Check for any danger to you, or anyone else at the scene.
Remember you cannot help anyone else if you become injured.
If the scene is not safe, call 999 and stay back.
If the scene is safe, put on protective gloves, if available and approach the casualty.
Response
Quickly check for a response using a non-painful stimulus.
Tap each shoulder and speak loudly, saying
“Are you alright?”
Call them by their name, if you know it.
If it is a baby, gently tap the sole of the foot and speak or clap loudly.
If they speak, move or open their eyes, they are responsive.
Call for help / Catastrophic bleeding
If they do not respond at all, treat them as unresponsive.
Ask someone to call 999 for an ambulance and bring an AED.
If you are on your own, call 999 yourself. Put the phone on speaker mode so you can follow the call handler’s instructions while giving care.
Check for life threatening bleeding and treat immediately before continuing to the next step.
A responsive person shows signs of awareness — they speak, move, open their eyes, or react when you talk to them or touch their shoulder. An unresponsive person does not wake, move, or react at all when you try to get their attention.
Is being unresponsive the same as sleeping?
No, a sleeping person will wake up if you speak to them, tap their shoulder, or call their name. An unresponsive person will not react at all, no matter how loudly you speak or how firmly you try to wake them. This lack of response is a sign that something may be seriously wrong.
If someone is unresponsive, they may not be able to protect their airway or breathe properly and this can quickly become life-threatening, so you must call 999 for emergency help immediately.
The ACVPU scale is a quick way to check how alert and responsive a person is. It helps answer one basic question:
How awake and responsive is this person right now?
What does ACVPU stand for?
A = Alert:
The person is awake, aware, and responds normally
C = Confusion:
The person is not orientated to place, date and time*
V = Voice
The person is not fully awake but responds when spoken to
P = Pressure / Pain:
The person does not respond to voice, but reacts to painful stimuli. This should be a small, and appropriate stimuli like a pinch, to avoid harm.
U = Unresponsive: The person does not respond to voice or pain
*Confusion means a NEW change in mental status. It does not include people with conditions such as dementia, who may not normally be orientated to place, date, or time.
Use AVPU for Children
When checking a child’s level of responsiveness, we do not always use the C for new confusion, because children may not reliably show or communicate confusion.
In babies, children and young people under 18, cardiac arrest is most commonly secondary to a breathing problem (such as choking, drowning, asthma, or infection) and they urgently need rescue breaths to try to correct the lack of oxygen.
If a paediatric casualty is unresponsive and someone is with you, get them to call 999 and to use the speaker function so that you can quickly check for breathing and then begin CPR starting with 5 rescue breaths. Ask the helper to fetch an AED, if feasible.
If you are alone with an and you have a mobile phone with you
Call 999 immediately and put the phone on speaker while you check for breathing.
If the child is not breathing normally, give 5 initial rescue breaths, then start CPR.
Continue CPR while following the instructions given by the emergency call handler.
Some ambulance services may also ask you to use the video function on your phone to help guide your actions.
If you are alone and you do not have a mobile phone with you
Immediately begin CPR starting with 5 rescue breaths and continue for about 1 minute before leaving to get help.
This ensures the child receives vital oxygen and circulation as early as possible. To minimise interruptions to CPR, if the child is an infant or small enough to carry, you may take them with you while you go to summon help.
Primary Cardiac Arrest
If a paediatric casualty is unresponsive and you suspect it could be a primary cardiac arrest (due to a heart problem rather than a breathing problem), call 999 immediately just as you would for an adult.
You should suspect a primary cardiac arrest when:
A previously well child suddenly collapses, especially during physical activity
A child complains of chest discomfort/pain/palpitations or a 'racing' heart before suddenly collapsing
A child has extreme dizziness or unexplained sudden shortness of breath during exercise before suddenly collapsing
