Managing an Unconscious Casualty: A First Aider’s Guide

When you are called to help someone who is unconscious, your actions need to be calm, structured, and deliberate. As a first aider, your priorities are to call for help, keep yourself safe, assess the casualty, and protect their airway.

Stop, Think, and Act

Before approaching, pause and assess the scene.

• Look for hazards that could put you or the casualty at risk
• Remove dangers if it is safe to do so
• Be alert for traffic, electricity, violence, or environmental risks

If possible, make sure someone is with you so they can call the emergency services if required.

Initial Contact and Response Check

Approach the casualty and introduce yourself:

“Hello, my name’s Keith. I’m a first aider.”

Gently tap the casualty on the collarbone and ask permission to help.

• If they are conscious, talk to them, find out what has happened, and encourage them to remain still while you assess the situation.
• If they are unconscious, you must immediately check whether they are breathing.

Checking for Breathing

To check breathing, you must first open the airway.

• Place one hand on the forehead and the other under the chin
• Gently tilt the head back and lift the chin to move the tongue away from the back of the throat
• Briefly look inside the mouth for any obvious obstruction and remove it only if it can be seen and easily removed

With the airway open, look, listen, and feel for normal breathing for up to 10 seconds:

• Look for the chest rising and falling
• Listen for breathing sounds
• Feel for air on your cheek

If the casualty is not breathing normally, you must start CPR immediately.

If the Casualty Is Breathing Normally

If the casualty is breathing, CPR is not required. However, you must still send someone to call an ambulance. Make sure they return and tell you when help is on the way.

Your next priority is to maintain an open airway and prevent choking.

Placing the Casualty in the Recovery Position

The recovery position helps keep the airway open and allows fluids, such as vomit, to drain safely from the mouth.

If gloves are available, put them on and carry out a quick head-to-toe check before moving the casualty:

• Check the head, shoulders, arms, and chest for deformity, bleeding, or fluid
• Check the hips and legs are in a normal position

If no injuries are found, place the casualty into the recovery position:

How to Put Someone into the Recovery Position

1. Kneel beside the casualty
2. Straighten both legs and bring the feet together
3. Place the arm nearest to you out at a right angle to the body
4. Take the far arm and bring it across the chest, holding the hand against the cheek nearest to you
5. With your other hand, bend the far knee so the foot is flat on the floor
6. Using the knee as a lever, gently roll the casualty towards you onto their side

Once they are on their side:

• Check the airway is open
• Tilt the head slightly back if needed to maintain breathing
• Adjust the legs to help support the position

Ongoing Care

From this point, your role is to:

• Keep the casualty comfortable and warm
• Speak to them reassuringly, even if they remain unconscious
• Monitor breathing continuously

If you are completely alone and have no phone, you may need to leave the casualty briefly to call emergency services. If you do:

• Check they are breathing before you leave
• Check again immediately when you return

Important Guidance on Injuries and the Recovery Position

Current guidance from the UK Resuscitation Council and the European Resuscitation Council (ERC) states:

• The recovery position is ideal for an unconscious casualty who is not injured
• If the casualty is injured, it is usually best to leave them on their back to avoid worsening injuries
• If the airway is compromised, or there is fluid in the mouth, the casualty may need to be placed in the recovery position despite injury
• If you must leave an injured casualty to get help, place them in the recovery position to protect their airway

Key Points to Remember

• Stop, think, and ensure the scene is safe
• Check response and breathing early
• Start CPR if they are not breathing normally
• Use the recovery position to protect the airway when breathing is present
• Monitor continuously until emergency help arrives

Calm, structured actions save lives.