Paramedics are highly trained emergency medical professionals. When responding to an unconscious person, their primary goal is rapid assessment, stabilization of immediate life threats, and safe transport to a medical facility. The initial minutes of care prioritize the patient’s survival by quickly identifying and managing conditions that could lead to irreversible damage. This systematic approach allows paramedics to transition from basic life support to advanced interventions without delay.
Scene Safety and Determining Responsiveness
Before approaching any patient, paramedics perform a scene size-up to ensure their personal safety and the safety of bystanders. This initial step involves assessing for environmental hazards, such as moving traffic, unstable structures, fire risks, or potential violence. Once the scene is deemed safe, the focus shifts to determining the patient’s level of consciousness.
Paramedics attempt to elicit a response by speaking loudly to the patient, such as asking, “Are you alright?”. If no verbal response occurs, a painful stimulus is applied to check for any physical reaction. This process uses the AVPU scale—Alert, Verbal, Pain, Unresponsive—to quickly categorize the patient’s neurological state and confirm true unresponsiveness. A patient who is unresponsive to all stimuli is considered a high-priority patient requiring immediate intervention.
Focusing on Airway Breathing and Circulation
Following the confirmation of unresponsiveness, paramedics launch into the primary assessment, focusing on managing immediate life threats involving oxygenation and perfusion. The first priority is securing a patent airway, as an unconscious patient’s tongue can fall back and obstruct the upper airway. Techniques like the head-tilt/chin-lift or jaw-thrust maneuver are used to physically open the passage, and paramedics may use specialized airway adjuncts to maintain patency.
The next step involves assessing the patient’s respiration, which includes looking for chest rise, listening for breath sounds, and feeling for air movement. If the patient is not breathing adequately, paramedics immediately provide assisted ventilation using a bag-valve mask device, often supplemented with 100% oxygen. Concurrently, they evaluate circulation by checking for a pulse, assessing the rate and quality of the heartbeat, and checking for signs of major external hemorrhage.
Any uncontrolled, life-threatening bleeding is addressed immediately with direct pressure or a tourniquet before moving on to less urgent interventions. Paramedics also assess the patient’s skin color, temperature, and capillary refill time to gauge the effectiveness of circulation and identify signs of shock. Inadequate oxygenation or circulation can quickly lead to cardiac arrest or permanent brain injury.
Diagnostic Testing and Advanced Procedures
Once the patient is stabilized, paramedics initiate a secondary assessment and advanced life support procedures to determine the underlying cause of unconsciousness. They perform a focused physical exam, checking for signs of trauma, unequal pupils, or medical devices like insulin pumps or continuous glucose monitors (CGMs). Diagnostic tools are immediately applied, including a glucometer to measure blood glucose, since severe hypoglycemia is a common and rapidly reversible cause of altered consciousness.
Paramedics also attach a cardiac monitor to obtain an electrocardiogram (EKG) and assess the heart’s electrical activity, which can reveal arrhythmias or signs of a heart attack. Establishing intravenous (IV) access is a parallel procedure, providing a route to administer fluids or emergency medications. If IV access is difficult, an intraosseous (IO) line may be placed directly into the bone marrow as an alternative route for rapid drug delivery.
Based on the assessment and diagnostic findings, specific medications are administered per protocol, often without direct physician contact. For instance, intravenous dextrose is given for severe hypoglycemia, and naloxone is administered if an opioid overdose is suspected. Paramedics also gather a patient history from bystanders, family, or medical alert jewelry to identify pre-existing conditions such as diabetes or epilepsy.
Continuous Monitoring and Destination Selection
Care continues as the patient is prepared for transport, ensuring all monitoring devices remain attached. Paramedics perform constant reassessments of the patient’s vital signs, checking blood pressure, pulse, and oxygen saturation every few minutes, especially after any intervention. The patient is carefully secured to the stretcher to prevent further injury during movement, including spinal motion restriction if trauma is suspected.
A communication report is made to the receiving hospital, providing a concise summary of the patient’s condition, interventions performed, and the suspected cause of unconsciousness. The choice of hospital is determined by protocol and the patient’s condition, prioritizing the “nearest most appropriate hospital.” For example, a patient who has suffered a stroke or severe trauma will be taken to a specialized stroke or trauma center, even if a closer general hospital is available.