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Unconscious casualty and recovery position
What is unconscious & recovery?
An unconscious casualty is a person who does not respond to voice or gentle shaking and cannot be roused, but who may still be breathing; in first aid we separate those who are breathing normally from those in cardiac arrest who need CPR. The recovery position is a stable side-lying position used for unresponsive but breathing casualties to maintain an open, draining airway while you monitor them and wait for an ambulance.
Without airway protection, an unconscious person can easily aspirate saliva, vomit or blood, leading to obstruction and severe lung injury; simply leaving them flat on their back is unsafe even if they appear to be breathing. Correct use of the recovery position is therefore a core first aid skill and appears in most workplace and clinical first aid curricula.
If someone is unconscious but breathing and has no other life-threatening injuries, putting them in the recovery position helps keep their airway clear and reduces the risk of choking on vomit or fluids.
Who needs this skill?
Health & Social Care
In health and social care, staff regularly encounter reduced consciousness after seizures, sedation, stroke, head injury or overdose; they must follow local escalation policies, protect the airway with appropriate positioning and be alert to spinal injury or other reasons not to move the patient. Regulators expect robust systems for recognising and responding to deterioration, not just for handing out information leaflets.Licensed venues & nightlife
In nightlife and licensed venues, staff may find patrons collapsed in toilets, smoking areas or outside; using a structured assessment rather than assuming intoxication, and placing unresponsive but breathing casualties into a safe recovery position with ongoing checks, can prevent avoidable aspiration and deaths.Schools
Pupils and staff may collapse from medical issues, substances or injuries; schools must not assume someone is “just sleeping it off” and should have staff confident in using the recovery position and calling 999 when needed.Workplaces
In workplaces, first aiders should know how to respond when a colleague faints, collapses from heat or illness, or is found unresponsive after an injury: completing a primary survey, calling 999 where indicated and using the recovery position when the casualty is breathing but cannot be kept safely on their back. This is part of demonstrating 'adequate and appropriate' first-aid arrangements under the Health and Safety (First-Aid) Regulations.How to manage unconscious & recovery
- 1Check responsiveness and breathingAfter ensuring the area is safe, gently shake the casualty's shoulders and shout to see if they respond, then open the airway with head-tilt, chin-lift and look for normal chest movement and breathing for up to 10 seconds.If they are unresponsive but breathing normally and have no obvious life-threatening injuries that prevent movement, prepare to place them in the recovery position and call 999 if you are at all concerned.
- 2Call for help and prepare the casualtyShout for help, call 999 if indicated, and remove glasses or bulky items from the casualty's pockets to make positioning easier, while keeping the airway open.If you suspect neck or spinal injury, follow local guidance and prioritise manual airway management and spinal care, seeking urgent help rather than moving the casualty unnecessarily.
- 3Position the limbsKneel beside the casualty, straighten their legs, place the arm nearest you at a right angle to the body with the elbow bent and the palm facing upwards, then bring the far arm across the chest and place the back of that hand against the cheek nearest to you.Hold the hand against the cheek to support the head, then bend the far knee so the foot is flat on the floor, ready to act as a lever.
- 4Roll into the recovery positionKeeping the hand pressed against the cheek, pull on the bent knee so the casualty rolls towards you onto their side, allowing their upper leg to rest bent at the hip and knee to stabilise the position.Adjust the head so it is slightly tilted back with the mouth pointing downwards, using the hand under the cheek to maintain an open, draining airway.
- 5Monitor and reassessStay with the casualty, check their breathing regularly and be prepared to roll them onto their back and start CPR if they stop breathing normally or you can no longer see chest movement.If you need to leave briefly to get help, only do so once they are stable in the recovery position, and turn them onto the opposite side periodically if you are waiting a long time and it is safe to do so.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Qualsafe Level 3 Award in Paediatric First Aid (RQF)
2 days
3 years
Common questions
Practical answers for employers, venue managers, and healthcare teams about unconscious & recovery training.
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You should be cautious about moving casualties with suspected spinal, pelvic or major limb injuries; in these cases, follow local guidelines and prioritise manual airway management and spinal stabilisation while waiting for trained help. However, if the airway is at risk from vomit or fluids, protecting breathing usually takes priority over keeping the spine perfectly still.
Placing an unconscious but breathing casualty on their side helps gravity keep the tongue away from the back of the throat and allows vomit or other fluids to drain from the mouth instead of entering the lungs. This simple position significantly reduces the risk of aspiration and is safer than leaving the person flat on their back.
For heavily pregnant casualties, guidance often advises positioning or tilting them onto their left side where possible to reduce pressure of the uterus on major blood vessels and improve blood flow. As always, maintaining a stable, open airway takes priority, so you should use the safest position that achieves this while considering pregnancy.
You should check breathing and responsiveness regularly, at least every few minutes, and reassess ABCs if you notice any change in colour, breathing pattern or level of consciousness. If you are waiting a long time and it is safe to do so, you may gently turn the casualty onto the opposite side periodically to relieve pressure areas while maintaining airway protection.