When encountering a person who is unresponsive, the minutes immediately following that discovery are a critical window for intervention and survival. Unresponsiveness means the person cannot be roused, is unconscious, and does not react to outside stimulation. This situation demands a rapid, sequential, and organized response to maximize the chance of a positive outcome until trained medical professionals arrive. The primary objective is to maintain the individual’s basic life functions—airway, breathing, and circulation—using simple, immediate techniques. Understanding the proper steps empowers any bystander to provide life-sustaining support during this medical emergency.
Securing the Scene and Confirming Unresponsiveness
Before attempting to help, the rescuer must first ensure the safety of the surrounding environment. Quickly scan the area for immediate threats like live electricity, chemical hazards, unstable structures, or approaching traffic. Only approach the patient once the area is secure. If the patient is in immediate danger, such as the middle of a roadway, they should only be moved if necessary to begin life support efforts or if the rescuer is also in danger.
Once the scene is safe, confirm unresponsiveness using the “shout-tap-shout” technique. Speak loudly to the person, asking, “Are you okay?” while simultaneously tapping or gently shaking their shoulder. For an infant, check responsiveness by tapping the bottom of the foot.
A person is confirmed unresponsive if they show no reaction to the verbal and physical stimulation, such as opening their eyes, moving, or speaking. If the person is unresponsive, immediately call for emergency medical services.
Activating Emergency Medical Services
Immediately after confirming unresponsiveness, activate the emergency response system by calling 911 or the local emergency number. This must be accomplished quickly, either by the rescuer or by delegating the task to a specific, named bystander. Pointing directly at an individual and giving a clear instruction, such as “You, call 911 and come back,” ensures the task is completed without confusion.
Provide the dispatcher with precise and accurate information, including the exact location of the patient and a clear description of the situation. State that the unresponsive person is not breathing normally or is only gasping, which signals the need for advanced help. The dispatcher is a trained professional who can provide instructions and guidance.
The rescuer should remain on the line until instructed otherwise. Dispatchers can provide guided, step-by-step instructions for performing cardiopulmonary resuscitation (CPR), often called Dispatcher-Assisted CPR. Securing this professional help early is important, as the prompt arrival of paramedics increases the chances of survival.
Assessing Airway, Breathing, and Circulation
Once emergency services are activated, focus on a rapid assessment of the patient’s airway, breathing, and circulation (the primary survey). The airway and breathing must be checked for no more than 10 seconds. If the patient is lying face-down, carefully roll them onto their back to begin the assessment, unless a spinal injury is suspected and the patient is breathing normally.
To check the airway, use the head-tilt/chin-lift maneuver. Place one hand on the forehead and gently tilt the head back while lifting the chin with the fingers of the other hand. This moves the tongue away from the back of the throat, preventing obstruction. If a head, neck, or spinal injury is suspected, use a jaw-thrust technique instead to open the airway without moving the neck.
Breathing is checked using the “Look, Listen, and Feel” method: observe the chest for movement, listen for breath sounds, and feel for air movement. It is important to distinguish normal breathing from agonal breathing. Agonal breathing, characterized by gasping, snorting, or irregular breaths, is not effective and must be treated as no breathing at all.
Lay rescuers should prioritize the assessment of breathing, as checking for a pulse is unreliable without medical training. If the patient is unresponsive and not breathing normally (no breaths or only agonal gasps), proceed immediately to the intervention phase, assuming cardiac arrest. The 10-second check must conclude with a decision to initiate life support or monitor the patient closely.
Providing Immediate Life Support
The findings from the primary survey dictate the immediate life support pathway until professional help arrives. If the patient is unresponsive but breathing normally, the intervention is to place them in the recovery position. This side-lying position helps keep the airway open by allowing the tongue to fall forward and prevents aspiration, ensuring fluids drain out of the mouth.
Recovery Position Steps
To place the patient in the recovery position:
- Place the arm nearest to the rescuer at a right angle.
- Bring the far arm across the chest, placing the back of the hand against the cheek nearest to the rescuer.
- Bend the far leg at the knee.
- Use the bent leg to roll the patient gently onto their side toward the rescuer.
- Ensure the head is slightly tilted back to maintain an open airway.
Monitor the patient continuously in this position, checking their breathing regularly for any change in condition.
If the patient is unresponsive and not breathing normally, immediate cardiopulmonary resuscitation (CPR) is required, beginning with chest compressions. Hands-only CPR is the recommended approach for lay rescuers. This involves pushing hard and fast in the center of the chest at a rate of 100 to 120 compressions per minute, pushing down by about 5 to 6 centimeters.
Continue chest compressions without interruption, minimizing pauses to circulate oxygenated blood to the brain and organs. If an Automated External Defibrillator (AED) is available nearby, retrieve it immediately and apply it to the patient’s bare chest, following the device’s audible prompts. Maintain interventions until emergency medical services arrive and take over care or the patient begins to breathe normally.