What would you do with a casualty who was unresponsive and breathing normally?

If someone becomes unresponsive they need someone to help keep them safe and prevent further harm. The type of help they need varies depending on why they have become unresponsive, whether they are breathing or not breathing and if they are baby, child or adult.

The guidance on resuscitation outside of a hospital setting has changed as a result of COVID-19. When CPR is carried out there is a risk of transmitting coronavirus, particularly through rescue breaths. However, this risk is small whereas taking no action, if the person has had a cardiac arrest, is certain to result in death.

If someone is unresponsive, you should shout for help and dial 999. Tell the call handler if you suspect that the victim has COVID-19. Make sure an ambulance is on its way.
Check for a response, but do not listen or feel for breathing by placing your ear and cheek close to the patient’s mouth.
If you're in any doubt about whether the patient has had a cardiac arrest, start chest compressions (see below for details).
Where possible, it’s recommended that you don’t perform rescue breaths or mouth-to-mouth CPR during the pandemic. Only perform chest compressions.
If there is a risk of infection, place a cloth or towel over the victim’s mouth and nose. Attempt compression-only CPR and early defibrillation until the ambulance arrives. Read on to find out how to do this.
If you have access to personal protective equipment like a mask, gloves or eye protection, you should wear them.
After performing compression-only CPR, you should wash your hands thoroughly with soap and water for at least twenty seconds. If you cannot wash your hands, you should use hand sanitiser which is at least 60% alcohol. Do not touch your face until you have done so. If you develop symptoms of COVID-19 you should self-isolate for at least seven days.

This leaflet is created from first aid advice provided by St John Ambulance, the nation's leading first aid charity. This advice is no substitute for first aid training - find a training course near you.

If someone is not responding to you and you think they are unresponsive, ask loudly: 'Are you alright?' or 'Open your eyes'. If they don't respond, pinch their earlobe or gently shake their shoulders. If they still don't respond, then you can presume they're unresponsive.

Step 1 of 5: Open the airway

Place one hand on the person's forehead and gently tilt their head back. As you do this, the mouth will fall open slightly.
Place the fingertips of your other hand on the point of the person's chin and lift the chin.

Step 2 of 5: Check breathing

Look, listen and feel for normal breathing - chest movement, sounds and breaths on your cheek. Do this for no more than ten seconds.

Step 3 of 5: Put them in the recovery position

This will keep their airway open.
Kneel down next to them on the floor.
The next three steps are for if you find the person lying on their back. If you find them lying on their side or their front you may not need all three.

Place their arm nearest you at a right angle to their body, with their palm facing upwards.
Take their other arm and place it across their chest so the back of their hand is against their cheek nearest you, and hold it there. With your other hand, lift their far knee and pull it up until their foot is flat on the floor.
Now you're ready to roll them on to their side. Carefully pull on their bent knee and roll them towards you. Once you've done this, the top arm should be supporting the head and the bent leg should be on the floor to stop them from rolling over too far.

Step 4 of 5: If you suspect spinal injury

If you think the person could have a spinal injury, you must keep their neck as still as possible. Instead of tilting their neck, use the jaw thrust technique: place your hands on either side of their face and with your fingertips gently lift the jaw to open the airway, avoiding any movement of their neck.

Step 5 of 5: Call for help

Once you've put them safely into the recovery position, call 999 or 112 for medical help.
Until help arrives, keep checking the person's breathing.
If they stop breathing at any point, call 999 or 112 straightaway and get ready to give them CPR (cardiopulmonary resuscitation - a combination of chest pressure and rescue breaths).

If an adult is unresponsive and not breathing, you'll need to do CPR (which is short for cardiopulmonary resuscitation). CPR involves giving someone a combination of chest compressions and rescue breaths to keep their heart and circulation going to try to save their life. If they start breathing normally again, stop CPR and put them in the recovery position.

What you need to do

If someone is with you, get them to call 999 or 112 for emergency help and ask them to get an automated external defibrillator (AED) if one is available.

How to perform CPR on an adult

Step 1: Giving chest compressions

Kneel down beside the person on the floor, level with their chest.
Place the heel of one hand towards the end of their breastbone, in the centre of their chest.

Place the heel of your other hand on top of the first hand and interlock your fingers, making sure you keep the fingers off the ribs.
Lean over the person, with your arms straight, pressing down vertically on the breastbone, and press the chest down by 5-6 cm (2-2½ in).
Release the pressure without removing your hands from their chest. Allow the chest to come back up fully - this is one compression.
Repeat 30 times, at a rate of about twice a second or the speed of the song 'Staying Alive'.
Give two rescue breaths.

Step 2: Giving rescue breaths

Ensure the person's airway is open.

Pinch their nose firmly closed.

Take a deep breath and seal your lips around their mouth.
Blow into the mouth until the chest rises.

Remove your mouth and allow the chest to fall.

Repeat once more.
Carry on giving 30 chest compressions followed by two rescue breaths for as long as you can, or until help arrives.
If an automated external defibrillator (AED) arrives switch it on and follow the instructions provided with it.

If the person starts breathing normally again, stop CPR and put them in the recovery position.

Adapted from the St John Ambulance leaflets: unresponsive breathing adult and unresponsive and not breathing adult. Copyright for this leaflet is with St John Ambulance.

This video provides a step-by-step guide on how to put someone into the recovery position.

Unconsciousness is caused by an interruption of the brains normal activity. This can be caused by strokes, head trauma, seizures or lack of oxygen. When a casualty is unconscious, their muscles become relaxed, including their swallowing muscles, and if the casualty is not placed on their side, they can choke on their own fluids. If an unconscious casualty is left on their back, their tongue may fall back and block the airway. An unconscious casualty is still breathing and has a pulse, but may not respond to gentle shouting and stimulation. They look like they are in a deep sleep, but cannot be woken up. They may not respond to verbal or painful stimuli.

Alcohol or asphyxiation
Epilepsy
Insulin
Diabetic
Overdose
Uraemia – Kidney damage
Trauma
Infection
Pretend, Pressure, or Poison
Stroke, Spinal Injury, Shock

Infants and small children should never be shaken as this can cause death or severe brain injury. They should be assessed by shouting and gentle stimulation.

Casualty has a pulse.
Casualty is breathing.
Casualty seems to be sleeping but cannot be woken up.
Casualty may moan or groan when stimulated or asked to open their eyes.

Seek medical aid immediately.
Give the casualty Nil by Mouth.
Place the casualty into the lateral position supporting the neck and Head.
- It obtains and maintains an open airway.
- Although you cannot swallow your tongue, the tongue can fall across the airway and block it. When placed in the lateral position tongue falls away from the back of the mouth.
- Fluids and objects will drain away from the mouth
Place the head in a low position to allow free drainage of fluid.
Even if cervical or spinal injury is suspected, the casualty must still be gently and carefully log rolled into the lateral position.
- One person supports the neck and head.
- One or two people support the back and the body.
- One person supports the legs.
- Roll the body smoothly and gently and in alignment with no twisting or jerking.
Avoid pressure on the chest.
Loosen any tight clothing from around the neck, chest, and waist. It makes breathing a lot easier.
Always talk to and reassure the casualty. Although they look like they are asleep, they can sometimes hear everything you say.
Do a head to toe examination.
Treat other injuries.
Cover the casualty lightly if they are cold.
Stay with the casualty and monitor their vital signs.