AVPU – A simple Way to Assess Responsiveness

By now, if you’ve been reading regularly, you should know a few different approaches to patient assessment. The 4Bs and the 3Ps come to mind. Up to now, we’ve not really talked about how to assess a person’s level of responsiveness, so let’s do that now. There is a more advanced system (called the G.C.S.) which we’re not going to cover here – this article is a simpler approach to consciousness.


English: (Photo credit: Wikipedia)

Why check responsiveness?

One of the things we need as first aiders is a simple way to determine how conscious (or not) a person is. This will help us decide if they can keep their own airway open, what position they should be in for treatment, etc. It will also allow you to monitor for any improvement or deterioration. For this, we used the AVPU scale:

  • Alert
  • Voice
  • Pain
  • Unresponsive


This is a person’s ‘normal’ level of responsiveness. You come along as the first aider, and they are looking at you before you even speak. They are looking around, want to know what is happening, watching what you are doing. They are generally aware of everything happening around them.


You talk to them, they answer. If they’re not able to answer, they at least react to your voice, look in your direction, make eye contact, etc. They may have been too preoccupied with illness/injury to notice you and be ‘alert’ but they’ll still react to your voice. Notice that there’s a range of responses here: from the person who can answer normally when prompted, all the way down to the person who just groans at the sound of your voice.


At the ‘P’ level of responsiveness, they didn’t react when you walked over to them, and still didn’t react to your voice. These people are close to ‘unresponsive’. Do they react to pain? Don’t deliberately try breaking fingers! Try pinching the skin on the back of the hand, or pressing firmly on the nail-bed. Remember you’re trying to assess their ability to respond, not inflict damage.


Still not got a reaction? Then they are ‘unresponsive’. Notice that we’re not saying ‘unconscious’ – that’s a sliding scale. We’re saying that despite your best efforts, the person does not respond at all. These people probably need to be in the recovery position.

Unresponsive, not unconscious?

Ok, you might say it’s just linguistics, but technically it’s hard to say when someone is unconscious – unless they’re dead of course. Even people under anaesthetic may have some degree of consciousness. We’d probably agree that the A & V levels are ‘conscious’ but when does the P become U – is there a point where we as first aiders can say they’re now ‘unconscious’? Probably not – it’s more of a sliding scale. Just how much pain do they need to not respond to in order to be unconscious? For first aid terms, we just say ‘unresponsive’ – that is, we can’t get them to respond to us. They might respond when a paramedic sticks a needle in, but for us they were unresponsive!

About Tony Howarth

Tony is a First Aid & CPR Instructor Trainer with Sea 2 Sky Safety Training Services and the company founder. Tony started with the British Red Cross in 1994. Has acted as first aid attendant for hundreds of events & treated many hundreds of people as a result. He is experienced in training a wide range of courses. He previously worked as an ambulance attendant with the British Red Cross. He is now in BC as a first aid instructor, and an instructor trainer (one who trains others to become instructors) Finally, Tony works at Squamish General Hospital as the pharmacist manager when not busy training safety
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