Position for unconscious man

Orion

Posting here to see if I'm missing something. Last weekend I was leaving my local and there was a young man on the ground surrounded by some friends. I'd seen him be escorted from the pub about half an hour earlier but he seemed worse now. I'm a first aider with an up to date qualification so I told one of the staff to ensure an ambulance was called and went over to assist. Nobody else there had a clue what to do so I took over which the others were happy for me to do. He was in a semi recovery position already - I made some minor adjustments to make him more comfortable and checked his circulation and breathing - both fine. However he was non-responsive and foaming at the mouth. Then I realised his hysterical girlfriend was on the phone to emergency services so I asked for the phone and it was passed to me.

This is where my confusion lies. I was prepared to keep the lad in recovery and monitor him until the professionals got there - which is obviously the extent of my first aid training. However the emergency dispatcher told me to roll him on to his back. I reiterated that he was non-responsive and foaming at the mouth so I had him in recovery. She insisted that I roll him on his back anyway. I did so and immediately he started choking so I put him back in recovery and informed her of this. She then said to keep him in that position until the ambulance arrived which got there in about 4-5 minutes.

In my opinion the advice to roll him on his back was bad advice considering the circumstances - breathing and circulation strong but unconscious and foaming. So I thought I'd ask here as I know there are paramedics on this forum. I fully realise that the dispatcher is much higher trained than I am but rolling someone on to his back with the described symptoms goes against every training I have received. Is there something I'm missing or not aware of?

flazio

With the greatest respect to the call taker, he/she wasn't at the scene and may not have been better trained as you think. You are well within your rights to keep the paitent in the recovery position, as you could see this was the position to best prevent the situation getting worse. The call taker was probably reading the information on his/her screen for a spinal paitent as either the girlfriend gave an answer to the automated questions to indicate spinal or not enough information was gathered therefore the call taker assumed worst case scenario which is spinal.

Had similar instructions recent. Obviously it is part of the script.

Leo Demidov

flazio wrote: »

either the girlfriend gave an answer to the automated questions to indicate spinal or not enough information was gathered therefore the call taker assumed worst case scenario which is spinal.

Airway would always take priority to spinal.

Orion

wexfjord wrote: »

Airway would always take priority to spinal.

That's what I think too. There was no indication of spinal and I'd be very certain that the dispatcher wasn't told that. While the girlfriend was hysterical I was calm and told the dispatcher exactly what was going on - key part was foaming at the mouth - that alone would keep me from putting him on his back unless he stopped breathing and I needed to do CPR.

Orion

flazio wrote: »

therefore the call taker assumed worst case scenario which is spinal.

He was already on his side when I got there. If it was spinal the advice should be not to move him at all unless absolutely necessary and let the paramedics take care of it so that doesn't apply either. Prevent further harm is the key aspect there - moving a patient with a spinal injury without correct training (which a first aider like me doesn't have) can cause further harm. I can't see any way where it was beneficial to roll an unconscious patient on to his back.

There was actually a first aid trainer just in my office and I mentioned this to him too - he couldn't believe that was the advice given.

flazio

Yeah, something wrong with the script there, while the NAS would say it's not the fault of the call taker, the job should allow for a bit of cop on from the call taker for the reality of the situations. Not one size fits all.

megabantz

a person I know rang an ambulance for a suspected spinal PT. (the 2 guys had done first aid training and knew a bit about spinal management through working with emt's and paramedics on various courses)

The PT was on her back but was choking on her own vomit (not drink related but head injury related possibly). the person making the call suggested a careful log roll with 2 others onto the PT side to stop the PT from getting worse and choking to death.. The call taker told the person to leave the girl on her back and wait for an ambulance even tho the airway was compromised.... common sense took over and the person was log rolled to prevent the person aspirating vomit and essentially choking to death.. im not bashing the call takers - far from it but the system seems flawed with removing logic and common sense from the equation. The situation I explained is a little more difficult to manage than OP situation but the outcome would have been very different if it was somebody who didn't have medical training of some sort that day to use their head and react to the situation in front of them.

GoProGaming

If at any point the pt has vomit/gue/ foam or whatever coming from their mouth they tell the caller to turn him/her on their side a quickly clean out their mouth and nose. Well they should as thats what AMPDS says to do. Then roll them flat on their back and do a head tilt chin lift to maintain the airway.

AMPDS is used in most countries for triage of emergency calls and works well. It was designed by a Dr and a team of industry experts.

Sometimes when 'first aiders' ring in they aren't the best following instructions, or so i am led to believe.

Orion

Well this man was foaming and i was told to roll him on his back. I queried it then did as instructed. Then rolled him back to recovery when he started choking. Seems the script wasn't followed so.

I'm not sure why you put first aiders in quotes. We're trained to a certain level but part of that training is to follow instructions of paramedics on the phone and to give accurate information to assist the paramedics.

GoProGaming

Orion wrote: »

Well this man was foaming and i was told to roll him on his back. I queried it then did as instructed. Then rolled him back to recovery when he started choking. Seems the script wasn't followed so.

