Please note that this information does not qualify you as an official first aider, and Virtual College advise calling 999 in the first instance at the scene of an emergency.
This material and any associated assessments do not constitute a qualification or accreditation as an official first aider. All content provided is for general information only.
Virtual College advocate dialling the emergency services before attempting any form of first aid.
There can be many reasons that a person may fall unconscious and require medical attention, but the process by which a first aider gauges the severity of the situation is generally the same. Most professionals will use the AVPU scale, which stands for Alert, Voice, Pain and Unresponsive. The aim of this system is to quickly find out at which level the casualty is at, which will help determine how to deal with an unconscious adult.
In this article, we’re going to go through each of the four stages, explaining what they mean, and how you can determine what level a casualty is at, should you encounter them in a first aid situation.
At the very top of the scale is a person that is visibly and clearly awake, and can respond to normal stimuli. They will be able to move of their own accord, respond to being spoken to, and will have their eyes open for the most part. They may however be confused and not fully aware of the situation that they are in, which is not uncommon for casualties who have previously been unconscious. In many cases, a person at this stage only, will not require emergency medical treatment unless their condition deteriorates. However, you should continue to monitor their condition.
Below the alert stage is that of people who can respond to being spoken to, but are otherwise not alert. Responses to being spoken to can include everything from a verbal reply, to physical movement (often known as a motor response), or the opening of their eyes. For example, if you are first on the scene of an accident, and encounter an unmoving person with their eyes shut, who opens their eyes when spoken to, they would be described as responding to voice. You may need to speak very loudly to some people in order to elicit a response, and this information should be relayed back to medical professionals.
Prior to determining that someone is completely unresponsive, you should see if they respond to pain signals. Again, a response may come in the form of eye, motor or verbal. This is one of the more delicate steps in first aid, as causing pain to a casualty could exacerbate the situation. As a result, the two primary recognised methods for applying pain without causing undue stress or damage are to either pinch the ear, or sharply press the bed of the fingernail. These actions should not cause damage to the person, but should be painful enough to elicit a response in all but those who are completely unconscious.
The most severe of the four levels is Unresponsive. This means that the casualty does not respond in any way, whether eye, verbal or motor, to either your voice or the application of pain. They will therefore almost certainly be entirely unconscious.
Note: If the person you’re dealing with moves between some of the above states, which is entirely possible in many circumstances, they are assumed to be at the level of the scale that they maintain consistently. If, for example, they always respond to pain, but only occasionally respond to voice, they are considered to be at the P rather than V stage.
In general, anyone found to be below A on the AVPU scale requires professional medical attention, and you or another attendant should call for the emergency services on 999 as soon as possible. It may be helpful to explain their current state in terms of the AVPU scale, as this can help determine further treatment and the severity of the situation.
A person who is unconscious should be placed into the recovery position until help arrives. The aim of this is to help them hold an unobstructed airway, and reduce the chances of choking on either vomit or their own tongue. In addition, you should look to treat any other ailments that they may be suffering from, such as bleeding. Should you encounter multiple people in varying states of response, those in lower levels of the AVPU scale should take priority.
For more information about how to place someone into the recovery position, please read our dedicated page on the subject here. We also have further resources and first aid courses on dealing with casualties in accident situations here.