Unconsciousness is an emergency: the person may lose airway protection, stop breathing, aspirate vomit, have a serious brain injury or be suffering from hypoglycaemia, poisoning, stroke, seizure or shock. The first aider’s task is to protect life, identify immediately reversible threats and arrange urgent medical assessment.
Add labelled images of AVPU assessment, airway opening, recovery position and CPR here.
Learning outcomes
- Define altered consciousness and distinguish alertness, responsiveness and coma.
- Use AVPU and, for trained learners, describe the Glasgow Coma Scale.
- Assess and protect airway, breathing and circulation in an unresponsive person.
- Place a breathing unconscious person in the recovery position safely and recognise when not to move them unnecessarily.
- Recognise red flags such as trauma, stroke, seizure, poisoning, hypoglycaemia and shock.
1. Levels of consciousness
| Level | Description | First-aid implication |
|---|---|---|
| Alert | Awake, interactive and oriented, though behaviour may be abnormal. | Assess symptoms, history and vital signs; watch for deterioration. |
| Confused/agitated | Disoriented, restless, inattentive or behaving unusually. | Could be hypoxia, shock, hypoglycaemia, infection, poisoning or head injury; urgent assessment. |
| Responds to voice | Opens eyes or moves only when spoken to loudly. | Protect airway, call for help and monitor continuously. |
| Responds to pain | Responds only to an appropriate painful stimulus by trained personnel. | Emergency; airway and breathing may deteriorate. |
| Unresponsive/coma | No purposeful response to voice or pain. | Open airway and check normal breathing immediately; CPR if absent or abnormal. |
2. AVPU and Glasgow Coma Scale
AVPU is a rapid first-aid screen: Alert, responds to Voice, responds to Pain, Unresponsive. The Glasgow Coma Scale is a trained clinical tool scoring eye opening, verbal response and motor response from 3 to 15. Do not use a GCS number without recording its components, because intubation, language, hearing loss, intoxication and facial injury can alter the assessment.
| GCS component | Best response | Examples |
|---|---|---|
| Eyes | Spontaneous, to voice, to pain, none | Record the stimulus needed, not merely “eyes closed”. |
| Verbal | Oriented, confused, inappropriate words, incomprehensible sounds, none | Document barriers such as language, hearing or intubation. |
| Motor | Obeys commands, localises, withdraws, abnormal flexion, extension, none | Compare sides and report new asymmetry. |
3. Immediate management: DRABC/ABCDE
- Danger: check electricity, traffic, violence, chemicals and body-fluid risk.
- Response: speak loudly and gently tap the shoulders. Do not shake a suspected head or neck injury.
- Airway: open with head-tilt/chin-lift if trauma is not suspected; use a jaw thrust by trained rescuers when spinal injury is a concern. Remove only visible loose obstruction.
- Breathing: look, listen and feel for normal breathing for up to 10 seconds. Gasping is abnormal.
- Circulation/catastrophic bleeding: control major bleeding and assess central circulation according to training. Start CPR when indicated.
- Disability/exposure: check AVPU, pupils, glucose if trained, temperature, injuries, medical alert jewellery and possible poisoning while preventing heat loss.
4. Recovery position
Use the recovery position when an unconscious person is breathing normally and has no immediate need for CPR, unless movement is unsafe because of a trapped casualty or suspected major spinal injury. Airway protection takes priority if vomiting or secretions are present.
- Kneel beside the person and remove glasses.
- Place the nearest arm at a right angle, palm upward.
- Bring the far arm across the chest and hold the back of the hand against the near cheek.
- Bend the far knee, then pull it toward you to roll the person onto their side while keeping the hand against the cheek.
- Adjust the upper leg for stability, open the airway, angle the mouth downward and recheck breathing.
- Stay with the person, monitor continuously and be ready to roll supine and start CPR if breathing becomes abnormal.
Add a step-by-step recovery-position image here.
5. When not to give anything by mouth
- Do not give water, food, tablets or glucose to an unconscious or drowsy person because of aspiration risk.
- If hypoglycaemia is suspected and the person is fully alert and able to swallow, give a fast-acting carbohydrate according to local protocol, then reassess and refer.
- If the person cannot swallow, treat it as an emergency; do not pour liquids into the mouth.
6. Common causes and clues
| Cause | Clues | First-aid emphasis |
|---|---|---|
| Head injury | Fall, unequal pupils, vomiting, seizure, fluid from ear/nose, worsening headache | Protect airway and spine, call emergency help; do not move unnecessarily. |
| Stroke | Face droop, arm weakness, speech difficulty, sudden severe imbalance | Record last known well time and activate emergency transport. |
| Seizure/post-ictal state | Jerking, stiffening, tongue injury, confusion afterwards | Protect from injury, time the seizure, do not restrain or put anything in the mouth. |
| Hypoglycaemia | Sweating, tremor, hunger, confusion, unusual behaviour, collapse | Check glucose if trained; oral sugar only if fully able to swallow. |
| Poisoning/overdose | Containers, unusual smell, pinpoint pupils, slow breathing, vomiting | Protect rescuer, call poison/emergency help, support breathing and preserve evidence. |
| Shock | Pale clammy skin, fast weak pulse, rapid breathing, thirst, confusion | Control bleeding, keep warm, lie safely and arrange urgent care. |
7. Seizure first aid
- Protect the head, clear nearby hazards and loosen tight clothing around the neck.
- Do not restrain the movements and do not place a spoon, fingers or any object in the mouth.
- Time the seizure. Call emergency help for a first seizure, a seizure lasting more than five minutes, repeated seizures without recovery, breathing difficulty, injury, pregnancy, diabetes or failure to return to baseline.
- After movements stop, assess breathing and place the person on their side if breathing normally. Stay until fully recovered.
8. Monitoring and handover
Record time found, mechanism, AVPU/GCS components, airway and breathing, pulse, skin, pupils, glucose if available, injuries, medications, witnesses, seizure duration and interventions. Repeat observations frequently and report any deterioration. A person who regains consciousness still requires assessment because the cause may be serious.
9. Scenario
Scenario: A woman is found unresponsive after collapsing at home. She is breathing normally but vomit is present near her mouth. Response: call emergency help, open and clear the airway of visible material, roll her into a safe recovery position, keep the airway open, monitor breathing continuously and preserve any medicine packets for clinicians. Do not give water or try to make her vomit.
Exam points and revision questions
- Explain AVPU and its importance in first aid.
- Demonstrate the recovery position and state when it should not delay CPR.
- List six causes of unconsciousness.
- Describe seizure first aid and three actions that are unsafe.
- Explain why oral fluids must not be given to an unconscious person.