Two situations are common and urgent: a person who is unresponsive but breathing, and a person who cannot breathe because something blocks the airway.
Unresponsive and breathing normally
A person who is not responding but is breathing normally is at risk. The tongue can fall back and block the airway, or vomit can enter the lungs. If you must leave them, or you are waiting for the ambulance, the recovery position helps keep the airway open and lets fluid drain from the mouth.
First, call 999 or 112, and check again that they are breathing normally. Then:
- Kneel beside the person and straighten their legs.
- Place the arm nearest you at a right angle to their body, elbow bent, palm up.
- Bring the other arm across the chest and hold the back of that hand against their cheek nearest you.
- With your other hand, pull up the far knee so the foot is flat on the floor.
- Keeping the hand against the cheek, pull on the knee to roll them towards you onto their side.
- Adjust the top leg so that the hip and knee are at right angles.
- Tilt the head back and lift the chin to keep the airway open. Adjust the hand under the cheek if needed.
- Keep checking their breathing and response until help comes. If they stay in this position for 30 minutes, roll them onto the other side.
If you suspect a spinal injury and the person cannot keep their airway open, keep the head, neck and spine in line while turning them, with a helper. Do not use the recovery position when the person is not breathing normally: that is a cardiac arrest, and needs CPR.
Choking
Choking is when the airway is blocked, usually by food. It can be mild or severe.
Mild choking. The person can speak, cough and breathe.
- Encourage them to keep coughing.
- Remove any visible object from the mouth, but do not poke blindly with your fingers.
- Stay with them. Do not slap their back while they are coughing effectively.
Severe choking. The person cannot speak, cough or breathe, and may clutch their throat or go blue.
Follow the sequence in the guidance of St John Ambulance and the Resuscitation Council UK for adults:
- Help them to lean forward and give up to 5 sharp back blows between the shoulder blades with the heel of your hand. Check the mouth after each blow.
- If that does not work, stand behind them and give up to 5 abdominal thrusts: put a clenched fist between the belly button and the bottom of the breastbone, grasp it with the other hand and pull sharply inwards and upwards. Check the mouth after each.
- Call 999 or 112 if the blockage has not cleared. Better still, send someone to call as soon as you see that the choking is severe.
- Carry on alternating 5 back blows and 5 abdominal thrusts until help arrives.
- If the person becomes unresponsive, lay them down, call 999 if this has not been done, and start CPR.
Anyone treated with abdominal thrusts should be checked by a doctor afterwards, because the thrusts can cause internal injury.
Babies and young children need a different technique. Learn it on a practical course. If you meet it before then, call 999 and follow the call handler.
Key points
- Unresponsive and breathing normally: call 999, then the recovery position.
- Unresponsive and not breathing normally: CPR, not the recovery position.
- Mild choking: encourage coughing. Severe choking: 5 back blows, then 5 abdominal thrusts, and call 999.
- Choking person who becomes unresponsive: begin CPR.