Side position of safety

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The side position of safety (or PLS ) is a gesture of First aid to be practiced when one is in the presence of an unconscious person, who breathes and who is dish-back.

This technique is used to maintain the freedom of the higher air routes, i.e. the passage of the air to the lungs. Indeed, the main risk is that the person chokes herself by the closing of the épiglotte (valve which normally prevents food from penetrating in the lungs) and contents of the Estomac (which is emptied slowly, since the Muscle which closes it does not have any more tonicity). With this intention, one places the victim on the side, in dog of rifle, by maintaining his head in rocker, the mouth directed downwards; sometimes in medical language, one speaks about side Décubitus to mean that the body horizontal and is turned on the side.

This technique is not an end in itself but falls under a step of first aid:

protection
assessment
put in PLS
alarm at the public helps
monitoring

Techniques to turn in PLS

Isolated rescuer

There exist several techniques of reversal. The technique suggested hereafter was recommended by the European ressuscitation council (ERC) in 2000 and was adopted by the countries of the European Union (in 2001 in France), and makes it possible to maintain the cervical ones (most fragile Vertèbre S, presenting the vital risk most important and most probably touched in the event of cranial Traumatism).

After having checked that the victim is unconscious and breathes (existence of ventilatory movements) and released the air routes (to unhook tie, collar, girdles, first button of the pants, visual inspection of the mouth to withdraw the possible foreign bodies), the rescuer withdraws the glasses if the victim in has and aligns the legs in the axis of the body.

Then, it is placed on the side of the victim (see discussion hereafter for the side of the reversal) on the level of the chest, and places the arm which is side of the reversal with right angle by making it slip palm upwards. The elbow is folded in order to form a right angle; because of the anatomy, the wrist is naturally with the top of the ground and the hand hangs slightly.

The rescuer seizes then the opposite wrist and places the back of the hand against the cheek which is side of the reversal; thus, the hand will make a cushion for the head, and the arm constitutes a rigid triangle which will be used to relay rotation and of crutch in final position. The rescuer plates then his hand against the palm of the hand of the victim; he thus supports the head during the reversal and avoids the mobilization of the cervical ones.

With the freehand (that side of the feet), the rescuer seizes the hollow poplity (back knee) of the leg opposed while passing over the knee. He raises the knee; the leg forms a triangle thus.

The rescuer moves back himself then to leave the place to the reversal, then made swivel the victim slowly and regularly while making use of the thigh like lever.

Once the victim in stable position, the hand which held the knee places at the elbow in order to maintain the arm while the rescuer withdraws his hand of lower part the head of the victim. The thigh which is used as crutch is placed at right angle compared to the body. It opens the mouth to him to support the flows.

The victim is protected from the bad weather, for example covered with a clothing or a cover (except the parts presenting an obvious traumatism), then the rescuer prevents or makes prevent the helps.

While waiting for the helps, it checks regularly (every minute) that the victim continues to breathe: it is placed vis-a-vis it, looks at its face, and places its hand on the abdomen to perceive the respiratory movements.

Technique with two or three first-aid workers

When two or three people are available and when a traumatism of the rachis is supposed, one uses both or three first-aid workers for the reversal, which makes it possible to maintain the axis right head-neck-trunk and without torsion. The first-aid worker more experienced (the chief) puts himself at the head of the victim and maintains it between its hands. It can use a latéro-side catch or a catch occito-mentonière; in this last case, the hand which maintains the chin is that which is side of the reversal, and the palm is placed against the cheek. It will be used as coordinator for the operation.

If the victim does not present obvious respiratory distress, one will take time to pose a cervical Collier before the reversal.

French method between 1991 and 2007

The second first-aid worker maintains the hip while the third aligns the legs. the arm on the side of the reversal is isolated body by making it slip on the ground palm to the top, until forming an angle slightly higher than the right angle. One poses a cushion, sometimes called “block” (cover or folded clothing), beside the head of the victim, side of the reversal; the thickness of this cushion must be half of the distance between the neck and the shoulder of the victim. Then, two solutions are possible:

the two other first-aid workers lay out themselves on the side of the patient, most extremely of both with the chest, the second with the legs; these two first-aid workers cross their hands (see figure) in order to ensure an optimal uniformity of the push, and thus one maintains spinal column in its alignment;
- or -
a first-aid worker is placed on the level of the chest, side of the reversal; with the hand which is side of the head, it seizes the opposite shoulder and makes pass the opposite arm of the victim on its arm; it puts its other arm on the opposite hip; the other scourist places himself at the feet of the victim, in regardatnt the head, and seizes the ankles.

The chief asks “for Team-members are you ready? ”; the team-members must answer “Ready (E)”, the team-member present at the feet speaking in first, followed by that being to the level of the trunk. The chief orders then: “Attention to turn… To turn! ”; in a synchronous way, the first-aid workers turn the victim of a block, without torsion, until a semi-ventral position (approximately 45° with the ground). The head rests then on the cushion.

The first-aid worker with the legs releases taken and comes to place the leg of the top at right angle, by bending the thigh. If the victim must be raised, it places the foot in the hollow poplity (back of the knee) of the leg on the ground. This same first-aid worker seizes follows the arm of the victim to place it elbow on the ground, wrist on the arm on the ground. At this time there, the victim is stabilized, and the first-aid worker with the chest can release taken delicately, by making sure that the victim does not move.

The échant case, a first-aid worker comes to maintain the head of the victim so that the chief can be removed the hand placed under the head; if not, the chief can keep this catch in preparation for the raising.

The victim is covered, and a first-aid worker places herself vis-a-vis the victim to supervise his face, and puts a hand on the abdomen in order to feel the persistence of the movement respiratory and to detect possible a respiratory Arrêt.

