When encountering an unconscious victim, it is critical to follow the proper steps in order to avoid causing further harm and give the victim the best chance of survival. There are some key things that should be done in a specific order when dealing with an unresponsive person.
Assess the Scene and Victim
The first step when coming across an unconscious person is to make sure the scene is safe. Look for any dangers or risks like live electrical wires, gas leaks, traffic, fire, or potential violence. Do not put yourself in harm’s way. Once the scene is secure, verify that the person is unresponsive by gently shaking their shoulder and loudly asking “Are you okay?” If there is no response, have someone call 911 or your local emergency number immediately.
Next, check to see if the victim is breathing normally. Place your ear near the nose and mouth and look to see if the chest is rising and falling. Abnormal breathing like gasping, slow breathing, or no breathing indicates the airway may be blocked or the person is in respiratory distress. If the victim is not breathing or has trouble breathing, be prepared to give rescue breaths.
You should also check for a pulse by placing two fingers on the side of the neck or on the wrist. An absence of a pulse is a critical situation requiring CPR. After assessing breathing and pulse, look for any life-threatening bleeding and signs of shock like pale, cool, clammy skin.
Position the Victim Properly
Once initial checks are complete, position the victim appropriately. If there are no suspected head or neck injuries, roll the person on their back. Tilt the head back and lift the chin to open up the airway if they are making abnormal breathing sounds.
If a head or neck injury is suspected, take extra care to support the head and neck by leaving the victim flat and stabilizing the head. Do not tilt or move the head or neck which could worsen a spinal injury.
Clear the Airway
With the victim in the proper position, open the airway by tilting the head back and lifting the chin. Check the mouth for any blockage and clear out any vomit, blood, or foreign objects. If the tongue is blocking breathing, use a finger sweep by placing your finger as far back as possible and sweeping out any obstruction.
Some key steps for clearing an airway obstruction:
| Age | Technique |
|---|---|
| Infants | Deliver 5 firm back blows then 5 chest thrusts repeatedly |
| Children | Deliver 5 abdominal thrusts or back slaps |
| Adults | Perform abdominal thrusts or chest thrusts if obese |
Abdominal thrusts, known as the Heimlich maneuver, involve making a fist and placing it just above the navel. Clasp the fist with your other hand and press inward and upward repeatedly to create pressure and dislodge the obstruction.
Give Rescue Breaths
If normal breathing is absent, rescue breaths must be administered. With the airway open, pinch the nose closed. Create a tight seal over the victim’s mouth with your own and give 1 breath over 1 second to make the chest rise. Give a second rescue breath and check for breathing again before starting compressions.
When giving rescue breaths:
- Maintain head tilt and chin lift
- Allow the chest to deflate between breaths
- Give breaths over 1 second each
- Watch for chest rise with each breath
- Use barrier device if possible to prevent disease spread
Start Chest Compressions
If the victim remains unresponsive with no breathing or abnormal breathing after 2 rescue breaths, begin CPR starting with chest compressions. Proper hand placement is key for effective compressions.
For adults, place the heel of one hand on the lower half of the sternum in the center of the chest. Place the other hand directly on top. Keep arms straight and shoulders directly over the hands.
For children, use one or two hands on the lower half of the sternum based on your hand size relative to the child’s chest.
For infants, use two fingers in the center of the chest, just below the nipple line.
Press down hard and fast on the sternum compressing at least 2 inches in adults, 2 inches in children, and 1.5 inches in infants. Allow full chest recoil between compressions. Perform compressions at a rate of 100-120 per minute.
Combine Compressions and Breaths
After 30 compressions, open the airway again and give 2 rescue breaths. Then immediately resume chest compressions without delays or interruptions. Continue cycles of 30 compressions and 2 breaths until advanced help arrives.
Guidelines for compression-breath cycles:
| Age | Compression to Breath Ratio |
|---|---|
| Infants | 30 compressions to 2 breaths |
| Children & Adults | 30 compressions to 2 breaths |
Minimizing pauses in compressions is critical to perfuse blood effectively. Limit breath pauses to under 10 seconds.
Use an AED
An automated external defibrillator (AED) can help revive someone in cardiac arrest. If an AED is available, have someone call for it immediately. Turn on the AED and attach the pads once retrieved. Follow the voice prompts which will guide you whether or not a shock is advised and when to resume CPR.
Key tips when using an AED:
- Place pads on bare skin based on diagram on pads
- Make sure no one is touching victim when shocking
- Resume CPR starting with compressions after shock delivered
- Continue cycles of CPR and AED analysis as directed
Provide Ongoing Care
Keep performing CPR and using the AED until professional rescuers arrive. Ensure 911 or emergency services have been contacted. Monitor the victim’s condition for any changes in breathing, consciousness, or pulse. Do not stop rescue efforts unless the scene becomes unsafe, you are too exhausted to continue, or the victim starts breathing normally and regains consciousness.
Some key aspects of ongoing care include:
- Recheck pulse every 2 minutes
- Limit interruptions in CPR
- Maintain open airway
- Treat any wounds or bleeding
- Keep victim warm
- Provide reassurance
Conclusion
Responding quickly and following proper steps is crucial when encountering an unresponsive victim. After calling 911, check the victim’s vital signs including pulse, breathing, and consciousness. Open and maintain the airway, provide rescue breaths if needed, and start chest compressions if there is no breathing or abnormal breathing present. Use an AED as soon as possible if available. Continue cycles of compressions and breaths until EMS arrives. With fast action, you can dramatically improve the chance of survival and recovery for an unconscious person.