Unconsciousness

Unconsciousness is an interruption of normal brain activity. It can happen suddenly or gradually. Unconsciousness can be caused by a range of injuries and medical conditions, as well as by a number of different drugs. An unconscious person may still have some reactions to pain or to commands, for example, or may have no reactions at all.

Whatever the cause or degree of unconsciousness, the immediate emergency treatment remains the same:

• Assess whether the person is unconscious by gently squeezing the shoulders and asking a question.
• Open the airway by lifting the chin, clearing the mouth and tilting the head.
• Check the breathing and be prepared to resuscitate if necessary.
• If breathing, check for life-threatening conditions and then turn into the recovery position.
• Call for emergency help.

This may be all that you have time to do before emergency help arrives. However, if you have longer, there are some things that you can do to gather information that may help medical staff with their diagnosis and treatment.

Assess the level of response

There is an agreed scale for assessing how responsive an injured or ill person is - the Glasgow Coma Scale. A fully alert person will score 15 while somebody who is totally unresponsive will score 3 with several variations in between. You can help collect information to inform medical staff using some of the checks from this scale:

Eyes. Do they:

• Open without you having to ask the person to open them?
• Open on command?
• Open if you cause the person pain (this is often done by pinching the earlobe)?
• Remain closed?

Movements. Does the person:

• Understand and follow sensible instructions?
• Move only in response to pain?
• Not move at all?

Speech. Does the person:

• Answer questions sensibly?
• Answer questions in a confused way?
• Make sounds that cannot be understood?
• Make no noise?

Do the checks of eyes, movement and speech every 10 minutes and record your answers.

Monitor and record breathing

Breathing is measured by counting the number of breaths in 1 minute (one breath being one rise and fall ofthe chest).

Monitor and record pulse rate

Pulse rate is measured by counting the number of beats at the pulse at either the neck or the wrist for 1 minute. The easiest place to feel a pulse is in the carotid artery in the neck, though you can also check the wrist. Take recordings of breathing and pulse rate every 10 minutes and write down the results for the medical staff.

Fainting

A faint is a briefloss of consciousness. Shock is one of the potential causes of fainting but other causes include lack of food, a reaction to emotional news or long periods of inactivity, for example guardsmen standing for a long time in the summer.

To treat someone who has fainted, open the airway and check for breathing. If the person is breathing and there are no signs of injury, then the best treatment is to lie her on her back with her legs raised. This puts maximum oxygen back to the brain and speeds up recovery from a faint. If she has not begun to come around after 3 minutes, or if breathing becomes difficult, put her into the recovery position and call for help.

Examining the unconscious person

Your initial check of the injured or ill person will be for life-threatening conditions, particularly serious bleeding. If you have more time while waiting for the ambulance, a more thorough check may show up less serious injuries or illness and potential clues to the cause of unconsciousness. This check should never be at the cost of monitoring and maintaining the airway or of keeping the injured person as still as possible. If doing a check of the body, it is sensible to do so in the presence of a third person.

Check the body from head ro toe, looking for areas of bleeding, signs of broken bones or burns, or clues as to the cause of unconsciousness.