The “tap and shout” technique, formally known as checking for responsiveness, is the first step in the Chain of Survival. This simple, non-invasive assessment confirms whether a person requires immediate life-saving emergency care, such as cardiopulmonary resuscitation (CPR). This evaluation must be performed only after confirming the scene is safe for the rescuer to approach. This action prevents delays in care for those in cardiac arrest and unnecessary interventions for those who are not.
The Immediate Goal Confirming Unresponsiveness
The primary purpose of the “tap and shout” sequence is to quickly establish a person’s level of consciousness. A collapsed individual may be unconscious, sleeping, intoxicated, or temporarily stunned from a fall. The goal is to differentiate these states quickly, as only a life-threatening lack of consciousness necessitates immediate intervention.
The technique involves physically stimulating the individual, typically with a firm tap or gentle shake on the shoulder for an adult, while simultaneously shouting a clear, loud question like, “Are you okay?”. This combination of physical and verbal stimuli is designed to elicit a response from someone who is only mildly affected or temporarily non-responsive. If the person is conscious, even minimally, the dual stimulus is usually sufficient to provoke a movement, a verbal response, or a groan.
If the person fails to respond to this dual stimulation, they are considered unresponsive, suggesting a potential cardiac arrest or severe medical event. This lack of response moves the rescuer immediately to the next steps of the protocol. The assessment avoids wasting time determining the exact cause of collapse by focusing solely on whether consciousness is present or absent. The entire assessment should take no more than 10 seconds before proceeding.
Mitigating Risk and Ensuring Safety
The secondary reasons for the “tap and shout” method center on safety for both the person needing help and the rescuer. CPR is an invasive procedure involving forceful chest compressions, which can cause injuries like fractured ribs or a broken sternum. Performing CPR on a conscious person is inappropriate and can cause significant, avoidable harm.
Confirming unresponsiveness prevents the rescuer from attempting CPR on someone who is conscious or who might react aggressively if startled. A conscious person does not require CPR because their heart is still pumping effectively enough to maintain consciousness. This initial assessment acts as a necessary safeguard, ensuring that the serious risks of chest compressions are only undertaken when the benefit of circulating blood outweighs the risk of injury.
The technique is also a matter of rescuer safety, ensuring the person is not violent or a danger before committing to providing care. Before approaching, the rescuer must first check the environment to ensure the scene is safe from hazards. Only once the environment is secure and unresponsiveness is confirmed can the rescuer safely commit to the time and physical effort required for high-quality CPR.
The Sequence Following Assessment
The outcome of the “tap and shout” assessment dictates the immediate subsequent actions in the emergency response sequence. If the person responds in any way—by moving, speaking, or opening their eyes—they do not require CPR. The rescuer should stay with the person, check for injuries or other medical conditions, and call the local emergency number if a life-threatening problem is suspected.
If the person remains completely unresponsive after the dual stimulus, the next immediate steps are to assume a life-threatening emergency is underway. The rescuer must immediately activate the emergency medical system by calling 911 or the local equivalent, or directing a bystander to do so. Simultaneously, the rescuer must check to see if the person is breathing normally, which should take no more than 10 seconds.
If the unresponsive person is not breathing or is only gasping—a sign of agonal breathing that indicates cardiac arrest—the rescuer must begin chest compressions immediately. The “tap and shout” step determines whether the next actions will be targeted first aid or the full, life-sustaining intervention of CPR and early defibrillation.