Response: ACVPU
- hellonotarealdr
- Jun 9
- 2 min read
Updated: Jun 26
Response is the second step in the primary survey, after checking for danger.
There are five different levels to responsiveness, which determine how you need to act. These levels follow the acronym ACVPU — Alert, Confused, Voice, Pain, and Unresponsive.
Stretch!
Some emergency services use the longer scale AVPU+, where confusion is broken down further into degrees of disorientation (time, place, person).
A: Alert
Alert means that the casualty is awake and able to respond to you. This is the best situation, and you can test it by asking them a question — for example, “Are you okay?” or “What is your name?”
C: Confused
Confused means that the person is awake, but may be unable to speak properly or respond to your questions. This could be a sign of shock or a head injury.
Stretch!
Confusion can indicate not just shock or head injury but also conditions like stroke, diabetic emergencies, or hypoxia (low oxygen, often seen in shock etc).
V: Voice
This means the person is able to react to the sound of your voice when you ask them a question, even if they are not able to respond verbally. Alert or Voice are good signs — it means the person is breathing.
P: Pain
If the person does not respond verbally, you can check if they are responsive to pain. First, lightly shake their shoulders. If they do not respond, then pinch their earlobe gently or pinch the top of their shoulders. If they do not respond to this, they are unresponsive.
U: Unresponsive
If the casualty does not respond to any of the above, they are unresponsive. At this point, you must call emergency services and move on to the next step of the primary survey — checking their airways.
Summary:
Response is the second step in the primary survey, and it is tested in five levels: Alert, Confused, Voice, Pain, and Unresponsive. If someone is unresponsive, you must call 999 and move on to checking their airways.
For Older Learners:
Use these questions to challenge yourself!
Why is it important to check for confusion separately, rather than just asking if someone is alert or not?
Why is it dangerous to assume someone who responds to pain is 'fine enough' while waiting for help?
If a casualty is confused, how could you distinguish between a head injury, stroke, diabetic emergency, or shock? What other signs would you look for to guide your next steps?
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