An unresponsive victim represents a medical emergency requiring immediate, systematic action to maximize the chance of survival. A person who does not respond to verbal or physical stimuli is unable to protect their airway, making a rapid assessment of life signs necessary. The initial steps involve determining if the victim is experiencing a life-threatening event, such as cardiac or respiratory arrest. Checking for a pulse and assessing breathing form a fundamental part of this assessment, guiding the rescuer toward the appropriate emergency intervention.
Initial Assessment of the Victim and the Scene
Before approaching an unresponsive individual, a rescuer must first ensure the safety of the environment. Hazards like traffic, fire, or falling debris must be identified and removed, or the victim moved to a safer location, if possible, without risking injury.
Once the scene is safe, the rescuer should attempt to establish responsiveness by gently tapping the victim’s shoulder and shouting, “Are you okay?” If there is no response, the rescuer must immediately activate the emergency medical system by calling 9-1-1 or the local emergency number.
If a bystander is present, they should be directed to make the call and retrieve an Automated External Defibrillator (AED), if one is available. Calling for help must precede any extensive treatment to minimize the delay in professional assistance arriving.
Locating and Assessing the Carotid Pulse
The carotid artery provides the most reliable pulse point in an unresponsive adult or child. This major artery is located in the neck, running close to the surface and directly supplying the brain. To locate it, the rescuer should place two fingers on the victim’s windpipe, or trachea.
The fingers should then be gently slid into the soft groove between the trachea and the large strap muscles at the side of the neck. A subtle, rhythmic pulsation should be felt beneath the fingertips. Use only two fingers and avoid using the thumb, as the thumb has its own strong pulse that can be confused with the victim’s.
A rescuer should dedicate no more than 10 seconds to feel for the pulse. This strict time limit prevents a delay in starting chest compressions if circulation has stopped. If a definite pulse cannot be felt within this 10-second window, or if the rescuer is uncertain, the victim should be treated as though a pulse is absent.
Current Guidance: When to Rely on Breathing and Movement
Modern emergency protocols, particularly for lay rescuers, have shifted the focus away from the manual pulse check due to common human error. Studies show that inexperienced rescuers frequently struggle to find a pulse, wasting precious time or incorrectly concluding a pulse is present when it is not. A delay in initiating chest compressions significantly lowers the chance of survival from sudden cardiac arrest.
Current guidelines emphasize that if an unresponsive adult is not breathing normally, or is only gasping, a lay rescuer should assume cardiac arrest is occurring. Gasping, often referred to as agonal breathing, is a sign of inadequate oxygenation and should not be confused with normal breathing. The most time-efficient action is to immediately begin chest compressions without attempting a pulse check.
Healthcare professionals who are trained and confident in their technique may still check for a pulse simultaneously with checking for breathing. However, the 10-second maximum remains the standard for all trained rescuers. If there is any doubt about the presence of a pulse or normal breathing, the intervention should proceed to chest compressions immediately.
Immediate Action Protocol Based on Findings
The assessment of the pulse and breathing status dictates the immediate action protocol.
Pulse Present, Breathing Normal
If the victim is unresponsive but a definite pulse is felt and they are breathing normally, the primary concern is maintaining an open airway. The victim should be carefully placed into the recovery position, which helps keep the airway clear and allows fluids to drain from the mouth, preventing aspiration.
Pulse Present, Breathing Absent
If the victim has a pulse but is not breathing, or is only gasping, they are likely experiencing respiratory arrest. The rescuer should begin rescue breathing, giving one breath approximately every five to six seconds. The pulse should be re-assessed about every two minutes while continuing rescue breaths until emergency help arrives.
Pulse Absent
If no pulse is detected or if the victim is not breathing normally, the condition is treated as cardiac arrest, and cardiopulmonary resuscitation (CPR) must be initiated immediately. The rescuer should begin with chest compressions at a rate of 100 to 120 compressions per minute. This action physically circulates blood and oxygen to the brain and other organs until definitive medical care can be provided.