Responsiveness is defined as an individual’s ability to react to external stimuli, such as sound or touch. Assessing consciousness is the immediate first step upon encountering a person who has collapsed or appears injured. This evaluation determines if the person is unresponsive and requires immediate life support measures. Following the proper sequence ensures that help is mobilized efficiently and safely.
Prioritizing Scene Safety
Before approaching any person in a potential emergency, the rescuer must rapidly assess the surrounding environment. Rescuers must quickly scan for immediate hazards like active traffic, falling debris, downed electrical power lines, or toxic fumes. Approaching an unsafe area risks turning one victim into two, which compromises the ability to provide aid effectively.
If the scene is deemed unsafe, a person should only be moved if they are in immediate danger. The movement must use proper dragging or lifting techniques that minimize the risk of injury to both the person and the rescuer. Identifying the mechanism of injury, such as a fall or motor vehicle crash, can help predict potential internal injuries. Once the environment is confirmed to be stable, the physical check for responsiveness can commence.
The Physical Assessment Technique
Once the environment is safe, the accepted method for checking responsiveness in an adult or child is the “Tap and Shout” technique. The rescuer should kneel beside the person and firmly tap their shoulders while speaking loudly and clearly, asking, “Are you okay?”. The stimulus must be firm enough to elicit a reaction but should never involve violent shaking or aggressive movement of the head or neck. This interaction attempts to disrupt the person’s consciousness to determine their level of awareness.
If the person gives any purposeful response—even a slight groan, movement, or eye opening—they are considered responsive. A responsive person needs continuous monitoring and professional medical evaluation, but they do not require immediate chest compressions. For infants, the technique is modified.
Instead of tapping the shoulders, the rescuer should gently tap the sole of the infant’s foot or stroke their chest, watching closely for any physical reaction. The goal remains the same: to gauge a reaction such as crying, movement, or a change in facial expression. For lay rescuers, the use of painful stimuli, such as a sternal rub, is discouraged because it can cause unnecessary injury and is not required by standard emergency protocols. Maintaining a neutral alignment of the head and neck during the physical check is important, especially if a spinal injury is suspected.
Activating Emergency Medical Services
If the person remains unresponsive after the physical assessment, the next action is to activate the local emergency medical services (EMS). Mobilizing professional help quickly increases the chance of a positive outcome. If other people are present, the rescuer should delegate the task clearly, stating, “You, in the red shirt, call 911 and tell them we have an unconscious adult who is not breathing.” This direct assignment prevents confusion and ensures the call is placed without delay.
The person calling EMS should provide the dispatcher with precise location details and a brief, accurate description of the situation. This includes the person’s age, whether they are breathing, and the nature of the emergency, such as a fall or sudden collapse. A lone rescuer should call EMS immediately before proceeding to the next steps for an unresponsive adult. If the unresponsiveness is likely due to a respiratory event, such as in pediatric cases, the lone rescuer should provide two minutes of initial care before calling EMS.
Checking for Breathing and Circulation
After activating EMS, the rescuer must assess the person for signs of normal breathing and circulation. Current guidelines emphasize that lay rescuers should not use the “Look, Listen, and Feel” technique, as it is often inaccurate and time-consuming. Instead, the rescuer should focus solely on visually observing the person’s chest for movement for no more than ten seconds. If there is no definite movement, the person should be assumed to have abnormal or absent breathing.
Agonal breathing is often mistakenly identified as normal breathing. Agonal breaths are gasping, noisy, or labored attempts at air intake that may sound like snorting or gurgling. This pattern is not effective breathing and is a common sign of cardiac arrest, requiring immediate intervention. If the person is only exhibiting agonal breaths, the rescuer should proceed as if no breathing is present and prepare to initiate chest compressions.
Checking for signs of circulation is the final stage of assessment, but the priority remains starting chest compressions if breathing is absent. In an adult or child, the pulse is typically checked at the carotid artery, located in the groove between the trachea and the large neck muscle. For an infant, the pulse is checked at the brachial artery, found on the inside of the upper arm.
Lay rescuers should spend no more than ten seconds attempting to locate a pulse. If they are unsure or cannot find it, they should immediately begin high-quality chest compressions. Time spent searching for a pulse delays the delivery of blood to the brain and heart. Immediate compressions ensure the person receives necessary circulatory support without delay.