The rapid assessment of an unresponsive individual is a fundamental step in emergency response, where speed and precision directly impact the chance of survival. A standardized, quick primary assessment is implemented to determine the immediate need for life-saving interventions. This process is designed to be streamlined and efficient, ensuring that no time is wasted before activating emergency services and beginning care.
The Initial Safety and Responsiveness Check
Before any physical interaction begins, the first priority is to ensure the safety of the scene for both the victim and the rescuer. Checking for dangers, such as traffic, fire, or unstable structures, must be the first step in the sequence of actions. Only once the environment is deemed safe should a rescuer approach the unresponsive person.
Following a safety check, the next action is to determine the victim’s level of responsiveness. This is typically done by gently tapping the person’s shoulder and shouting a question loudly, like “Are you okay?”. An individual who is unresponsive will not move, speak, or open their eyes in response to this stimulus. If there is no reaction, emergency medical services (EMS) must be contacted immediately, or a bystander must be directed to call for help and retrieve an Automated External Defibrillator (AED) if one is available.
The Critical 5 to 10 Second Breathing Assessment
After confirming unresponsiveness and calling for help, the next immediate step is to assess for normal breathing. Current emergency protocols specify that this assessment should take no less than five seconds but no more than ten seconds. This narrow window is enforced because any delay in starting chest compressions for a person in cardiac arrest significantly reduces their survival prospects.
To check for breathing, the airway must first be opened by tilting the head back slightly and lifting the chin. The rescuer should then look for the rise and fall of the chest or abdomen to confirm the presence of effective air movement. While older methods included listening for breath sounds and feeling for air on the cheek, the current focus is on rapidly and visually confirming chest movement, as this is the most objective and efficient measure. If a rescuer is unable to definitively confirm normal breathing within that ten-second limit, the person must be treated as if they are not breathing at all.
Recognizing Normal Versus Agonal Breathing
A person who is breathing normally will display a regular, quiet, and effortless pattern of chest rise and fall. Normal adult respiration rates typically fall within 12 to 20 breaths per minute, and the breaths are consistent in depth and rhythm. This regular pattern indicates that the person is effectively exchanging oxygen and carbon dioxide.
In contrast, agonal breathing is a distinctly abnormal pattern that must not be mistaken for effective respiration. Agonal respirations are often described as infrequent, noisy gasps that may sound like snorting, gurgling, or labored moaning. These are involuntary reflex actions caused by the brainstem’s attempt to regulate oxygen flow when the heart has stopped circulating blood effectively.
Crucially, agonal breathing does not provide adequate oxygen to the body, and it serves as a definite sign that the person is in cardiac arrest. If the rescuer observes only these sporadic, ineffective gasps during the ten-second check, they should proceed immediately to intervention. The presence of any breathing that is not normal signals a dire emergency that requires immediate action.
Steps Immediately Following a Negative Assessment
If the ten-second assessment concludes that the person is unresponsive and not breathing normally, the definitive action is to initiate Cardiopulmonary Resuscitation (CPR) without delay. The time taken between recognizing a lack of normal breathing and starting chest compressions should be minimized. High-quality chest compressions are the most important initial intervention for a person in cardiac arrest.
Compressions should begin immediately in the center of the chest, pushing hard and fast at a rate of 100 to 120 compressions per minute. If the rescuer is trained, they should alternate 30 chest compressions with two rescue breaths, ensuring only minimal interruption between cycles. This sequence continues until professional help arrives, the AED is ready to use, or the person begins to move or breathe normally.