AVPU and Emergency Medicine

How you check for consciousness: the AVPU (Alert, Voice, Pain and Unresponsiveness) scale.

On the HEAT course we teach Emergency Medicine rather than First Aid.

First Aid promotes the ABC (Airway, Breathing, and Circulation) system, although bleeding is the most common cause of avoidable death. In many hostile environments, you could face the threat of bullet wounds and mine injuries, especially from anti-personnel and anti-tank mines.

Imagine a colleague driving over an anti-tank mine, or stepping on an anti-personnel mine whilst you are working in a hostile environment. As a result of the mine explosion, your colleague sustains horrific injuries: his right lower leg above the knee has been blown off; his left hand and two of the fingers on his right hand are missing; shrapnel has lacerated his face and upper body; and both his eyes are hanging out of their sockets by their optic nerves.

Your initial reaction might be to presume that your colleague is dead, but his life can be saved by knowing certain principles of emergency medicine, especially AVPU.

With the traumatic amputation of a leg, blood vessels constrict as arteries withdraw and close up by themselves as a natural reaction to limb loss. Most bleeding can be stopped by applying firm pressure at the point of injury, or by applying pressure on the “pressure points” where the major arteries pass over large bones. By elevating the damaged limb above your colleague’s heart you can also help reduce blood loss. However, arterial bleeding might not stop by pressure and elevation alone, so you might need to improvise a tourniquet.

These emergency medicine techniques are taught during our H.E.A.T. course.

Gunshot wounds are also a serious form of trauma that can result in the destruction of flesh by: a bullet; damage form the bullets’ shockwave in the body; and fragmentation of both internal organs and muscle caused by the tumbling effect of a bullet.

Whatever the cause of such violent injury, do not remove any objects (wood or metal splinters) from a wound as this could increase blood loss.

Wrap absorbent pads (a dressing, clothes or tampons can be used) around the wound after you have cleaned it with a canned fizzy drink, urine, beer, white spirits or water. If using a can of fizzy drink, shake the can first and spray the contents into the wound to clean it, or alternatively use honey.

Honey has been proven to be both a good antiseptic and a natural healing agent.

Since your colleague will most likely have fallen into shock, you need to provide him with water or a cup of hot sweet tea. Also, you must talk to the victim in a clam but reassuring tone because one’s sense of hearing is the last sense to disappear before death.

But, following a traumatic incident, how do you determine the victim’s levels of consciousness?

During our emergency medicine training we teach you how to monitor consciousness using the AVPU scale.

As in any traumatic incident trauma you must monitor the patient’s AVPU.

AVPU (Alert, Voice, Pain and Unresponsiveness) scale is a means of assessing the level of consciousness.

  • If the patient is awake and responds to questions, he or she is Alert
  • If the patient does not open their eyes spontaneously, does not move but does respond to a Voice, than you can gauge their level of consciousness.
  • If the patient responds to Painful stimuli only, and moans when you apply a drip, tweak their ears or rub their sternum with a knuckle of your middle finger, then they are responsive to pain.

If the victim is Unresponsive to both voice and pain, then you need to apply your emergency medicine techniques.


The above tool is an effective way of assessing a victim’s level of consciousness and should be used irrespective of whether the victim has experienced a mine or gunshot trauma.