An unconscious person will not respond when you speak to them, tap their shoulders, or shake them gently. Their body will be limp, their eyes closed, and they won’t react to what’s happening around them. Recognizing unconsciousness quickly matters because the next steps you take, particularly checking for breathing, can be the difference between life and death.
The Step-by-Step Check
Start by trying to get a response. Approach the person, tap both shoulders firmly, and speak loudly: “Are you okay? Can you hear me?” A conscious person, even one who is confused or drowsy, will typically react in some way. They might open their eyes, groan, shift their body, or try to speak. Someone who is truly unconscious will do none of these things.
If there’s no response to your voice or touch, the person is at minimum deeply unresponsive and needs emergency help. Call 911 (or have someone nearby call) before doing anything else. Then immediately check whether they’re breathing normally by looking at their chest for rise and fall. This two-part assessment, consciousness then breathing, is exactly what the American Heart Association recommends for anyone without medical training.
What Unconsciousness Looks Like
An unconscious person’s muscles go slack. Their jaw may hang open, their head will fall to one side, and their limbs will feel heavy and floppy if you lift them. If you raise an arm and let go, it drops straight down without any resistance. This total loss of muscle tone is one of the clearest physical signs separating unconsciousness from sleep, where a person still maintains some muscle control and will usually stir if disturbed.
Their eyes will be closed and won’t open when you call their name. In deeper levels of unconsciousness, even brushing a fingertip lightly across the eyelashes won’t trigger a blink.
Levels of Responsiveness
Consciousness isn’t all or nothing. Someone can fall anywhere on a spectrum, and a simple framework called AVPU helps you quickly gauge where they are:
- Alert: Eyes open on their own, responds to questions, moves voluntarily. This person is conscious, even if confused.
- Voice: Eyes stay closed until you speak. They might open their eyes, grunt, moan, or move slightly in response to your voice, but they’re not fully awake.
- Pain: No response to voice at all. The person only reacts when they feel something painful, like a firm pinch or pressure on their chest bone.
- Unresponsive: No reaction to anything. Eyes stay shut, no sounds, no movement, regardless of what you do.
Anyone at the “Pain” or “Unresponsive” level is unconscious and needs emergency medical care immediately.
How Pain Stimulus Testing Works
When someone doesn’t respond to voice or touch, trained responders apply a controlled painful stimulus to see if the brain is still processing input. You may see paramedics or hospital staff use one of three methods: pressing knuckles firmly into the center of the chest bone (a sternal rub), squeezing the trapezius muscle at the base of the neck between the thumb and two fingers, or pressing into the bony ridge just above the eyebrow.
If the person grimaces, pulls away, or makes any sound in response to pain, their brain is still partially active, even though they’re unconscious. If there is zero reaction to a painful stimulus applied for up to 10 seconds with increasing pressure, the person is deeply unresponsive. This distinction helps medical teams determine how serious the situation is.
Check Breathing Carefully
Once you’ve confirmed someone is unresponsive, the most critical next step is assessing their breathing. Look at their chest: is it rising and falling in a regular rhythm? Listen near their mouth and nose for the sound of air moving in and out.
Be cautious about gasping. More than half of people in cardiac arrest will gasp, and bystanders frequently mistake this for normal breathing. Gasping can sound like snoring, gurgling, moaning, or snorting. It’s irregular, labored, and looks nothing like relaxed breathing. It typically stops within about four minutes. If you see someone who is unconscious and making these kinds of sounds, treat it as cardiac arrest and begin chest compressions. Research from the University of Arizona found that among cardiac arrest patients who received bystander CPR, 39 percent of those who were gasping survived, compared to only 9 percent of those who were not gasping. The gasping is actually a sign the brain is still alive, and starting compressions immediately gives that person their best chance.
Unconsciousness vs. Fainting
Fainting is a brief, temporary loss of consciousness, usually lasting seconds to a minute. It happens when blood pressure drops suddenly and the brain briefly loses adequate blood flow. Common triggers include standing up too quickly, dehydration, heat exposure, emotional distress, low blood sugar, and heart problems. Before fainting, a person will often feel dizzy or lightheaded, their vision may white out or black out, and their skin turns cold and clammy.
The key difference is recovery time. Someone who has fainted will typically start to come around within a minute, especially once they’re lying flat. If a person collapses and does not regain consciousness within a minute or two, this is not a simple faint. It suggests something more serious: a seizure, stroke, diabetic emergency, drug overdose, head injury, or cardiac event. The longer someone remains unconscious, the more urgent the situation becomes.
What to Do While Waiting for Help
If the person is unconscious but breathing normally, roll them onto their side into what’s called the recovery position. This keeps their airway clear by allowing any fluid or vomit to drain from the mouth rather than blocking the throat. Tilt their head back slightly to keep the chin lifted and the airway open. Stay with them and keep checking their breathing until help arrives.
If the person is unconscious and not breathing normally, or only gasping, start chest compressions. Push hard and fast in the center of the chest, aiming for a rate of about 100 to 120 compressions per minute. Don’t stop until paramedics take over or the person starts showing signs of life. Current guidelines prioritize compressions over rescue breaths for untrained bystanders, since getting blood moving to the brain quickly is what saves lives.
Do not try to give an unconscious person food, water, or medication by mouth. They cannot swallow safely, and anything placed in their mouth risks blocking the airway or entering the lungs.