- decreased level of consciousness (glasgow coma scale < 10) or precluding ability to self-reposition. - hemodynamic instability (systolic blood pressure < 90 mmhg and or lactate >5 mmol/l or hr >120, not responsive to fluid resuscitation). - complete bowel obstruction. - active upper gastrointestinal bleeding. - poor neck mobility or patient inability to lie prone comfortably. - unstable spine, femur, or pelvic fractures. - pregnancy - third trimester. - full resuscitation status including icu and willingness to accept invasive mechanical ventilation (i.e. r1/r2 goals of care). - imminent palliation or end of life expected on admission (i.e. c1/c2 goals of care).

- decreased level of consciousness (glasgow coma scale < 10) or precluding ability to self-reposition. - hemodynamic instability (systolic blood pressure < 90 mmhg and or lactate >5 mmol/l or hr >120, not responsive to fluid resuscitation). - complete bowel obstruction. - active upper gastrointestinal bleeding. - poor neck mobility or patient inability to lie prone comfortably. - unstable spine, femur, or pelvic fractures. - pregnancy - third trimester. - full resuscitation status including icu and willingness to accept invasive mechanical ventilation (i.e. r1/r2 goals of care). - imminent palliation or end of life expected on admission (i.e. c1/c2 goals of care).