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BLS Basics: Positioning Best Practices

When performing basic life support in the field, it’s absolutely essential that the

patient as well as those delivering the care be in the best possible positions.

While some instances may find the victim in an awkward position due to

incapacitation, the chest compressions of BLS rely heavily on the physics of action.

As such, a poorly positioned patient or provider can dramatically reduce the

effectiveness of resuscitation efforts. In emergency medical situations, or those in

which the patient has undergone some type of trauma, the problem of patient

positioning becomes even more of a challenge.

Even in a hospital or emergency room setting, patients receiving CPR should always

be positioned correctly. Attempting to perform CPR on someone who is lying on a soft

bed, for example, will likely not result in the most effective perfusion.

Additionally, having to work around a team of other responding medical personnel can

further exacerbate the situation. These problems compound even more once ACLS

begins; however, even with BLS, delivering the proper compressions and breaths can

be likened to a well-choreographed dance.

To optimize your ability to deliver effective basic life support to patients in your

care and improve the likelihood of a positive outcome, let’s take a deeper dive into

the best practices of patient positioning below.

Orienting the Patient


To achieve optimal results with BLS, the patient should be lying flat on his or her

back, on a hard surface, and ideally one which provides accessibility to his or her

head. Of course, as most experienced emergency medical professionals and first

responders are already well aware, this simply isn’t always possible. It can be

nerve wracking to determine whether or not a patient could or should be moved into

the correct position to receive CPR, particularly in instances in which there may be

other injuries that have not yet been diagnosed and/or treated. In cases of life-

threatening medical events, however, such as cardiac arrest, moving the patient

immediately, prior to a spinal clear, is often necessary for their chances of


In the field, it can be incredibly difficult to move a patient into the proper

position for BLS best practices. Even if the event occurs in a public place, there

may simply not be adequate space to stretch the victim out in order to administer

chest compressions. In these instances, the priority should be getting the patient

onto a stretcher as quickly as possible and, hopefully, into the ambulance where CPR

can be properly performed. It should be noted, however, that the amount of time it

takes to transport the patient will play a role in his or her likelihood of

survival. As such, EMS workers should always exercise their best judgment when

determining why and how a patient is moved for CPR.

Backboard Use


Using backboards is also important in BLS patient positioning. In order for chest

compressions to work, the heart must be effectively squeezed between the hands and a

hard surface. Beds, grass or other soft surfaces typically do not provide for

adequate squeezing of the heart, which means the compressions may not be able to

effectively push blood through the patient’s body. Moving the patient onto a

backboard, however, counteracts this, ensuring that the compressions are effective

and improving the overall survival chances of the victim.

It can be easy to arrive onto a chaotic emergency medical situation and want to

begin compressions immediately, but the mechanics involved must always be

considered. This is especially the case if the patient happens to be lying on a bed

or other soft surface, in which case rolling them onto their side and sliding the

backboard underneath them before resuming compressions is advised. Forgetting or

overlooking this important step could severely impact the patient’s ability to


To accommodate this need, most crash carts include a short backboard. Likewise,

ambulances are also equipped with hard, flat boards that can be used. The challenge

lies in remembering to get them into place during a chaotic emergency medical

situation. To prevent this, always keep in mind the critical importance of a hard

surface when administering CPR and utilize the tools that are available to you.

Care Team Placement


Highly effective life support generally requires more than one person. In some

cases, you may not have this luxury and may therefore find yourself faced with

performing CPR entirely by yourself. In those cases, it’s important to focus solely

on compressions. But because compressions can be downright exhausting, which can

impact your effectiveness, it can be helpful to enlist the help of an additional

person who can assist with those compressions. That way when one person becomes

fatigued, the other can step in and take over without any dangerous interruptions to

the patient’s care.

Another important component of BLS is the rescue breaths. If more than one person is

present to assist in administering CPR, rescue breaths can be attempted. If there

are only two people working on the patient, they can switch off between each job.

This can, at the very least, alleviate some of the strain that compressions can


In ideal cases, when an entire care team is present, one person is typically

designated to hold and operate the bag-valve-mask while several other providers

focus on compressions, switching off with one another as needed. Ideally one person

should be positioned at the head for breaths, one should be at the chest doing

compressions and the rest should remain on standby, ready to take over if and when

necessary. It is through this collaborative team effort that BLS can be most

effectively performed, greatly improving the patient’s chances of survival.

Delivering life-saving medical care is no small feat. In order for BLS to be

effective, everyone involved must be in the best position possible – especially the

patient receiving the care. The guideline above should help clarify the importance

of using a hard flat surface, what your options are and which best practices should

be followed for optimal results.

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