First Aid Daily: 4.1-'DR.ABC'- Assessing Response

So it’s now day two of our ‘DR.ABC’ breakdown and we’re doing ‘R’. Response.

All too commonly when teaching students who have little previous experience in first aid, ‘response’ is typically one of the harder points to remember within the acronym. Within the primary survey, it is important to remember that ‘response’ refers to the level of consciousness of a casualty, and not the act of responding to a situation.

Establishing the level of consciousness of a casualty is a critically important section of the primary survey, as we can easily deduce, the more conscious a casualty, the less serious the circumstance. So, to assess response we go through the following acronym “AVPU”:


  1. Alert- The casualty is visibly alert, eyes are open and they are able to engage in conversation.
  2. Voice- Casualty does not initially appear to be alert. Eyes may be closed and casualty could look asleep. However, when the casualty can give a response when spoken to.
  3. Pain- Casualty does not respond when spoken to, however, when the casualty is touched, or a light sensation of pain is delivered we receive a response.
  4. Unresponsive- We are completely unable to obtain a response from the casualty.


As a first aider, we must always appropriate our response. When we assess a colleague, we can assume we do it in a different manner to assessing someone we don’t know on the streets. Hence, if we find a person who appears unconscious we must go through the following.


  • Simply ask with a slightly elevated voice “Hello, are you okay?”. If this does not yield a response, shout a command at the casualty such as “open your eyes”.
  • If they are not responding, we must proceed to ‘Pain’. For someone we don’t know, for example, someone passed out on the street, we should keep our distance and tap the sole of their shoes with our own repeatedly. This, however, is inappropriate for someone we know. In this circumstance, we should squeeze the casualty’s shoulder and possibly pinch their earlobe.
  • If all above steps have not yielded a response, we shall determine that the casualty is unresponsive.  

For more serious conditions, such as a heart attack or a stroke, we may find a casualty slip down the levels of responsiveness. In this circumstance, it is our responsibility as a first aider to continuously engage with the casualty and prevent loss of response from occurring. Sometimes just talking to a casualty can save a life in some serious cases.