled gently with no twisting and minimal movement of head and neck turned with spinal alignment maintained
  2. Turned on the side to ensure adequate airway
  3. Jaw thrust is preferable to head tilt in this case
  4. Any head movement must be undertaken gently


With unconscious casualty, care of the airway takes precedence over any injury including the possibility of spinal injury.


The unconscious casualty is turned on the side called as recovery position:

Obtain and maintain a clear airway Provide ready access to the airway Facilitate drainage and lessen the risk of inhaling a foreign material Avoid unnecessary bending and twisting of the neck Permit observation of the casualty


It is important that whichever method is used that the casualty should be in as near a true lateral position as possible, with the head in a low position to allow for free drainage of fluid. The position should be stable any pressure on the chest that impairs breathing should be avoided. It should be possible to turn the casualty onto the side and return back easily and safely having particular regard to the possibility of cervical spine injury Good observation of and access to the airway should be possible Should minimize further injury to the casualty

Steps for Recovery position

  1. Kneel on the floor to one side of the person as shown in picture 1

Picture 1

  1. Place the person’s arm that is nearest you at a right angle to their body, so it is bent at the elbow with the hand pointing upwards. This will keep it out of the way when you roll them over as shown in picture 2



  1. Gently pick up their other hand with your palm against theirs (palm to palm). Now place the back of their hand onto their opposite cheek (for example, against their left cheek if it is their right hand). Keep your hand there to guide and support their head as you roll them as shown in picture 3

Picture 3

  1. Now use your other arm to reach across to the person’s knee that is furthest from you, and pull it up so that their leg is bent and their foot is flat on the floor. Gently pull their knee towards you so they roll over onto their side, facing you. Their body weight should help them to roll over quite easily as shown in picture 4

Picture 4

  1. Move the bent leg that is nearest to you, in front of their body so that it is resting on the floor Bend their knee so that it is at a right angle to their body. This position will help to balance their picture 5

Picture 5

  1. Gently raise their chin to tilt their head back slightly, as this will open up their airway and help them to breathe. Check that nothing is blocking their airway. If there is an obstruction, such as food in their mouth, remove this if you can do so safely. Stay with them, giving reassurance, until they have fully recovered as shown in Picture 6

Picture 6



            The possibility of a spinal injury must be considered in the overall management of all accident casualties. Due to the fracture or dislocation, the spinal cord may already be damaged completely or partially. Therefore extreme caution should be taken in moving the causalities so as to minimize the risk of further injuries or damage. The principles of management of AIRWAY, BREATHING, and CIRCULATION must take priority in the care and management of a suspected spinal injury.


The spinal injury must be considered in all situations where the casualty has been involved in:

  • A motor vehicle crash
  • Any incident where the casualty is unconscious
  • A dive into shallow water, being Dumped in the surf
  • A fall from a height
  • A sporting accident

When a casualty is conscious he is usually aware of the pain in the injured region and may have an injury to the spinal cord. If the spinal cord is already damaged the casualty may complain of pins and needles, numbness, weakness, and inability to move the limbs. Causality should remain still if there is pain or altered sensation in the neck or any other region. Ideally, the casualty will only be moved by first aiders trained in specialist manual handling. If movement is necessary then the injured/painful area must be supported and movement of the spine must be minimized.



  1. Check the airways. If breathing is noisy, sounding as though the casualty is snoring means a partially obstructed airway.
  2. Check the pulse and the breathing by looking at the expanding chest and feel for breathing by your palm in front of the casualty nose. Normal respiratory rate is 16/min in adults and 30-40 times min in babies. Pulse rate is 70-80/min in adults and 130-140/min in children.
  3. Check for breath to detect any smell like acetone in a diabetic coma.
  4. The Colour of the casualty should also be checked cyanosis may indicate asphyxia, which may be due to inhalation of vomit, teeth, or dentures.
  5. Check bleeding from ear and nose. Clear straw coloured fluid is an indication of a fractured skull.
  6. Pupils should be examined for any movement.
  7. The scalp should also be examined for any lacerations
  8. The contour of the cervical spine should be checked for the conscious casualty to find out if there is pain in the neck or any tenderness when pressure is applied.
  9. The chest and spine should be examined, look out that both sides of the chest move to the same extent with each breath.
  10. Check for any penetrating injury and any tender spots over the rib cage
  11. Check the spine by sliding the hand under the back of the casualty
  12. Do not remove the casualty with a spinal injury.
  13. The pelvic area is checked by gently exerting pressure on both sides at the same time to compress the pelvic ring, if there is tenderness should suspect for a fracture.
  14. The abdomen should be examined for any open wound and bruising.
  15. Limbs should be examined for any swelling, deformity, or major bleeding.
  16. Look out for a medic alert around the wrist or neck. They indicate to a particular condition or drug therapy, especially steroids, drug addicts may have injection marks on their arms.
  17. Assess the level of consciousness by noting
    1. Eye-opening
    2. Purposeful movement
    3. Spoken response
  18. In the case of spinal injury, the casualty may be unable to feel below the level of injury.

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