Editing Recovery position (section)

==History==
The earliest recognition that placing unconscious patients on their side would prevent obstruction of the airway was by Robert Bowles, a doctor at the Victoria Hospital in [[Folkestone]], England.<ref name=aha>{{cite journal|publisher=American Heart Association|journal=Currents in Emergency Cardiovascular Care|volume=12|number=3|year=2001|title=A brief history: The Recovery Position|last=Handley|first=Anthony J|url=http://www.americanheart.org/downloadable/heart/1054148696790fall2001.pdf}}</ref> In 1891 he presented a paper with the title ''<nowiki>'</nowiki>On Stertor, Apoplexy, and the Management of the Apoplectic State<nowiki>'</nowiki>'' in relation to [[stroke]] patients with noisy breathing from airway obstruction (also known as [[stertor]]).

This paper was taken up by anaesthetist Frederick Hewitt from the [[Royal London Hospital|London Hospital]] who advised a sideways position for postoperative patients.  This thinking was, however, not widely adopted, with surgical textbooks 50 years later still recommending leaving anaesthetised patients in a supine position.<ref name="aha"/>

[[First aid]] organisations were similarly slow in adopting the idea of the recovery position, with 1930s and 1940s first aid manuals from the [[British Red Cross]] and [[St John Ambulance]] both recommending lying a patient on their back.  The 1938 British Red Cross First Aid Manual goes so far as to instruct "place the head in a such as position that the windpipe is kept straight, keeping the head up if the face is flushed, and in line with the body if it is pale".<ref>{{cite book|title=British Red Cross Society First Aid Manual No. 1|author=St. J.D. Buxton|year=1938|publisher=Cassell and Company Ltd|edition=Eight}}</ref> By contrast, the St. John manual advocated turning the head to the side, but it was not until the 1950 40th edition of the St. John Manual that it was added "if breathing is noisy (bubbling through secretions), turn the patient into the three-quarters prone position",<ref name=aha/> which is very similar to a modern recovery position.

A large number of positions were experimented with, mostly in Europe, as the United States did not widely take up the recovery position until its adoption by the [[American Heart Association]] in 1992.<ref name=aha/>  Positions included the "Coma Position", "[[Franz Rautek|Rautek's Position]]" and the "HAINES (High Arm IN Endangered Spine) position".

In 1992, the [[European Resuscitation Council]] adopted a new position where the arm nearest the floor was brought out in front of the patient, whereas it had previously been placed behind the patient.  This change was made due to several reported cases of nerve and blood vessel damage in the arms of patients.

ILCOR made its recommendations on the basic principles for recovery positions in 1996, but does not prescribe a specific position, and consequently, there are several in use around the world.
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[http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-115]
===If spinal or neck injuries are possible===
When the injury is apparently the result of an accidental fall, collision or other trauma, the risk of spinal or neck injuries should be assumed. Movement of spinal-injured victims runs the risk of causing permanent paralysis or other such injuries, and is best left to trained medical personnel.[http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-115] They should be moved to a recovery position only when it is necessary to drain vomit from the airway, or when it's obvious the patient has lost their Coug/Swallow reflex due to the increased risk of a silent aspiration.

In such instances, the correct position is called the "HAINES modified recovery position" (High Arm IN Endangered Spine.) In this modification, one of the patient's arms is raised above the head (in full [[Abduction (kinesiology)|abduction]]) to support the head and neck.[http://www.australianfirstaid.com/hains.html][http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-115] There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage and is the only recovery position with clinical evidence to support its use. The two clinical studies benchmarked the HAINES Recovery Position against the Lateral Recovery Position, which the latter was clearly proven to be inappropriate for use in "Unconscious, suspected spinal injured" patients.[http://www.medscape.com/medline/abstract/10172477]

If an individual has suffered a fall or injuries that suggest damage to the spine, as a first aider the priority is to keep the airway open.  If breathing, position should not be changed.  If breathing has stopped, regardless of possible injury to the person, perform standard checks: DR & ABC (Danger, Response, Airway, Breathing, Circulation) and then move them into the recovery position to open the airway.  If they do not start breathing, begin CPR. If they begin to breathe, keep them in that position.

===Pregnant victims===
A pregnant woman should always rest on her left side, as lying on the right side may cause the uterus to compress the [[Inferior vena cava]], possibly resulting in death.

===Victims with torso wounds===
A victim with torso wounds should be placed with the wounds closest to the ground to minimize the possibility of blood affecting both lungs, resulting in [[asphyxiation]]. -->