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What to do when a person is found down: Trauma and Emergency Education

Emergency Medicine
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A Person is Found Down

Scene Safety & Calling for Help
If you find someone down, the priority is to ensure that the location is safe prior to tending to the individual. If the area appears safe to you, the next step is to call for help.
If you are alone and you are able, call 112 for assistance. If you are not alone, send the person you are with to call for or obtain help.

Basic Victim Assessment & Basic Life Support

Airway
Once the scene is safe and you have called for help, approach the individual who is down and ask them if they are OK. If you see any obvious bleeding or traumatic injuries, please read the article on “trauma bleeding”.
If the patient responds, ask them if they are injured and obtain help from that point.
If the patient does not respond, the priority is to make sure the patient has a clear airway and can breathe without any obstruction.
If the person is able to communicate with you clearly, then you can be reassured that their airway is open.
If their speech is gargly, unclear or have clearly labored breathing, start by placing the patient on their back, lift their chin to extend their neck and tilt the head back, chin up to help open the airway. Place a hand on each side of the persons jaw (under their jaw line) and pull it forward. This serves to open the patient’s airway.
If there is lots of blood in their mouth, then turn them to their side to allow the blood to drip out. If they are conscious, with a significant amount of blood, have them sit up, and lean forward. Keep them in this position. Do NOT have them lean back or lie down, this will make worsen their ability to breathe.
Breathing
Once you have tilted the individual’s head back to open the airway, the next step is to check that they are breathing. Look to see if the victim’s chest is rising and falling in a breathing pattern.
Listen near the victim’s mouth to hear for breath sounds. Place your hand on the patient’s chest to see if you can feel the chest rising and falling in a breathing pattern.
If the individual is breathing and has no obvious injuries, await for help. Keep talking to the individual and keep assessing for breathing to ensure that they don’t stop breathing. If the patient has low responsiveness or has unclear speech but they are breathing, you may place them on their side in the recovery position (Picture 1).
In the recovery position, the individual’s head rests on their arm on the ground, and their top knee is brought over to be leaned on keep the patient on their side, like an easel. This position help keep the individual’s airway open. It also prevents them from choking on vomit or saliva. In this position, continue to assess for breathing and call for help if able.
If the individual is not breathing, ensure help has been called for and have someone get an automated external defibrillator (AED) if available. If you are alone, stay with the individual.
The next step is to start cardiopulmonary resuscitation (CPR).
Circulation – Cardiopulmonary Resuscitation (CPR)
CPR serves to maintain and restore breathing and blood circulation in a patient who does not appear to be breathing on their own and who may be in cardiac arrest, meaning the heart has stopped pumping blood around their body. CPR helps to support an individual’s breathing and blood circulation to important organs when there are not doing it themselves.
Start CPR immediately if a person found down is found to be unresponsive, not breathing and without a pulse. If the person has a pulse, administer breaths only without chest compressions. CPR is described in the next paragraph.
To perform CPR, place the patient flat on their back, with their arms at their side or arms out at shoulder level if they are a large individual and you cant get close to their chest. Kneel next to the patient, with your knees perpendicular to the patients body.
Feel for the breastbone or sternum on the patient (the middle bone in upper chest, below the neck). Place one of your hands over the other hand, over the center of the patient’s chest (Picture 2).
You should be standing tall on your knees. Leaning over the person chest, with your arms straight, push down onthe patient’s chest by leaning forward with your weight into your palms. Let the chest recoil back to it’s original position. The chest should go down 2-3 inches.
It will seem like you are pushing “too hard” but this is necessary in order to get blood flow to the brain. Count in your head “One and two and one and two and etc.”
Push down on ONE and release on TWO. Continue this until help arrives.
After 30 compressions, provide two breaths to the individual. To provide breaths, you will lift the patients chin up in the air, extend the neck, and breath into the patients mouth, do this twice. Then continue with compressions in the order: 30 compressions and 2 breaths, 30 compressions and two breaths, and so on. If you have help, alternate with the help when you get tired. If you do not feel comfortable providing breaths to the individual, continue with compressions.
If at any point during this process the individual starts breathing or begins responding, place them in the recovery position and assess for breathing as described under breathing above.
Otherwise, continue the compressions and breaths until help arrives. If someone brings an AED, attach the pads to the individual’s chest and follow the instructions in the AED kit. It may prompt you to analyze the individual’s heart rhythm with the machine, do CPR, or otherwise.
References
  1. Berg RA, Hemphill R, Abella BS, et al. Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S685-705.
  2. Olasveengen TM, Semeraro F, Ristagno G, et al. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation. 2021;161:98-114.
  3. Nickson C. Basic Life Support. Life in the Fast Lane. https://litfl.com/basic-life-support/. Updated November 3, 2022. Accessed2022.
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