Whilst finding someone unconscious is a scenario that very few people are likely to experience in their lives, it’s something that is always covered in first aid. Unconsciousness can be a sign of a serious medical incident, and the speed and skill with which you handle the situation can save someone’s life.
In order to make it easy for people to react quickly and effectively when someone is unconscious, several acronyms and techniques have been developed that present a clear course of action based on what has happened. This includes the AVPU scale, DRS ABC, and the recovery position.
In this article, we explain each of the four stages of the AVPU scale, what to do if an unconscious person is breathing, and how to respond to an unconscious casualty that has stopped breathing.
Please Note: The information in this article does not qualify you as an official first aider, and Virtual College advises calling 999 in the first instance at the scene of an emergency before attempting any form of first aid.
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.
Unconsciousness is a physical state where a person is unable to respond to any stimuli and is not aware of their environment. It may appear as if they are asleep, but they cannot be woken up.
When someone is unconscious, they usually fall to the ground as they are no longer able to hold themselves up. They won’t respond to being spoken to or touched, which can make it difficult to move them into a safe space or position.
People are sometimes only unconscious for a few seconds, after fainting for example, or can remain unconscious for months or even years in a comatose state. If you discover someone unconscious, it is important to first determine whether they are totally unaware of their surroundings and unable to respond to stimuli, which the AVPU scale can help with.
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.
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.
Before 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.
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 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.
If you discover someone unconscious, the acronym ‘DRS ABC’ can be used to dictate the steps you take to help them. This is also known as the ‘primary survey’ and begins by checking for danger around the casualty and then checking for a response from them if you feel like the situation is safe.
After shouting for help, the next step of the primary survey is to open the unconscious casualty’s airway and then check for breathing.
To check whether someone is breathing, you should first make sure they are lying on their back and that their airway is open. You can open their airway by pressing two fingers underneath their chin and tilting the head back.
The easiest way to check for breathing is with a visual check. Look at the person’s chest and see whether it is rising and falling, indicating that they are still breathing.
You can also audibly check for breathing by getting close to the casualty’s face and checking to see if you can hear their breath. If you feel comfortable being this close, you might also be able to feel their breath on your cheek, or you could use your hand to check for this as well.
If you check for breathing and find that the person is breathing but unresponsive, you should call for an ambulance by dialling 999. If you’re with someone else, try and get them to do this whilst you are checking the casualty’s breathing.
The best thing to do next is to put the unconscious person in the recovery position.
A person who is unconscious but breathing should be placed in 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.
To put someone in the recovery position, place the arm that is near to you at a right angle and the other arm across their body so their hand is resting on their face. Take hold of the knee that is away from you, bend this, and then use it to roll the person onto their side. Their bent leg and bent arm should keep them stable on their side, whilst their other hand should give their face some protection from the ground.
Once someone is in the recovery position, tilt their head back again to ensure that their airway remains clear. If you’re really struggling to move the casualty into the position outlined above, just focus on rolling them onto their side and keeping their airway open.
If the unconscious casualty looks injured, you are still advised to move them into the recovery position, unless doing so is obviously going to cause significantly more damage. 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.
If you check to see whether an unconscious casualty is breathing and you don’t think that they are, the most important thing you need to do is call for an ambulance. Explain to the operator that the person is unconscious and not breathing so that help can hopefully arrive as soon as possible.
If you feel confident, you are advised to give the person that isn’t breathing CPR to try and get them breathing again and keep the blood circulating around their body. Start giving chest compressions by placing one hand on top of the other and putting the heels of your hand in the middle of their chest. Press down firmly and release in a regular rhythm until help arrives.
If you can, you can also give rescue breaths in between chest compressions, although you may not feel comfortable or confident and that’s fine. Chest compressions are most important, but you can give two rescue breaths every 30 compressions if you want.
The first thing you should do if a person is unconscious and not breathing is to call the emergency services on 999. Tell them what has happened and that you have a casualty that doesn’t appear to be breathing, and in many cases the operator will talk you through what you should do next.
To check whether someone is breathing, you are recommended to watch to see if their chest is rising and falling for at least ten seconds. You can also listen over their nose or their mouth for sounds of breathing, or lean your cheek over their face and try to feel their breath on your skin.
The recovery position puts someone in a position where their airway is open and clear. This gives them the best possible chance of continuing to breathe normally and also minimises the risk of them choking whilst they are unconscious.
It’s easy to panic if you find someone unconscious or someone you are with becomes unconscious, especially if you’ve never had to administer first aid before. Staying calm and following guidance is the best way to manage the situation and prevent any serious harm to you or the casualty, and following the steps that we have outlined above is the best way to do this.
For more information about what to do if you find someone unconscious, we cover this topic and many more in our ‘First Aid at Work’ online course, which focuses on how to carry out the primary survey.