French method version 2007

The setting in PLS was modified in order to approach the method to a person. After the installation of the cervical collar, the second first-aid worker takes the front armlever of the victim opposed to the side of the reversal, and poses the back of the hand against the ear on the side of the reversal; this hand is maintained by the hand of the chief, palm against palm. Then, the second first-aid worker sets up the arm on the side of the reversal (arm with right angle of the body, bends folded with right angle, palm upwards), and seizes the shoulder and the hip on the side opposed to the reversal.

The chief orders then: “Attention to turn… To turn! ”; the second first-aid worker makes roll the victim while drawing on the shoulder and the hip while the chief accompanies the head. Once the victim on the side, the second first-aid worker seizes the lower extremity located in top, and bends the thigh and the knee with right angle. Then, it places a cushion under Al hand of the chief who supports the head, and will open the mouth so necessary.

In the event of obese victim, the second first-aid worker can make use of the leg like lever, as for the PLS with a rescuer.

Particular cases

Expectant mother

An expectant mother must always be lengthened on the left side , in order to avoid the risk of a crushing of the lower vena cava by the fetus, which can result in the death of the patient.

Flexible victim

In the case of a flexible victim, at the time of the setting on dimensioned by a rescuer alone, the victim will not turn completely and the trunk risks to remake it to rock on the back. To avoid this, it is enough that the rescuer fixes the knee of the victim with his knee. It thus keeps its freehand to finish positioning the victim in PLS.

Helmeted victim

The withdrawal of the helmet is a delicate operation which should be carried out only by one trained first-aid worker. If it is the case, then the helmet is withdrawn before the setting in PLS. If not, the victim can be turned in PLS with its helmet. Of course, the report of the stop of breathing forces to withdraw the helmet to be able to carry out a cardiopulmonary Réanimation effective.

Victim sitting in a vehicle

A sitted victim is not lengthened on the back, the problem of the air obstruction of the routes is thus not posed same manner. In this case, one leaves the victim sitting in the vehicle, and one delicately rectifies it on his seat: the first-aid worker places a hand under the chin and the other behind the nape of the neck (taken occipito-mentonnière), and brings back the head in neutral position, in the axis of the trunk, by exerting a light traction; he keeps this psition until the arrival of the helps.

In team, in the case of a victim located at front, a first-aid worker assied on the back seat and maintains the head by a latéro-side catch, by pressing its front armlevers on the file of the seat.

Victim flat belly

In the French texts between 2001 and 2007, one considered that a victim flat belly did not require a setting in PLS. Indeed, the position “on the belly” ensures to maintain the freedom of the higher air routes, it thus had just to be made sure that the victim breathed well.

In 2007, procedure with changed: a victie unconscious and lengthened on the belly must be turned on the back in order to be able to control its breathing; then, if necessary, it is put in PLS.

Monitoring

The monitoring of the victim consists with:

To control the evolution of the vital functions of the victim: to stimulate regularly the victim to detect a resumption of the conscience, to control breathing to detect a respiratory Stop
To visually note the signs of evolution of the state of the victim: sweat, paleness, etc
To announce to the helps the evolution of the state of the victim: as soon as the state of the victim evolves/moves, it is imperative to announce it to the first-aid organizations: that can modify their answer (e.g.: rescue squad sending simple can be followed by medicalized team sending if an unconscious victim makes a respiratory Arrêt)
Parler and to reassure the victim: even if she does not speak, she can hear the voice of the rescuer. Simplest being to explain the gestures in progress.

A person who takes again conscience must be imperatively supervised until the victim is dealt with by specialized helps.

Moreover, in front of a victim whose state of consciousness changes on several occasions (conscious => unconscious => conscious), it is essential to note specific times of the changes of states. One speaks then about free intervals.

PLS and traumatisms

The fact of putting a person in PLS implies a mobilization of the members and back, which can worsen a possible traumatism (for example to worsen a fracture). It is necessary well to put out of balance two things:

one is sure that the victim is unconscious, and this unconscious will emerge within times runs towards a smothering by the fall of the language and the épiglotte, and by the invasion of the lungs by the contents of the stomach (the contents of the stomach are acid and will damage part of the lungs, Syndrome of Mendelson); perhaps
the victim has a traumatism, which will be perhaps worsened by the setting in PLS; one thinks in particular of the risk of paralysis or death in the event of traumatism of the Spinal column, but also of a possible internal bleeding caused by the movement of a fracture.

The medical position of the authorities in France is clear: the risk of death of an unconscious person precedes in front of the possible aggravation of a possible traumatism, therefore any unconscious person, who breathes and who is found dish-back will be turned in PLS while waiting for the helps . In addition, the method of reversal was studied to minimize the risks of aggravation. The guide of the ERC specifies besides:

“Finally, it should be stressed that in spite of possible problems during the drive and the implementation, it is absolutely certain that the setting in position side of safety of an unconscious victim and who breathes can save the life to him. ” (free translation of Finally, it must Be emphasized that in splashes off possible problems during training and in uses, it remains above doubt that placing the unconscious, breathing victim into the recovery position edge Be life saving. )

Other countries can have another step; one is within the framework of a debate of experts who escapes the rescuers, there is probable that it is no miracle solution, it is thus advisable to conform to the practices and the legislation of each country.

External bonds

European Resuscitation Council Guidelines 2000 for Adult BASIC Life Support, file pdf (7p, 145 KB) - nonvalid Bond
European Resuscitation Council Guidelines 2005 for Adult BASIC Life Support BLS Life Support 2005
European Resuscitation Council pdf Document Young stag

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