The sudden discovery of an unresponsive person demands immediate and calm action. Unresponsiveness is the inability to react to external stimuli, such as being spoken to loudly or being gently touched or shaken, indicating an alteration in consciousness. When a person is unresponsive but still breathing adequately, the immediate threat is the potential for airway blockage, not a lack of oxygen. The primary goal of a layperson is to protect the airway and ensure professional help is activated quickly. This initial care provides a bridge to advanced medical intervention.
Initial Safety Assessment and Emergency Activation
Before approaching, rapidly assess the environment to ensure personal safety and prevent further harm. Hazards like traffic, downed power lines, or toxic fumes must be avoided before any direct care begins. Once the scene is safe, confirm unresponsiveness by gently tapping the shoulder and speaking loudly, asking, “Are you okay?”.
If they do not respond, immediately activate the Emergency Medical Services (EMS) system by calling the local emergency number. If a bystander is present, direct them specifically to make the call and retrieve an Automated External Defibrillator (AED) if available nearby. Providing this clear instruction ensures professional help is not delayed. The person making the call should stay on the line with the dispatcher, providing updates and following instructions.
Positioning the Patient to Protect the Airway
The most significant danger to an unresponsive, breathing person lying on their back is muscle relaxation, which can cause the tongue to obstruct the airway. Relaxation of the stomach sphincter can also lead to regurgitation or vomiting, risking aspiration into the lungs. To counteract this risk, the patient must be moved into the lateral recovery position. This position uses gravity to keep the tongue forward and allows any fluids to drain safely from the mouth.
Performing the Recovery Position
Kneel beside the patient and ensure both legs are straight. Extend the arm closest to you straight out from the body at a right angle, palm facing upward, to act as a stabilizing support. Bring the patient’s far arm across their chest and hold the back of that hand against the cheek nearest to you. This hand will cushion the head as you roll them.
Bend the knee of the far leg and pull it up so the foot is flat on the ground, creating a lever for the turn. Gently pull on the bent knee to roll the person toward you and onto their side in a controlled motion. Ensure you support their head and neck during the movement.
Once they are on their side, the bent knee should rest on the ground, stabilizing the position. Tilt their head slightly backward to keep the airway open. Adjust their hand under their cheek to maintain this position, ensuring their mouth is slightly open and facing downward for drainage. This lateral position is generally safe because maintaining a patent airway takes precedence, even if a spinal injury is suspected.
Ongoing Monitoring While Awaiting Professional Help
Once the patient is safely placed in the recovery position and EMS has been alerted, the rescuer must remain with them and continuously monitor their condition. The primary focus is watching for changes in the breathing pattern, which should be regular and relatively effortless. Visually confirm the chest is rising and falling, and periodically listen or feel for breath near the mouth and nose.
Note the time and any observed changes, such as a change in skin color—bluish lips or fingertips may indicate a lack of oxygen—or signs of movement, seizures, or attempts to speak. Maintain the patient’s body temperature by covering them with a blanket or coat. If the patient stops breathing or breathing becomes irregular and inadequate, the rescuer must be ready to quickly roll the patient onto their back and begin cardiopulmonary resuscitation (CPR).
Critical Actions to Avoid
A layperson should avoid several common but dangerous interventions. Never attempt to give an unresponsive person anything by mouth, including water, food, or medication, as the lack of a protective swallow reflex makes aspiration highly likely. Do not try to forcefully wake the person through aggressive physical contact, such as slapping, shaking, or dousing them with water, as this is ineffective and harmful.
Unless the patient is in immediate danger or requires CPR, avoid moving them unnecessarily, especially if a fall or traumatic injury is suspected. If movement is necessary for safety, try to keep the head, neck, and torso aligned as a single unit. Finally, do not place a pillow or any object under the patient’s head while they are on their back, as this can block the airway.