What to Do: Unconscious
You’ve found someone unconscious. You’re not sure what’s happened. It could be a family member at home; it could be a perfect stranger in the street. Either way, they may need medical help — and if you’re the only one there, you’re the only one who can get it for them. What do you do?
This post is based on my experience and knowledge as a first responder. This is not medical advice. Always protect your own safety first. In a medical emergency, always call 999 and follow the instructions you're given.
If you go through any decent first aid course, one of the things you’ll be taught is the primary survey. This is your initial assessment of the scene. There’s a handy mnemonic to remember it: DR ABC.
Each of these steps gets you — and the emergency services, when you call — more information about what’s going on. Each step also has some points at which you should step back and call 999 immediately for further instructions.
Danger. You’re the first responder. Your safety is the absolute first priority; you can’t help anyone if you put yourself in danger or get yourself injured. Check the scene and the immediate area for obvious hazards; look for clues about what may have happened. Is there an exposed electrical cable? Is there a heavy object lying next to the patient’s head that might have fallen? Check and clear any hazards that you are safely able to before continuing.
Call 999 immediately if: any scene safety issues are present (electrocution, hazardous materials, major trauma especially from unknown cause, drowning, etc) or if you’re unable to safely assess any further.
Response. Is the patient responsive or unresponsive? Call out to them; gently shake a shoulder if it’s safe to do so. Do they respond normally, are they sluggish or confused, or are they completely unresponsive? If they’re responding normally, ask what’s happened so that you can start to understand what’s going on. Ask if they need help — they may simply be homeless and trying to sleep.
Call 999 immediately if: the patient becomes aggressive or, again, if you’re unable to safely assess any further.
Airway. If they’re not fully responsive, check the airway itself is clear — make sure there’s no food, vomit, or other obstructions blocking their ability to breathe. Check they’re not choking on anything, if possible. Clear any obstructions so they have a clear airway.
Call 999 immediately if: the patient is or may be choking, or you’re unable to clear their airway.
Breathing. Check if they’re breathing. You may be able to see their chest rising and falling. If it’s safe, put your ear next to their mouth and look towards their chest so that you can look, feel, and listen for any breathing.
Call 999 immediately if: the patient is not breathing, making funny noises, gasping, barely breathing, turning blue or purple, etc.
Circulation. Obviously you can’t check internal circulation, but check for any obvious external bleeding. Note roughly how much blood there is and whether it’s still bleeding or has now stopped. Is there a pool of blood, or is it a few drops from a small scratch?
Call 999 immediately if: there is a significant volume of blood lost, or if there is blood gushing or pouring non-stop from anywhere, or if blood is coming in spurts from anywhere.
Immediate First Aid
There’s not a whole lot you can do for an unconscious person as a first responder without any equipment. There are two major things you can and should do, however: control any bleeding, and maintain the patient’s airway.
Pre-hospital, there’s effectively one way of controlling bleeding: pressure. With enough pressure, you can control almost any bleeding. Find something clean and dry — not tissue, that’ll just stick to it, but a cloth, towel, clothing, something like that — make sure it’s right on top of the wound and press hard. It takes more pressure than you think, and if the patient is at all conscious then it’s going to be uncomfortable, but a little discomfort is better than bleeding out.1
Maintaining an airway is even easier: turn the patient on their side. If you know what the recovery position is, use it, but as long as you get them propped on their side, that works just as well. This ensures that they don’t choke on their own tongue, and that if they vomit it all comes out instead of getting trapped and potentially blocking their airway again.
Side note: if you’re on the phone to me, I’ll tell you to lay the patient flat on their back and give you instructions to tilt their head back. I’m doing this because I’ll be staying on the phone to monitor their breathing, and I will give further instructions if they start breathing ineffectively. If you’re on your own and not yet talking to 999, lay the patient on their side.
Important: if the cause of the patient’s condition is traumatic (i.e. fall, assault, injury), do not move them — call 999 and follow instructions. Moving the patient could cause further damage; the 999 operator will tell you what is the safest thing to do.
Lastly, stay with the patient until the ambulance arrives. If things get worse it’s important that there’s someone there to call back and let the ambulance service know (or just to tell the operator, if they’re still on the line). Your super-important meeting is less important than someone’s life.
If you can’t find anything to control the bleeding with, use your hand. The cloth is only there to keep things from being too messy, but if you haven’t got anything — not even a spare piece of clothing — then you’re only left with your hands. If you have gloves, put them on, but ultimately an infected wound is still better than bleeding to death. ↩