Unresponsive Person: When to Start CPR and What to Do
An unresponsive person does not answer when you speak loudly and does not react to an appropriate tap. That finding is serious, but it does not automatically mean chest compressions begin at once. The next critical distinction is whether the person is breathing normally.
If an adult is unresponsive and not breathing normally—or is only gasping—call 911 and start CPR. Put the phone on speaker so the dispatcher can guide you. Send someone for an automated external defibrillator (AED) when one is available. If the person is breathing normally, keep the airway open, monitor closely and follow the dispatcher’s instructions.
The short sequence to remember
- Check for danger. Traffic, electricity, fire, gas, water, violence and unstable structures can injure rescuers.
- Check responsiveness. Speak loudly and tap appropriately. Do not shake an injured person violently.
- Call 911. Use speaker mode and give the exact location first.
- Check for normal breathing. Look for regular chest movement. Gasping or irregular snorts are not normal breathing.
- Start CPR when directed or when the person is unresponsive and not breathing normally.
- Use an AED. Turn it on and follow its prompts as soon as it arrives.
The NHS first-aid assessment guidance emphasizes responsiveness, airway and normal breathing, and warns that agonal gasps can occur after cardiac arrest. Do not let occasional gasping delay CPR.
What “unresponsive” looks like
A sleeping person should respond to voice or touch. An unresponsive person remains still or shows no purposeful reaction. Seizure activity, intoxication, overdose, stroke, low blood sugar, trauma and many other conditions can reduce responsiveness. A bystander does not need to determine the cause before calling 911.
Do not use painful stimulation, slap the face, throw water or place anything in the mouth. Observe breathing and obvious life-threatening bleeding while the dispatcher organizes the response.
Normal breathing versus gasping
| Observation | Meaning for the bystander |
|---|---|
| Regular, quiet breathing with consistent chest rise | Normal breathing may be present; monitor and follow 911 instructions |
| Occasional gasp, snort or irregular breath | Do not treat as normal breathing; start CPR when directed |
| No visible chest movement | Not breathing normally; begin the emergency response |
| Breathing becomes abnormal after initially appearing normal | Update 911 and be ready to start CPR |
Limit the breathing check to a brief assessment. Long pulse checks and repeated rechecking delay compressions. A trained healthcare responder may have a different protocol; a lay rescuer should follow their course and dispatcher.
How to organize the 911 call
State the location, that the person is unresponsive and whether breathing is normal. Give building access details. If another bystander is present, point to that person and say, “Call 911 and bring the AED.” A general shout—“Somebody call”—can leave everyone assuming another person acted.
Put pets away, unlock the door and send someone to meet responders when staffing allows. Do not leave the person alone to perform minor tasks. The dispatcher may ask about age, collapse, breathing, hazards and known medical history.
Starting chest compressions
Place the person on their back on a firm, flat surface when this can be done safely. Kneel beside the chest. Place the heel of one hand in the center of the chest, place the other hand on top and keep the arms straight. Position shoulders over hands and press hard and fast, allowing the chest to return fully after each compression.
Current public CPR guidance commonly teaches an adult compression pace of 100 to 120 per minute and a depth of about 2 inches, while avoiding excessive depth. Training is the right place to practice rhythm, depth, recoil and body mechanics. During an emergency, follow the dispatcher.
The NHS public CPR guide describes hands-only CPR for adults when a rescuer is not trained or not confident with breaths, and CPR with breaths for trained rescuers.
Hands-only CPR or CPR with breaths?
For a suddenly collapsed adult, hands-only CPR is an appropriate option for a bystander who is untrained or unwilling to give breaths. A trained rescuer can provide compressions and rescue breaths according to their course. Pediatric, drowning and respiratory causes make breaths especially important, so follow training and dispatcher guidance.
A barrier device may be used if it is immediately available and the rescuer knows how. Do not delay compressions while searching for one. For more context, read why CPR barrier devices are used.
Add the AED without creating a long pause
- Turn the AED on.
- Expose and dry the chest as needed.
- Attach the pads according to the pictures.
- Stop touching the person when the AED says it is analyzing.
- Make sure no one is touching the person if a shock is advised.
- Resume compressions immediately when prompted.
The AED analyzes the heart rhythm; the bystander does not decide whether a shock is appropriate. If no shock is advised, that does not mean the emergency is over. Resume CPR as directed.
When the person is breathing normally
An unresponsive person who is breathing normally still needs emergency help. Keep the airway open and monitor continuously. The dispatcher may direct the recovery position if there is no concern that prevents movement. If breathing stops or becomes abnormal, begin CPR.
Do not give food, drink or medication. Do not leave the person unattended. If vomiting occurs, follow dispatcher guidance to protect the airway.
Special scenes require the same first priority: safety
Electrical exposure
Do not touch the person until the power source is controlled. Household current, downed lines and industrial equipment require different safety responses.
Water
Do not enter unsafe water. Use trained rescue methods. Once the person is on a safe surface, assess responsiveness and normal breathing.
Opioid emergency
Call 911. If naloxone is available, use it according to its instructions without delaying CPR for a person who is not breathing normally.
Trauma
Move the person only when necessary for immediate safety or lifesaving care. Airway and breathing remain urgent despite concern for the spine.
What commonly slows the response
- Assuming gasping means the person is breathing
- Searching for a pulse for too long
- Waiting for a family member’s permission to call 911
- Trying to move the person to a bed or couch
- Stopping compressions for repeated checks
- Failing to assign the AED task to one person
- Believing an AED can harm someone by delivering an unnecessary shock
How to switch rescuers
Chest compressions are tiring, and quality can fall before the rescuer notices. When a second trained person is available, plan a quick switch during a natural pause, such as an AED analysis. The incoming rescuer gets into position before the outgoing rescuer stops.
Use short words: “Switching after this cycle.” Avoid a long discussion over the person. One rescuer should keep track of the sequence while the other focuses on technique.
A five-minute household drill
Use a CPR manikin, never a person, for compressions. Start in a different room each time. The first learner checks safety and responsiveness. The second calls a simulated 911 line and states the address. A third retrieves the training AED. Practice moving furniture only if it can be done without delaying the start.
Debrief three points: How quickly was 911 assigned? Did anyone call gasping “breathing”? Was the AED opened promptly? A short, repeated drill builds faster retrieval than rereading a list.
When do you stop?
Continue CPR until the person shows clear signs of life and begins breathing normally, trained emergency professionals take over, the scene becomes unsafe, an AED or dispatcher directs a brief pause, or you are physically unable to continue. Do not stop because the person does not respond quickly.
After responders arrive, give a concise handoff: time found, responsiveness, breathing pattern, when CPR began, AED messages and any known event. Then step back so they have room.
Frequently asked questions
What if I am not sure the person is breathing?
Call 911 and describe exactly what you see. The dispatcher will guide the decision. Occasional gasps are not normal breathing.
Can I hurt someone with compressions?
Injury is possible, but delaying CPR during cardiac arrest is far more dangerous. Start when the person is unresponsive and not breathing normally.
Do I check a pulse first?
Lay rescuers should not allow a difficult pulse check to delay CPR. Follow your training and dispatcher instructions.
What if the person has a medical device?
Turn on the AED and follow its pictures and prompts. The dispatcher can address specific concerns.
Practice recognizing cardiac arrest and delivering effective compressions with MyCPR NOW CPR Certification.
