19.2 Airway, Unconsciousness and the Recovery Position

Unconsciousness means the brain is not working properly. The Caribbean Emergency First Aid book, the first-aid text in the GPF learner package, says this may be caused by lack of oxygen in the blood — when breathing is interfered with, or when there is a shortage of blood supply to the brain, as in fainting and shock — or by injury or disease of the brain. After a crash on the East Bank, in Georgetown, or on the Soesdyke–Linden Highway, the cause may be a blow to the head, blood loss, or both. You do not need to name the hospital diagnosis before you protect the air-passage.

You know a person is unconscious if he does not answer when you ask him something, does not respond when you touch him, and does not feel pain when pinched. The main danger to that casualty is that breathing may stop. First aid at this point is not conversation about who had the right of way at a roundabout. It is keeping air moving in and out of the lungs.

If the casualty is lying on his back, the muscle of an unconscious person is completely relaxed. The tongue will fall back and block the throat. That is the prescribed book’s airway fact, and it is the reason you do not leave an unconscious breathing person flat on the back as if sleep were safe. Rain, blood, or vomit on a Guyana verge makes the block worse: fluid can run into the air-passage. The recovery position exists to keep the tongue and fluids from drowning the person you have just pulled from further traffic danger.

Opening the air-passage

The book’s method is specific. Do not replace it with a different modern drill for this exam.

1. Kneel next to the casualty’s head.
2. Put one of your hands under his neck and the other on his forehead.
3. Move his head backwards.
4. Listen and look to see if breathing starts.
5. If breathing starts, place the casualty in the recovery position. If not, start artificial respiration at once.

That head-backward tilt with a hand under the neck is the package method. If breathing begins after the tilt, you have opened the air-passage; keep it open by rolling the person into the recovery position. If breathing does not begin, you do not wait for a doctor on the East Coast road. You start mouth-to-mouth at once.

Finding out whether the casualty is breathing

1. Kneel beside the casualty and place your hands on his chest and abdomen (belly).
2. Look and feel if he is breathing. If the chest and abdomen rise and fall, he is breathing. If you are not sure, go to the next check.
3. Put your cheek to the casualty’s nose and mouth. If he is breathing you will feel his breath.
4. If he is not breathing, start artificial respiration (mouth-to-mouth breathing).
5. Make sure the casualty continues to breathe by putting him in the recovery position.

Looking at the chest and belly, then feeling breath on your cheek, is how the book tells a learner to decide. Guessing from skin colour alone is not the test.

If breathing stops

The book’s sequence is:

1. Remove the cause from the casualty or remove the casualty from the cause.
2. Find out if the casualty is breathing. If not, continue.
3. Open and keep open the air-passage. If still not breathing, continue.
4. If the air-passage is blocked, check the position of the head. Then check mouth and throat for objects and remove them if possible. If still not breathing, continue.
5. Start artificial respiration at once and continue until the casualty is breathing.
6. Call qualified aid.
7. When breathing starts, place the casualty in the recovery position.
8. Watch the casualty carefully. Breathing may stop again. If possible, stay with the casualty.

The book’s reminder is blunt: breathing is essential for life.

Artificial respiration (mouth-to-mouth)

1. Open the air-passage by tilting the casualty’s head backwards.
2. Pinch his nose with the thumb and first finger of your hand placed on his forehead.
3. Take a deep breath.
4. Open your mouth wide. Place your mouth firmly over the casualty’s mouth to form a seal and blow air into his mouth.
5. Repeat quickly three more times. Check for breathing.
6. If breathing starts, place him in the recovery position. If not, seal the casualty’s mouth again and blow.
7. Look to see if the chest rises.
8. Take a deep breath again and continue the same way. Do this in the rhythm of your own breathing until the casualty is breathing or until qualified aid comes.

If you cannot blow air in, or the chest does not rise and fall, air is not getting into the lungs and the air-passage is blocked. Check the position of the casualty’s head and your hands. If the air-passage stays blocked, check the mouth for an obstacle.

Objects in the air-passage

A completely blocked air-passage: the person cannot speak, will panic and hold his throat, and will try to cough. A partly blocked air-passage: coughing all the time, strange-sounding breathing, scared and restless. Food can do this in an adult; nuts or playthings can do it in a child. After a crash, teeth, blood, or debris can also block.

For an adult who is standing, the book says place the casualty with the upper part of the body hanging down and hit with your open hand between the shoulders. If there are two of you, hold each other’s arm and bend the casualty over them, then hit with an open hand between the shoulders. If the person is lying, kneel and roll the casualty on his side facing you, put the chest against your knees, and hit with an open hand between the shoulders. If you cannot get the object out and the casualty is getting enough air, take him to qualified aid at once. If breathing stops, give artificial respiration. A child is put over your knee and hit between the shoulders. A small child is held as the book illustrates and hit gently between the shoulders.

The recovery position

Use this when the casualty is unconscious and breathing. The book’s steps are:

1. Kneel beside the casualty.
2. Stretch his nearer arm along his body and place the hand under his buttock.
3. Put his other arm across his chest.
4. Straighten the near leg and cross his other leg over the knee of that leg.
5. Support his head with your hand. Grasp his clothing at the hip with your other hand. Pull him gently over.
6. Support him against your knees. His bent arm will prop up his chest.
7. Gently lower his head and tilt it backwards.
8. Grasp his knee and pull upwards to make a right angle.
9. Ease the casualty’s other arm from under his body.
10. Check that his head is tilted backwards.

This position keeps the casualty stable and comfortable. With the head tilted back and turned to one side, the casualty will not swallow his tongue or drown in his own vomit or blood. That is why the book prefers this position to leaving the person on the back once breathing is present.

Fainting in the same book is a short loss of consciousness. Reasons include strong emotion (fear, grief, hysteria) and exhaustion (standing in the heat, hunger, sickness). Heat on a Georgetown pavement or after a long wait at a junction can produce a faint. Treat loss of consciousness by the same breathing check; do not assume a faint is harmless if it followed a crash.

On a wet East Coast shoulder or a night crash near Timehri, stay with the casualty if you can. Qualified aid still has to reach you. The next section covers bleeding, burns, and shock — the other reasons an unconscious or injured driver may fail on this exam topic.