Any departure from full alertness after an accident is cause for worry. An injured person who seems dazed and confused can be regarded as not fully conscious. In reality, there are different levels of consciousness from fully alert, through drowsiness (where the casualty can be roused) and stupor (where he or she responds only to pain) to coma (where the casualty cannot be roused at all). Unconsciousness may be the result of brain damage, loss of blood, lack of oxygen to the brain, chemical changes in the blood, or a drug overdose.
The main danger in an unconscious person is choking, so the first aider's immediate task is to relieve or prevent any obstruction to breathing.
Clear the mouth of debris. If the casualty is not breathing, contact emergency medical services and start cardio-pulmonary resuscitation (see Breathing). When breathing and pulse are stable, put the casualty into the recovery position. Loosen tight clothing at the neck and waist, and check the pulse at 5-minute internals. Do not leave the person alone.
In this position, the airway cannot be obstructed by the tongue or by vomit. The aim is to get the person lying almost on his or her front, with the face turned to one side, the jaw pointing upwards and outwards, with one knee and one elbow half propping up the weight of the body.
If you suspect a Spinal Injury, do not place the person in the recovery position unless there is vomiting, and even then, try to move the person without bending, twisting, or jolting the spine. The best way to do this is a log roll. Put some form of collar around the patient's neck and where possible have three people to roll the patient over with one specifically supporting the head. In such cases, choking and being unable to breathe are the immediate threats to life, not the spinal injury.
If you suspect broken bones (see Fractures) put the person in the nearest approximation to the recovery position, but avoid putting any weight on the broken part. Use rolled-up blankets or coats to support the person in the recovery position if necessary.
Anyone who becomes unconscious for more than a few seconds, even though apparently recovered, should be seen by a doctor.