2 Immediate Stabilization Decisions

Priorities while help is coming

The goal of immediate stabilization is to prevent death or further harm while emergency medical services are coming. A lay responder should make the scene safe, recognize immediate threats, call 911, provide care within their training, and keep reassessing. Follow dispatcher instructions; advanced interventions and decisions about the destination belong to EMS clinicians and local protocols.

Assess and address immediate threats

Use a quick, repeatable primary assessment. Address catastrophic bleeding as an immediate threat, then assess airway, breathing, circulation, and mental status. New confusion, abnormal breathing, unresponsiveness, or severe bleeding warrants emergency help.

For catastrophic bleeding, put on gloves or use a barrier if available. Apply firm, continuous direct pressure. For severe bleeding from a limb, use a tourniquet if available and you know how; for an appropriate deep wound, pack it with gauze or clean cloth and maintain pressure. Call 911. Do not remove an embedded object; apply pressure around it.

If a person is unresponsive, check whether they are breathing normally. If they are breathing, keep the airway clear and monitor them. A trained responder may use a head-tilt/chin-lift if trauma is not suspected. If trauma is possible, minimize neck movement and follow dispatcher guidance. Do not put anything in the person's mouth or perform a blind finger sweep.

Occasional gasps are not normal breathing. If an adult is unresponsive and not breathing normally, call 911, send for an AED, and begin CPR; follow AED prompts. If the person is unresponsive but breathing normally, place them on their side when appropriate to help protect the airway, especially if vomiting is possible.

After serious injury or illness, suspect shock if the person becomes pale, weak, clammy, confused, or increasingly drowsy. Treat a cause you can address, such as external bleeding; keep the person comfortably warm, monitor them, and give nothing to eat or drink. Do not force them to lie flat if that worsens their breathing or comfort.

Sudden confusion or reduced alertness is a warning sign, not a diagnosis. Check for immediate threats to breathing and bleeding, note when the change began, and arrange urgent evaluation. Possible stroke signs include sudden facial droop, arm weakness, speech difficulty, and vision or balance changes. Call 911, record when the person was last known well, and do not drive them yourself.

Respond to other time-critical conditions

A severe allergic reaction may be indicated by trouble breathing, throat or facial swelling, or collapse after a possible allergen. Call 911 and help the person use their prescribed epinephrine auto-injector if needed. Do not delay the call to see whether symptoms pass.

If a person is difficult to wake or breathing abnormally and an opioid overdose is suspected, call 911, give naloxone if available, and stay with them. Support breathing or begin CPR if needed and within your training.

During a seizure, protect the person from nearby hazards, cushion their head, and time the seizure. Do not restrain them or put anything in their mouth. Call 911 if it lasts more than 5 minutes, seizures repeat, the person has difficulty breathing or waking afterward, there is a serious injury, or other emergency warning signs occur.

For chest pain or severe breathing difficulty, call 911 promptly. Keep the person at rest in the position that makes breathing easiest, and watch for worsening or loss of responsiveness. Do not let them walk or drive to care.

Reassess and leave transport decisions to EMS

An immediate threat to life—including an obstructed airway, abnormal or absent breathing, cardiac arrest, uncontrolled major bleeding, shock, stroke signs, severe allergic reaction, or worsening consciousness—requires emergency activation and urgent EMS assessment. While waiting, continue appropriate care and reassess responsiveness, breathing, and bleeding.

Tell responders what changed and when, any known conditions or medications, and when symptoms began or the person was last known well. Do not delay 911 to arrange private transport for a time-critical emergency. EMS can begin care en route and, according to local protocols and the patient's condition, select an appropriate destination, such as a stroke-capable or trauma center. A nearby hospital is not necessarily the most appropriate destination; destination choice is an EMS decision guided by regional systems and medical control.

• Anaphylaxis