You have come across a person who appears to be unconscious. After checking for danger for hazards and ensuring it’s safe to approach, your next step is to check for a response.

Whether or not they can respond to you will dictate your next moves.

An unconscious casualty provides many unique challenges to the first aid techniques you may need to use. A conscious casualty could provide a whole different range of challenges.

Knowing how to properly check for response can be a life saving task that must not be over looked.

What is Unconsciousness?

If a person is unconscious, it means that their body is still operational, but they are not able to respond to anything happening to or around them.

They may appear as though they are asleep and breathing, but they cannot be woken.

The causes of unconsciousness can be classified into four broad groups:

• Low brain oxygen levels
• Heart and circulation problems (e.g. fainting, abnormal heart rhythms)
• Metabolic problems (e.g. overdose, intoxication, low blood sugar)
• Brain problems (e.g. head injury, stroke, tumour, epilepsy)

An unconscious person may have a combination of causes. For example, they may have a head injury from a fall that was caused by the influence of alcohol.

Before loss of consciousness, the person may experience yawning, dizziness, sweating, change from normal skin colour, blurred or changed vision, or nausea.

A casualty may be conscious but not responding. An example would someone having an Absence Seizure, where they remain conscious, but unable to respond to questions and commands. Therefore, a casualty that is unresponsive should always be treated as unconscious.

How to Check for a Response

The C.O.W.S method is an excellent way to assess if the casualty is responsive. Easy to remember, it involves talking to, and touching them, using both questions and commands.

There is no need to aggressively shake or yell at a casualty to gain a response. Just touching the casualty on the hand/shoulders and talking assertively is an effective method and will awaken a sleeping person.

Can you hear me?

Asking, can you hear me? Are you hurt or sick? May I help you? Yes/no questions are easy to respond to as they require little consideration. The last question has the added advantage of gaining consent, or not, as well as eliciting a response.

Open your eyes.

Instructing the casualty to open their eyes is the most instinctive action the casualty will take, if they are able to. If their eyes are open, ask if they are able to look left and right. This may indicate that they can hear your instructions and respond to them, even if they can’t speak or move other parts of their body.

What is your name?

Asking their name is also instinctive. It does not matter if they give the correct name, so long as they respond to your question.

Squeeze my hands.

Squeeze the casualty’s hand to see if they squeeze back. A casualty that cannot hear you may feel your squeeze and respond accordingly.

Checking for a Response in Children and Infants

If a child or infant is unresponsive, or only showing the slightest signs of awareness, always call Triple Zero (000) immediately.

Do not shake children or infants. This can cause damage to their brain and spinal cord.

You can use the same C.O.W.S method for children, however their responses may be different to an adult. A young child or infant may not be able to speak back to you as an adult would.

Instead, look for any movement, facial expression, or sounds that they appear to be making purposefully. This may indicate that they can hear or feel you.

If the casualty DOES respond

If the casualty responds by speaking or moving and appears conscious, leave them in the position in which you find them (provided there is no further danger or risk).

Perform a ‘secondary survey’ by doing a verbal and visual assessment of their condition.

A verbal assessment is asking questions of the casualty such as: What happened? Are you injured? Do you have any pain? Do you feel ill? Do you have a medical condition?

A visual assessment is a head-to-toe examination, looking for bleeding, burns, bites, abnormal swelling, etc. Also look for medical alert bracelets.

Get help if required and proceed with providing first aid as needed. Always ask for consent before performing any first aid procedure if the person is alert and aware.

Observe and reassess the casualty regularly.

If the casualty DOES NOT respond

Send for help by calling Triple Zero (000) and asking bystanders for assistance.

Move forward with DRSABCD by checking their airway and breathing, and performing CPR as necessary.

Conclusion

Checking for a response is critical before proceeding with any first aid assistance.

Knowing if a casualty is conscious or not allows you to use the appropriate techniques.

Using gentle but firm responsiveness techniques, such as the COWS method, mean you can check for a response while remaining respectful to the casualty.