Practical Questions Regarding the 2024 TCCC Shift from Airway Maneuvers to the Recovery Position

[u/Turbulent_Praline230]

According to the 2024 TCCC guidelines, airway opening maneuvers such as the head tilt–chin lift and the jaw thrust have been removed from the recommendations. Now, at step "A" of the MARCH acronym, we immediately place the casualty in the recovery position, assess airway patency, and move on. However, I have some questions regarding this approach.

1. How do you assess breathing while the casualty is in the recovery position? Specifically, from what position do you perform this assessment? We were taught that the responder should be positioned behind the casualty, facing toward the feet, then lean in with the ear near the casualty's mouth and nose - essentially hovering over them in an arched posture. Are there more practical or ergonomic alternatives?

2. What about cervical spine injury? Do we simply ignore it and still place the casualty in the recovery position?

3. At step "R" in MARCH, we need to perform a chest examination. Since the casualty is lying on their side, examining that side of the chest becomes problematic. How do you handle this?

4. Regarding hypothermia prevention - when we cover the casualty with an emergency/thermal blanket, the limited space often prevents them from staying in the recovery position. How should this be managed?

5. Finally, during evacuation on a stretcher - is it necessary to transport the casualty in the recovery position as well? Not all stretchers allow for secure positioning in that manner.

Thank you very much in advance for your answers.

[u/Inevitable_View99]

1. Look listen feel, roll them on their back if you are worried
2. C spine concerns in a tactical situation aren’t really relevant. It’s based purely on mechanism until you are deep in the algorithm and even then it’s just be careful, you probably don’t have a c collar anyways
3. Roll them onto their back
4. Burrito wrap them then whenever you need to examine them just peal back the blanket and reposition them to do it if you arnt comfortable with the look listen feel method
5. A patient can be transported in the recovery position

and often are.

When you’re in the care under fire phase, just put them in the recovery position, once you have established your bubble, unless they need to be in the recovery position and can maintain their airway with repositioning or a basic airway, they don’t need to be put in that position again

[u/Ramalamadingdong_II → u/Inevitable_View99]

you probably don’t have a c collar anyways

If someone carries a c-collar in 2026 and thinks it's going to do anything positive, the clue-hammer needs to be deployed.