Unconsciousness may develop for a number of reasons, not all of which will be obvious to someone who has just arrived on the scene of an accident. Depending on the cause and the extent of the injury or illness, the level of unconsciousness may also vary – from slight loss of consciousness, as in a fainting attack, to a coma from which the casualty cannot be roused. Between these extremes are several levels of responsiveness in which the casualty may, for example, respond only to a hard pinch, may respond only to direct questions, or may seem totally confused. Anyone who cannot answer straightforward questions such as what day it is, the time and where he or she is should be treated as unconscious and referred for medical help. You should stay with, and keep a check on, the condition of anyone who seems slightly confused following, say, a knock on the head, because he or she may lapse more deeply into unconsciousness and require further treatment. It may help to look for a bracelet, necklace or ID card, because people who suffer from conditions such as diabetes or epilepsy are at risk from unconsciousness. The bracelet or card bears instructions or a phone number where expert advice can be obtained.

Treatment guidelines

The most important first aid measures are, as always, to try to locate and neutralize the cause of the unconsciousness, without putting yourself in danger, and after that to check the casualty’s circulation and breathing. Anyone whose heart has stopped will also have stopped breathing, and in this case cardiac massage must be started immediately, in conjunction with artificial respiration, after you have checked the casualty’s airway is not obstructed. Once breathing has resumed, place the person on his or her front, with the head turned to the left. Bring up the left knee, bend the left arm and extend the chin to ensure a stable position and an unobstructed airway. The aim of this procedure is to make sure that the casualty can continue to breathe without the airway being obstructed by the tongue, and that if he or she is bleeding from the mouth, or vomits, this can drain away without causing choking. For this reason the casualty’s head should preferably be kept lower than the rest of the body: no pillow should be used. In the case of someone in bed, raise the foot of the bed slightly. For stretcher cases, carry the foot of the stretcher higher than the head. You should then proceed to deal with any other injuries as appropriate. Keep the casualty warm by covering him or her with a single blanket during the journey to hospital, which should be arranged as quickly as possible. Someone who has suffered only minimal loss of consciousness – confusion and drowsiness – may not need to be put in the recovery position described above, but they should certainly see a doctor as soon as possible. Remember, give nothing by mouth, because this may delay any subsequent surgery.