Unconsciousness is a state where a person cannot be aroused and is completely unresponsive to external stimuli, such as loud speech or gentle pain. This unresponsiveness signals a severe compromise in brain function, often indicating a life-threatening medical event. Paramedics follow a systematic approach focused on rapid stabilization while simultaneously working to determine the underlying cause. The primary goal is to secure the patient’s basic life functions and stabilize them for transport to a hospital for definitive care.
Initial Assessment and Life Support
Paramedics first prioritize safety, ensuring the environment is secure before approaching the patient. The initial assessment begins with determining the patient’s level of consciousness using the Alert, Verbal, Pain, Unresponsive (AVPU) scale. A patient who is “Unresponsive” receives immediate attention focused on the core functions of Airway, Breathing, and Circulation (ABCs).
Securing a patent airway is the immediate priority, as the tongue can obstruct the throat in an unconscious patient. Simple maneuvers like the head-tilt chin-lift are used for medical patients, while the jaw thrust is preferred if a traumatic injury to the neck or spine is suspected. If these simple measures are insufficient, paramedics insert an adjunct, such as an oropharyngeal airway (OPA) (for fully unconscious patients) or a nasopharyngeal airway (NPA).
Breathing is assessed by checking the rate and quality of respirations. If breathing is absent or inadequate, assisted ventilation is provided using a bag-valve-mask device with supplemental oxygen. In cases where basic adjuncts do not maintain a clear airway or ventilation remains poor, advanced procedures like endotracheal intubation may be performed to secure a protected connection to the lungs.
Circulation assessment involves checking for a pulse, skin color, temperature, and signs of severe bleeding. If a pulse is absent, cardiopulmonary resuscitation (CPR) is initiated immediately. For patients with suspected traumatic injury, spinal motion restriction (SMR) is implemented using a rigid cervical collar and securing the patient to the stretcher to protect the spinal cord.
Identifying the Cause and Targeted Treatment
Once breathing and circulation are stabilized, the focus shifts to a systematic search for the cause of unconsciousness. Paramedics obtain vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to establish a baseline. A crucial diagnostic test is checking the blood glucose level, as severe hypoglycemia (low blood sugar) is a common and reversible cause of altered mental status.
History gathering is performed by asking bystanders, family members, or witnesses for information, utilizing the SAMPLE mnemonic (Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events). Paramedics also conduct a focused physical exam, specifically looking for medical alert bracelets, signs of trauma, or substances like drug paraphernalia. A neurological assessment includes checking the pupils for size, equality, and reaction to light, which can provide clues about the underlying issue, such as pinpoint pupils suggesting opioid toxicity.
Based on the assessment, empirical treatments are administered. If the blood glucose is dangerously low, dextrose (a sugar solution) is administered intravenously, which can lead to rapid awakening. For suspected opioid overdose, Naloxone (Narcan) is given via the intravenous, intramuscular, or intranasal route.
For patients with a suspected cardiac event, a 12-lead electrocardiogram (ECG) is acquired, providing an electrical view of the heart. This image is often transmitted wirelessly to the receiving hospital, allowing physicians to prepare specialized resources before the patient arrives. Intravenous access is established early, allowing for the administration of necessary medications and fluids to manage blood pressure or correct electrolyte imbalances.
Preparing for Transport and Transfer of Care
With the patient stabilized and initial treatments underway, preparation for transport to the hospital begins. Continuous monitoring of the patient’s heart rhythm, oxygen saturation, and blood pressure is maintained. Any advanced airway device that has been placed is carefully secured and continually monitored to ensure proper position during movement.
Before leaving the scene or while en route, paramedics communicate with the receiving hospital using a pre-arrival notification, or “patch,” to alert them to the patient’s condition. This concise report includes the patient’s age, chief complaint, current vital signs, initial treatments administered, and the estimated time of arrival. This notification allows the hospital to activate specialized teams, such as a trauma or stroke team, as needed.
Upon arrival at the emergency department, a formal transfer of care occurs. The paramedic provides a verbal hand-off report directly to the hospital staff, relaying a concise summary of the patient’s history, findings, and all interventions performed in the field. This verbal report is followed by a written or electronic patient care report, ensuring the hospital team has the necessary information to take over treatment.