Assessing responsiveness is the first action in any emergency situation. Responsiveness is the ability to react to external stimuli, such as voice, touch, or pain, signaling that the central nervous system is functioning. Determining a person’s level of awareness quickly allows a first responder or bystander to gauge the severity of a medical event. This initial check dictates the immediate steps of care.
Defining Levels of Consciousness
Medical professionals and first responders rely on the standardized AVPU scale to categorize a person’s level of consciousness quickly and consistently. This straightforward system organizes responsiveness into four distinct categories, simplifying the more complex neurological assessment used in hospital settings.
The AVPU Scale
- A (Alert): The person is fully awake, has spontaneously open eyes, and can react to their environment independently.
- V (Verbally responsive): The individual responds to a verbal prompt, such as opening their eyes, making a sound, or moving a limb when spoken to.
- P (Pain responsive): The individual only reacts to a painful stimulus, such as a sternal rub or a firm squeeze on a fingernail bed.
- U (Unresponsive): There is a complete absence of reaction to any verbal or painful stimuli.
Performing the Initial Emergency Assessment
To perform a physical check for responsiveness, follow the “Shout and Tap” protocol after ensuring the immediate scene is safe from hazards. Begin by loudly asking the person a simple question like, “Are you okay?” to elicit a verbal response. If there is no reaction, the next step is to introduce a physical stimulus to gauge motor function.
For an adult or child, gently tap or shake the shoulder to see if they move, groan, or open their eyes. If the person is an infant, apply the gentle physical stimulus by flicking the sole of the foot. Look for any movement or sound during this brief assessment period, which should take no more than 10 seconds. If the person remains completely non-responsive to both checks, they are considered unresponsive.
Simultaneously, call for help or instruct a bystander to activate emergency medical services (EMS). The prompt activation of EMS, typically by calling 911, should occur immediately upon determining the individual is unresponsive. If alone, the call should be made while performing the assessment or immediately after, often using a mobile device on speakerphone. This ensures professional help is on the way while the first aid provider begins life-saving interventions.
Immediate Next Steps Following Unresponsiveness
Once a person is determined to be unresponsive and EMS has been contacted, the immediate next step is to prioritize the airway, breathing, and circulation. The tongue is the most common obstruction in an unresponsive person, as it can relax and block the upper airway. To remedy this, perform the head-tilt/chin-lift maneuver by gently tilting the forehead back and lifting the chin to open the airway.
After opening the airway, assess for normal breathing by looking for chest rise, listening for breath sounds, and feeling for air movement against the cheek for no more than 10 seconds. If the individual is breathing normally, they should be placed into the recovery position, which helps maintain an open airway and allows fluid to drain. If the person is not breathing or is only gasping, chest compressions must be initiated immediately. Cardiopulmonary resuscitation (CPR) or the use of an Automated External Defibrillator (AED) should be started until EMS arrives.