I'm not sure why you put first aiders in quotes. We're trained to a certain level but part of that training is to follow instructions of paramedics on the phone and to give accurate information to assist the paramedics.

I put them in quotes as first aid is such a broad term and comes with a huge array in the difference and quality. AMPDS works great when it's read verbatim and followed verbatim.

megabantz

GoProGaming wrote: »

If at any point the pt has vomit/gue/ foam or whatever coming from their mouth they tell the caller to turn him/her on their side a quickly clean out their mouth and nose. Well they should as thats what AMPDS says to do. Then roll them flat on their back and do a head tilt chin lift to maintain the airway.

AMPDS is used in most countries for triage of emergency calls and works well. It was designed by a Dr and a team of industry experts.

Sometimes when 'first aiders' ring in they aren't the best following instructions, or so i am led to believe.

Don't automatically presume the 'first-aider' couldn't follow instruction and it wasn't the call taker not communicating effectively! As the OP says he queried the instruction but performed it anyways and he had to intervene when it didn't go so well!

Rachiee

I have been told by dispatch on several occasions to place OD cases who are unconscious but breathing on their flat on their back. When I queried this in first aid training with an advanced paramedic I was told that you sometimes get a much better airway in that position and recovery position is more to stop a person choking on their own vomit so once they are being monitored and can be rolled if they do start to Choke, flat on back is a good position for airway.the risk is if you were to walk away ore something I suppose.

megabantz

Rachiee wrote: »

I have been told by dispatch on several occasions to place OD cases who are unconscious but breathing on their flat on their back. When I queried this in first aid training with an advanced paramedic I was told that you sometimes get a much better airway in that position and recovery position is more to stop a person choking on their own vomit so once they are being monitored and can be rolled if they do start to Choke, flat on back is a good position for airway.the risk is if you were to walk away ore something I suppose.

I would agree with a better airway but the key difference in flat on the back vs recovery is the recovery doesn't require somebody to manually manage the airway but somebody lying flat on the back requires somebody to maintain a head tilt chin lift or at least perform this and monitor the airway

Mycroft H

Stick to your training. You were right to leave them in the recovery. Stick to your ABCs and you cannot go far wrong

megabantz

Mycroft H wrote: »

Stick to your training. You were right to leave them in the recovery. Stick to your ABCs and you cannot go far wrong

Well if the OP is right then you can go wrong if your following the wrong information in the first place

Zambia

You can imagine the information the girl was peddling to the call taker. She probably said he was dying so the call taker is trying to address that.

Well done by the way.

Orion

That is the reason I took the phone off her - she was hysterical so I've no idea what she had said. I gave the despatcher calm, accurate information. I informed her I was a first aider and described the symptoms as best I could including the position I had him in and his responsiveness state.

Thanks.

Greenmachine

Orion wrote: »

That is the reason I took the phone off her - she was hysterical so I've no idea what she had said. I gave the despatcher calm, accurate information. I informed her I was a first aider and described the symptoms as best I could including the position I had him in and his responsiveness state.

Thanks.

Sorry to hear about this. Must have been stressful to be given bad advise, in a critical situation like this. Don't know what to say, about the call responder, but, I think what another poster has said might have nailed it; what the injured guy's gf said might have led to his decision making process.

I could tell you a thing or two about eye witness testimony, and hysteria influencing people, to the point where you may as well be bashing your head against a wall to detail what really happened, in one case with dash board footage that someone should have been interested in.

AmboMan

GoProGaming wrote: »

If at any point the pt has vomit/gue/ foam or whatever coming from their mouth they tell the caller to turn him/her on their side a quickly clean out their mouth and nose. Well they should as thats what AMPDS says to do. Then roll them flat on their back and do a head tilt chin lift to maintain the airway.

AMPDS is used in most countries for triage of emergency calls and works well. It was designed by a Dr and a team of industry experts.

Sometimes when 'first aiders' ring in they aren't the best following instructions, or so i am led to believe.

AMPDS was designed by an EMT in the 1970s !

GoProGaming

Yep, version 1 was. We are now on v13. Alot of changes since then!

AmboMan

GoProGaming wrote: »

Yep, version 1 was. We are now on v13. Alot of changes since then!

Still based on a system from the 70s ! Are there changes an improvement?

Hooch

AmboMan wrote: »

Still based on a system from the 70s ! Are there changes an improvement?

The wheel is based on a 6,000yr old design........just because it's based on something from the 70s doesn't mean it's not relevant. If it is failing in some part give feedback and drive the necessary change

AmboMan

Hooch wrote: »

The wheel is based on a 6,000yr old design........just because it's based on something from the 70s doesn't mean it's not relevant. If it is failing in some part give feedback and drive the necessary change

The wheel you refer to as the AMPDS system operated by the NAS is more like a square. The basic design of the wheel is still functional today whereas the AMPDS system is not fit for purpose.

stoneill

AMPDS?
ABC followed by DCAP-BTLS then SAMPLE is where it's at now!

civdef

Don't forget your AVPU, CSM, OPQRST and IMIST-AMBO!