Recovery Position

[Guest guest]

In a message dated 2/27/2007 8:46:38 A.M. Central Standard Time,

ken.forinash@... writes:

hence all ambulance stretchers have been installed on the driver side of the

patient compartment since the early 70s.

except for all those that have center mounts

Louis N. Molino, Sr., CET

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[Guest guest]

An article in JEMS.com says the reason to put the patient on the left

side for the recovery position is because of the anatomy of the

stomach. But I've heard a dozen different things over the last 25

years, but nothing definitive. Does anyone have anything more

definitive than this, or is this finally the real answer?

=Steve=

http://www.jems.com/safety/jemsmagazine/13252/

Tricks of the Trade: Monsters at the Gate

*Are you making people barf?*

By THOM DICK

There's nothing like barf to turn a routine day into a memorable

occurrence. Barf on your uniform, on your cot, on your deck and on your

nice, shiny boots. Stuck under the hardware on your deck and in your

compartment door tracks.

EMS providers deal with emesis so often that pretty soon they can tell

what people have had to eat just by its odor. There's barbecue barf,

barbiturate barf, baloney barf, bean barf, beef barf, burrito barf, beer

barf (very common --- but not the same as bourbon barf or burgundy

barf), blood barf, bile barf, even baby barf. Come to think of it, I've

never seen popcorn barf. Maybe popcorn is good for you. Jelly beans, too.

All barf is nasty. It's slippery, slimy, sticky and smelly, and it gets

into every nook and cranny of an ambulance. It always produces a stench

that doesn't go away until at least a few days later. (OK, maybe even

months.) No matter how you try to cover it up, it's like it gets in your

nose or something and stays there to filter your day.

I'm thinking we deal with an awful lot more barf than we need to. In

fact, maybe we've been making perfectly good people barf for years ---

even before the esophageal obturator airway was invented.

The 1969 American Red Cross Advanced First Aid manual said that when

somebody was unresponsive, you were supposed to put them on their left

side. It never explained why. The famed Orange Book, which was published

that same year and from which I learned my first EMT stuff, said the

same thing: left side. Again, no explanation. My first EMT instructor

said it really didn't make any difference, but he was wr --- wr ---

possibly mistaken.

The ambulance driver who taught me how to run calls saw things a little

differently, but at least he had a reason. " Put them on their right

side, " he said. " That way, if they throw up they hit the wall instead of

throwing up all over you. "

Over the years, hundreds of thousands of EMTs have learned from

instructors who used that reasoning. It's become a basic principle of

transport. But I think it's a mistake.

It's true that if you transport people on their right side and they

throw up, you don't get a shower. But in my own experience, when you put

them on their left side, they don't throw up. Not nearly as often,

anyway. I think there's a good reason for that, and like all good

reasons, it's about as simple as beer flowing downhill and not up.

Think back to your first introduction to human anatomy. Where's the

stomach? It's to the left of the midline, directly under the diaphragm.

Where does it fill? It fills in the midline, at the point where it

attaches to the esophagus. Normally, the cardiac sphincter is like a

check valve. It allows the contents of the esophagus into the stomach,

but doesn't let them come back and say howdy.

If somebody's stomach is empty, you can put them on whichever side you

want to and they won't ralph. But if their stomach is full and the

patient is on their right side, you're defying gravity. That's dumb! The

entire contents of the stomach are uphill from the opening of the

esophagus, and now you're taking them for a bumpy ol' ambulance ride

(urp). Ever see Lord of the Rings? Remember when all those monsters were

banging on the gate of that big castle? That was a pretty strong door,

but sooner or later the monsters busted through it.

Do yourself a big favor. Next time you have an unconscious patient and

they're not in a C-spine device or cardiac arrest, put them on their

left side. That, and give them a nice, smooth ride to the hospital.

They have mops there.