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.
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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