If someone is unresponsive but breathing normally, the recovery position keeps their airway open and clear, and stops vomit or fluid from choking them. But when you suspect a spinal injury, the rules change: unnecessary movement can make the injury worse, so the default is to keep the casualty still and only move them if their airway is in danger — because an open airway always takes priority over keeping the spine still.
This guide explains when to move someone with a suspected spinal injury, when to leave them where they are, and how to move them safely — on your own, with a helper, or as a team using the log roll.
Last reviewed: September 2026 — checked against Resuscitation Council UK Guidelines 2025.
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First: call 999 and check their breathing
Before you think about any position, follow this sequence:
- Check for a response. Talk to them loudly and gently squeeze their shoulders. If they don’t respond, they are unresponsive.
- Call 999 straight away for any unresponsive person. Put the phone on speakerphone so your hands are free, and follow the call handler’s instructions. If others are nearby, send someone to meet the ambulance.
- Check their breathing. Look for chest movement and listen and feel for breath. If you suspect a spinal injury, open the airway without tilting the neck: place your hands on either side of their head and gently lift the jaw with your fingertips (a “jaw thrust”), taking care not to move the neck.
- If they are not breathing, or not breathing normally, start CPR immediately. Occasional, noisy gasps (agonal breathing) are not normal breathing — treat them as absent. Give 30 chest compressions in the centre of the chest, pressing down 5–6 cm at a rate of 100–120 per minute, then 2 rescue breaths if you’re trained and confident (hands-only CPR if not). A suspected spinal injury does not change this: CPR takes priority, and the casualty must be on their back on a firm surface.
- If they are breathing normally, use the guidance below to decide whether to leave them still or move them.
When to leave them where they are — and when to move them
Suspect a spinal injury if the person has fallen or dived from a height, been crushed by machinery or a heavy object, or been involved in a road traffic or sporting accident — or if they complain of severe neck or back pain, cannot move their neck, feel weak, numb or unable to move, or have lost control of their limbs, bladder or bowels.
If they are unresponsive but breathing normally, do not move them into the recovery position. Instead, leave them in the position you found them, kneel behind their head and hold their head and neck steady with your hands to keep them in a neutral, in-line position, and keep monitoring their breathing until the emergency services arrive.
If they are awake and alert, encourage them to keep their neck still themselves in a comfortable, stable position. Never force an uncooperative person into any position, as this may make an injury worse.
Only move them if the airway is at risk — for example, they vomit, you cannot keep the airway open where they lie, or you have no choice but to leave them alone to get help. If you must move them, keep the head, neck and spine in a straight line and roll them as a single unit, ideally using the log roll with several helpers.
If they are lying face down, check whether their airway is open and hold their neck stable. If you need to open the airway, ask others to help you carefully roll them as a unit onto their back, keeping the neck in line with the body, then support the head as described above.
How to perform the recovery position for spinal injuries:
Performing the recovery position solo:
- With the person lying on their back on a flat surface, kneel on the floor at their side. Throughout, try to keep the head, neck and spine in a straight line.
- Extend the arm nearest you at a right angle to their body, with the palm facing up.
- Take their other arm and fold it across their chest so the back of their hand rests against the cheek closest to you, and hold it there.
- With your free hand, bend the knee farthest from you to a right angle.
- Carefully pull on the bent knee to roll them towards you onto their side, moving them slowly and smoothly so the head, neck and back move together and stay in line. Their bent arm will support the head, and their extended arm will stop you rolling them too far.
- Make sure the bent leg stays at a right angle to stabilise them.
- Check the airway is open and that nothing is blocking it, supporting the jaw rather than tilting the neck.
- Stay with them and monitor their breathing continuously until help arrives.
Performing the recovery position with a helper:
- One of you should kneel behind the casualty’s head and keep the head, neck and spine in a straight line while maintaining an open airway.
- The other rolls the casualty into the recovery position following the steps above, moving on the head-holder’s signal so the body turns as one unit.
Performing the recovery position with four or more people:
If there are four or more people, the log roll method can be applied.
- While supporting the casualty’s head and neck to keep them in line and maintain an open airway, ask your helpers to gently straighten the casualty’s limbs.
- Position two or three people along one side of the casualty to roll them towards themselves, with the person at the head leading and giving the commands.
- The helpers preparing to roll the casualty should place their hands to support the shoulders and arms, the hip, and the far leg, so that the whole body can turn together.
- On the head-holder’s signal, roll the casualty as a single unit, keeping the head, neck and spine straight and the airway open at all times.
- Once the casualty is on their side, support the upper leg to keep the spine straight. Continue to keep the airway open and the head, neck and spine in line until the emergency services arrive and take over.
While you wait for the ambulance
- Keep monitoring their breathing. If they stop breathing normally at any point, roll them onto their back and start CPR straight away.
- Keep them warm with a coat or blanket, and do not give them anything to eat or drink.
- Do not leave them alone unless you have absolutely no other way of calling for help.
- Note any changes in their condition — and when they happened — so you can tell the paramedics.
What to tell the 999 call handler
- Your exact location.
- What happened — the mechanism of injury matters, so mention a fall from height, a dive into shallow water, a crush injury or a road traffic collision.
- Whether the person is responsive, whether they are breathing normally, and any obvious injuries or bleeding.
- Stay on the line, keep the phone on speaker, and follow the call handler’s instructions — they will talk you through exactly what to do until the ambulance arrives.
If you or your employees need first aid qualifications, take a look at our range of first aid training courses. Alternatively, get in touch today to find out more.
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