Brief overview
- What does shock positioning mean? In the shock position, the first aider positions the legs of the victim lying flat on their back higher than their head. This is to prevent them from becoming unconscious or their circulation collapsing.
- This is how the shock position works: lay the victim flat on their back on the floor, place their legs about 20 to 30 degrees higher than their upper body/head on a solid object (e.g. stool) or hold them up.
- In which cases? For various types of shock.
- Risks: None, unless shock positioning is used in the wrong cases (see under “Caution!”).
Caution!
- Do not use shock positioning for shock originating in the heart (cardiogenic shock, e.g. heart attack) – the shock position would put additional strain on the heart!
- Do not use the shock position for severe hypothermia, respiratory distress, broken bones, chest and abdominal injuries or injuries to the head and spine! In the case of injuries and wounds above the hip, the shock position would increase the blood flow there.
How does shock positioning work?
Shock positioning (shock position) is used in first aid to stabilize a patient’s circulation until the emergency services arrive. It is used if the victim is still conscious.
How to proceed with shock positioning:
- Position his legs about 20 to 30 degrees or about 30 centimeters higher than his upper body/head. You can either hold them or place them on a box, step, etc. This will improve blood flow to the brain and other organs.
- Keep the victim warm, for example with a jacket or (rescue) blanket.
- Talk reassuringly to the person lying down and avoid causing them any further excitement.
- Check the patient’s breathing and pulse regularly until the emergency services arrive.
- Try to stop any bleeding (e.g. with a pressure bandage).
The blood from the legs flows back to the center of the body during shock positioning. The vital organs are thus better supplied with oxygen. It is best to lay the affected person on a blanket and wrap them up. This prevents hypothermia. Talk to the patient reassuringly and avoid any unnecessary strain. If the patient loses consciousness before the emergency services arrive, place them in the recovery position.
Do not allow the patient to eat or drink anything if they are in shock.
What is shock?
Doctors distinguish between different types of shock, including
- Hypovolemic shock (triggered by a lack of volume, i.e. severe loss of fluid/blood)
- Cardiogenic shock (triggered by an inadequate pumping capacity of the heart, e.g. in the event of a heart attack, myocarditis or pulmonary embolism)
- Anaphylactic shock (severe allergic reaction)
- Septic shock (in the context of blood poisoning = sepsis)
- Neurogenic shock (in the event of failure of nerve-related blood pressure regulation, e.g. spinal cord injuries)
Shock can be recognized by symptoms such as pale skin, shivering, trembling, cold sweats, restlessness and anxiety. Listlessness and impaired consciousness are also signs of shock.
Shock must always be expected in injured and/or sick people. Small children in particular may initially appear to be fine until they suddenly collapse.
When do I perform shock positioning?
Shock positioning is carried out if the affected person is still conscious and breathing on their own. It is generally considered in the following cases:
- volume deficiency shock (unless it is due to severe bleeding in the upper part of the body, as the shock position would then increase the blood flow there and thus the blood loss)
- anaphylactic (allergic) shock
- septic shock
When should I not use shock positioning?
Do not use shock positioning for
- cardiogenic shock and cardiac diseases in general
- respiratory distress
- Head and spinal injuries
- Chest and abdominal injuries (generally for wounds above the hip)
- broken bones
- severe hypothermia
Risks associated with shock positioning
As a first aider, there is not much you can do wrong with the shock position – unless you use it in cases where the shock position is not recommended. For example, if you elevate the legs of a patient who is bleeding from the head, chest or abdomen, this can increase the bleeding.
If you place a patient with a spinal injury in the shock position, moving them can aggravate the injury.
If someone is severely hypothermic, the well-intentioned shock position can cause a lot of cold blood to flow back into the center of the body. This can exacerbate hypothermia.
The shock position can also be very dangerous for patients with shock originating from the heart (cardiogenic shock) – the increased blood reflux caused by elevating the legs puts additional strain on the pumping weak heart.
