CPR - Responsive or Unresponsive?

The words responsive and unresponsive are used in all the Basic Life Support (BLS) literature. All BLS instructors are taught to use both terms when describing and assessing a potential victim. Yet, no where in the literature are the terms clearly defined for the lay rescuer.

One of the interesting findings of our user testing for the TeamSafe™ App was that most people did not understand what responsive and unresponsive mean in the context of dealing with a player down on the field. The confusion was with regard to the relationship of breathing to responsiveness. In other words, could the player be breathing and unresponsive? The quick answer is "yes." (Ref)

Let's review the steps one by one in a "player down" situation. The first step is to walk quickly to the player and ask, "Are You OK" while gently touching/tapping/shaking the player's shoulders.

UNRESPONSIVE

If a player is clearly not breathing, they are unresponsive. If that player is breathing (so far as you can tell), but does not move and verbally respond in any way (words, grunt, groan), they are unresponsive. If this is the case, then you call to someone to dial 9-1-1 or do it yourself. Then you start CPR. See steps below.

RESPONSIVE

If the player is clearly breathing AND moves part of his/her body, the player is responsive. If the player is clearly breathing AND verbally responds using words, the player is responsive. A brief grunt or groan is not considered responsiveness. Moaning and groaning would be responsive. I know, this is splitting hairs, but it is important when you call 9-1-1.

But responsiveness does not mean all is OK. Tell the player not to continue to move ("Stay still" "Don't move") and further assess the situation. Are they bleeding, have a clear deformity (broken bone or dislocated joint), possible head/neck injury, possible blunt trauma (a hard hit to the abdomen or back) injury?

The bottom line is, if in doubt, CALL 9-1-1, don't move the player, and keep the player still! The worst that can happen is an ambulance comes and everything checks out. Actually, the worst that can happen is that you DON'T call 9-1-1 and things deteriorate rapidly!

Lastly, when you call 9-1-1 and speak to the operator, it is very helpful for them to know if the player is responsive or unresponsive. Use that term when describing the situation. For example, "We have a 10 year old boy, approximately 90 lbs, who is unresponsive."

Why is this important? Different areas of the country have different Emergency Management Systems (EMS) and different protocols. For instance, in some areas not all ambulances travel with paramedics. Some have EMTs only. An EMT has about 200 hours (16 weeks) of emergency medical training while a paramedic has over 1000 hours (12 months or more).

Paramedics have all the necessary training and equipment to effectively deal with an unresponsive player. This is not the case with EMTs. Click here for more about the differences between EMT vs Paramedic training. ** This does not mean EMTs are not well trained, they simply do not have the same training or necessarily carry the same equipment as a paramedic.

Back East, the county I lived in had about 160 ambulances. About 40 traveled with paramedics and the remainder EMTs only. The 9-1-1 operators were trained to dispatch a paramedic unit in all cases of "unresponsiveness." We trained the coaches in the school system to use the terms responsive and unresponsive. If the 9-1-1 operator was told a player was unresponsive, a paramedic unit was dispatched.

Here in Texas, the area in which I live has paramedics on almost all ambulances. Big difference!

Don't Hope and Pray, Prepare and Act!

LAY RESCUER HANDS ONLY CPR (Ref)

Designated Person Walks Quickly to Player Down

Ask “Are You OK?” Touch/tap/gently shake shoulders

If no response