An unconscious person dies of their own tongue and their own vomit long before dying of whatever made them collapse.
ACT
Three questions, in this order. Don't skip a step.
- Do they respond? Speak loudly, gently shake their shoulders. No response: they're unconscious.
- Get someone to call for help. Point to a specific person — "you, call 112" — rather than the group in general.
- Are they breathing? Gently tilt the head back and lift the chin: this alone moves the tongue away from the back of the throat. Lean in, ear near the mouth, eyes on the chest. Look, listen and feel for ten seconds.
They're breathing normally. Turn them onto their side, in the recovery position: head slightly tilted back and turned towards the ground, mouth open and facing down. This position does one thing, and it's vital: it lets vomit drain out instead of being breathed in. Cover them, don't leave them alone, and check their breathing regularly.
They're not breathing, or breathing abnormally — a few slow, noisy, irregular gasps. That isn't breathing: it's a sign of cardiac arrest. Start chest compressions immediately: in the centre of the chest, arms straight, pressing five to six centimetres (about 2 to 2.4 inches) deep, about two per second, letting the chest come fully back up between each one. Don't stop.
If an automated defibrillator is available, have it brought and switch it on: it talks and guides you step by step. It only delivers a shock if one is needed.
ADAPT
You suspect a spinal injury — a fall from height, an accident. Breathing comes before everything. Someone who isn't breathing will die; someone moved badly risks an injury. Turn them anyway, but keep the head in line with the body, with several people if possible.
It's a child. The sequence is the same. Compressions are done with one hand for a child and two fingers for a baby, pressing to a depth suited to their size — about a third of the chest's depth.
You're alone with no phone. There's one exception to the rule "call first": in adults, cardiac arrest is most often heart-related and the defibrillator is decisive, so calling comes first. In children and in drowning, the cause is almost always respiratory: start with one minute of resuscitation, then go and get help.
You're exhausted. Take turns every two minutes if someone else is there. The quality of compressions drops fast, and the rescuer doesn't notice it themselves.
The person wakes up. Keep them lying down, don't let them stand up, keep them warm and watch them: they may lose consciousness again. Look for what made them collapse — heat, bleeding, cold — and see the matching sheets: Heatstroke, Severe external bleeding, Hypothermia.
They're unconscious in the cold. Handle them extremely gently: a chilled heart is electrically unstable and a sudden movement can stop it. See Hypothermia.
UNDERSTAND
Unconsciousness removes two protections at once.
Muscle tone disappears. Lying on the back, the tongue falls backwards and blocks the throat. It's the most common cause of suffocation in an unconscious person, and simply tilting the head back lifts it.
Protective reflexes disappear. A conscious person who vomits coughs and leans forward. An unconscious person breathes it in — which causes lung damage that is often fatal, sometimes several hours later. The recovery position doesn't treat anything: it simply uses gravity so that whatever comes up comes out.
Abnormal breathing needs stressing, because it's the most common and most serious mistake. In the first minutes of a cardiac arrest, many victims show slow, deep, noisy, widely spaced breathing movements. It looks like breathing, and many witnesses conclude the person is breathing. It isn't. If in doubt, start compressions: doing them on someone who is breathing causes little harm; not doing them on someone in cardiac arrest is certainly fatal.
Finally, about the compressions themselves. Without circulation, the brain suffers irreversible damage within minutes. Compressions almost never restart the heart: they move blood that still carries oxygen and buy time until the defibrillator or help arrives. Every pause makes the pressure drop, and it takes several compressions to build it back up. That's why the rule is to push hard, push fast, and not stop for anything.
This sheet describes what to do. It doesn't replace a first aid course, which takes a few hours and actually makes you practise.