Responsiveness measures a person’s level of consciousness and their ability to react to external stimuli. Assessing this status is the first step in a medical emergency, determining if the individual is aware of their surroundings or requires urgent intervention. An inability to respond indicates a significant medical or traumatic event, such as cardiac arrest, stroke, or severe injury, which necessitates professional medical help.
Scene Safety and Initial Assessment
Before rushing to an individual who appears to be unconscious, the primary concern must be the safety of the rescuer and the person in need. A rapid scan of the environment is necessary to identify hazards, such as live electrical wires, oncoming traffic, fire, or chemical exposure. Only after confirming the scene is safe should an approach be made, as entering a dangerous situation could result in two victims instead of one.
Activate the emergency medical services (EMS) by calling your local emergency number, or by instructing a specific bystander to do so. This ensures that professional help is on the way while you begin your physical assessment. Delays in calling for help can drastically reduce the chance of survival.
Practical Steps for Checking Consciousness
The physical check for consciousness in an adult or older child should follow a clear progression of increasing stimulus intensity. Begin by using a loud verbal stimulus, speaking directly into the person’s ear to see if they stir, open their eyes, or respond in any way. Ask a simple, direct question like, “Are you okay?” to try and elicit a purposeful response.
If there is no reaction to the verbal prompt, the next step is to apply a gentle yet firm physical stimulus. Firmly tap or shake the person’s shoulder to provide a sensory input that might break through an altered level of consciousness. A positive response could be as subtle as a groan, a slight movement of the head, or blinking of the eyes.
If both the verbal and physical stimuli fail to produce any reaction, a painful stimulus may be used. This involves firmly rubbing your knuckles on the breastbone (sternum) or squeezing the trapezius muscle at the neck. This action gauges the depth of unresponsiveness by testing the brain’s ability to react to a noxious input. If the person remains completely motionless and silent following all three types of stimulation, they are considered fully unresponsive.
Using the AVPU Scale
The AVPU scale is a tool used by first responders and medical professionals to quickly classify a person’s level of consciousness. This mnemonic stands for Alert, Voice, Pain, and Unresponsive, providing a uniform way to communicate a patient’s neurological status. This classification system is used immediately after the physical assessment is complete.
An individual classified as “Alert” is fully awake and aware of their environment, able to track movement and answer questions coherently. “Voice” means the person only responds when spoken to, perhaps by opening their eyes or mumbling a word after a verbal command is given. The “Pain” classification is assigned if the person only reacts to the painful stimulus, such as a sternal rub, by moving a limb or making a noise.
The “Unresponsive” classification is used if the person shows no reaction to any of the stimuli—verbal, physical, or painful. The AVPU score is a rapid method of triage, indicating the urgency of the situation and the degree of potential brain impairment. A score of “P” or “U” suggests a decreased level of consciousness that carries a high risk for complications like airway compromise.
Immediate Actions Following Assessment
Once the level of responsiveness has been determined, the focus must shift immediately to the person’s breathing. For no more than ten seconds, look for the rise and fall of the chest and listen for normal breath sounds. Gasping or irregular breathing is not considered normal and should be treated as absent breathing.
If the person is unresponsive and not breathing normally, cardiopulmonary resuscitation (CPR) must be initiated immediately, beginning with chest compressions. However, if the person is unresponsive but is breathing regularly, the appropriate action is to place them into the recovery position. This position involves gently rolling the person onto their side with the head tilted back slightly.
The recovery position is designed to keep the airway open and prevent the tongue from falling back. It also allows any fluids, such as vomit or blood, to drain from the mouth, minimizing the risk of aspiration into the lungs. Continuous monitoring of the person’s breathing and responsiveness is necessary until trained emergency personnel arrive to take over care.