Responsiveness refers to an individual’s level of awareness of their internal state and the external environment, reflecting neurological function. Assessing this awareness is a primary step in any emergency situation. Determining if a person is conscious guides subsequent actions, from providing basic care to alerting emergency professionals. A diminished or absent response suggests a serious, potentially life-threatening medical event requiring immediate intervention.
Understanding the Spectrum of Responsiveness
Consciousness is not a simple “on or off” state but exists on a gradient, and first responders use simplified frameworks to quickly categorize this spectrum. A widely recognized system is the AVPU scale, which sorts a person’s level of response into four distinct categories. This scale is preferred in emergency settings because it offers a quick, repeatable measure of a person’s mental status.
The highest level is “Alert,” signifying the person is fully awake, has spontaneously open eyes, and can respond to questions about their name, location, and the time. The next level, “Verbal,” is assigned when the person does not appear fully alert but responds only after being spoken to. This response might include opening their eyes, groaning, or making a slight movement toward the sound of a voice.
A person categorized as “Pain” only reacts to a physical, non-harmful stimulus, showing no response to verbal commands. This reaction might involve an involuntary movement, a moan, or withdrawal from the stimulus itself. The final category is “Unresponsive,” indicating the person shows no reaction whatsoever to any form of external stimulus. Any categorization below “Alert” suggests an altered mental status that requires immediate medical attention.
Step-by-Step Techniques for Assessment
The assessment of responsiveness must follow a strict, escalating sequence of stimuli to determine the person’s level of consciousness accurately. The initial check involves applying a verbal stimulus to see if the person is alert or responsive to voice. Approach the person and speak loudly and clearly, asking a simple question like, “Are you okay?” or giving a command such as, “Open your eyes”.
If there is no response to the verbal stimulus, the next step is to apply a gentle physical stimulus, often referred to as “shout-tap-shout.” This involves gently tapping or squeezing the person’s shoulder while simultaneously repeating the question, “Can you hear me?”. Observe closely for any reaction, including eye movement, a change in breathing, or a slight physical shift.
If the person remains unresponsive to verbal and gentle physical checks, a painful stimulus should be applied next, using a method that avoids causing actual injury. A common technique is a gentle sternal rub, which involves rubbing the knuckles firmly but briefly on the center of the person’s breastbone. Alternatively, a firm pinch of the trapezius muscle or a gentle pinch of the earlobe are acceptable methods for eliciting a pain response.
The goal of the pain check is to see if any reaction occurs, which would place the person in the “Pain” category of the AVPU scale. If the person still exhibits no response to this controlled physical stimulus, they are considered “Unresponsive”. The entire assessment process should be completed quickly, ideally in less than 10 seconds.
Immediate Emergency Actions for Unresponsiveness
Once it has been determined that a person is unresponsive, the immediate priority is to activate the emergency medical system by calling 9-1-1 or the local emergency number. If there are bystanders, designate one person to make the call and another to locate an Automated External Defibrillator (AED), if one is available nearby. This immediate action ensures professional help is on the way while you begin providing care.
After the call is made, the next step is to quickly check for normal breathing, which should take no more than 10 seconds. Look for the rise and fall of the chest, listen for breath sounds, and feel for air movement near the mouth and nose. If the person is unresponsive but is breathing normally, they should be placed into the recovery position.
The recovery position involves carefully rolling the person onto their side, which helps keep the airway open and prevents aspiration of fluids. However, if a head, neck, or spinal injury is suspected, the person should be left in the position they were found, unless they must be moved to perform Cardiopulmonary Resuscitation (CPR). If the person is not breathing normally or is only gasping, CPR must be initiated immediately.
CPR involves cycles of chest compressions and rescue breaths to circulate oxygenated blood until emergency services arrive. Throughout the entire process, monitor the person for any changes in their condition, such as a shift in breathing or a regaining of consciousness, and inform emergency responders of your findings.