When a person cannot be roused from sleep, it signals a serious medical event rather than simple deep sleep. Unresponsiveness means the person is unconscious and fails to respond to external stimuli, indicating a potentially life-threatening situation. The primary goal is to rapidly assess the person’s condition to determine if immediate emergency medical intervention is required. Acting quickly is important, as brain cells can begin to die within minutes without proper oxygenation.
Immediate Steps to Assess Responsiveness
Initial assessment should be a sequential process, starting with the least invasive stimulation. First, speak loudly and clearly, asking “Are you okay?” while gently tapping the person on the shoulder. If there is no response to voice or light touch, the next step is to apply a painful stimulus to gauge their level of consciousness. This tiered approach is a simplified version of the AVPU scale, which classifies a person as Alert, responsive to Voice, responsive only to Pain, or entirely Unresponsive.
A common method for providing a painful stimulus is the sternal rub, which involves rubbing the knuckles of a closed fist firmly against the breastbone. Alternatively, a sharp pinch of the trapezius muscle at the base of the neck can be used. The purpose of this stimulus is to provoke any reaction, such as a moan, a grunt, or withdrawal, classifying the person as responsive to pain. If the person remains completely limp and motionless, they are classified as unresponsive, necessitating immediate escalation of care.
The next step is to check for normal breathing, which should take no more than ten seconds. Carefully tilt the head back and lift the chin to open the airway, as the tongue can relax and block the throat in an unconscious person. Look closely for a rhythmic rise and fall of the chest and abdomen, and listen for normal breath sounds. Gasping, snoring, or irregular, noisy breaths, known as agonal breathing, must not be mistaken for normal breathing and should be treated as if the person is not breathing at all.
Current guidelines for the layperson emphasize checking for breathing rather than attempting to find a pulse. Pulse checks are often unreliable for untrained individuals and can cause a dangerous delay in starting chest compressions if they are needed. If the person is unresponsive and not breathing normally, or is only exhibiting agonal gasps, it is a clear sign to call emergency services and prepare to begin cardiopulmonary resuscitation (CPR).
Recognizing Signs of a Medical Emergency
While assessing the person, quickly scan the immediate environment for clues regarding the cause of unresponsiveness. Look for overturned pill bottles, drug paraphernalia, or empty alcohol containers suggesting an overdose or poisoning. A medical alert bracelet or necklace can indicate a known condition, such as diabetes or a severe allergy, which is valuable information for emergency responders.
Observe the person’s body for physical signs of trauma or illness. Check for any obvious severe bleeding, which requires immediate direct pressure to control. Note any abnormal posturing, seizure activity, or signs of a fall, such as bruising or an injury to the head. The color of the skin is also telling; a blue or gray tint around the lips or fingertips suggests a lack of oxygen, while extreme paleness could indicate significant blood loss or shock.
Any known medical history, such as recent medication changes or a history of heart conditions, should be noted and relayed to the dispatcher. This context is essential for medical professionals to quickly determine the most appropriate treatment upon arrival.
Activating Emergency Services and Stabilization
Once unresponsiveness and abnormal breathing are confirmed, immediately activate emergency medical services. When calling, remain as calm as possible and provide the exact location, including the street address, building number, and any special instructions for access. Inform the dispatcher that you have an unresponsive person who is not breathing normally, and provide the person’s approximate age and sex.
Answer all questions the dispatcher asks, as they are trained to follow a structured protocol and may already be sending help while you talk. Do not hang up until the dispatcher tells you to do so; they can provide telephonic CPR instructions and guide you through basic life support until paramedics arrive. Following their guidance ensures you are providing the most effective care for the situation.
If the person is unresponsive but breathing normally, the priority shifts to maintaining an open airway and preventing aspiration. Gently roll the person onto their side into the recovery position, which allows any fluid to drain safely from the mouth. To perform this, extend the arm closest to you straight out, bring the other arm across the chest, and bend the far leg at the knee. Use the bent knee as a lever to gently roll the person toward you, resting their head on their extended lower arm for support.
If the person is unresponsive and not breathing, or only gasping, immediately begin hands-only CPR. Position the person on their back on a firm, flat surface. Place the heel of one hand in the center of the chest, placing the other hand on top. Push hard and fast, aiming for a compression depth of about two inches, at a rate of 100 to 120 compressions per minute. Continue compressions without interruption until professional help arrives or the person shows signs of movement.