Sleeping or Unconscious?
February 10, 2022
Hoping for some guidance from you both please. If a calltaker asks “Are they awake?” and the caller responds “No, they are asleep,” should this be marked as No without clarification, or should our calltakers clarify if a patient can be roused? Sleeping is the opposite of awake, and it’s a clear response. However, personally, I would be inclined to clarify if the patient can be roused in the belief this question is trying to clarify consciousness.
There’s a bit of debate here as to whether that clarifier should ever be asked/is over clarifying/delaying an accept point, so I’d love to provide some clear direction to our calltakers.
Thanks in advance,
Acting Quality Audit Lead
I have seen a Q&A or an article on this topic and I cannot find it—are you able to assist please?
Hi Fiona & Mel:
I think a potential reason for this occurring is the wording change of Case Entry Question 3 that occurred in MPDS® version 12.0 when we began asking “Is s/ he awake?” versus “Is s/he conscious.” We did this to enhance layperson understanding, even though we knew the term “awake” was less specific.
The Academy conducted a related survey and asked ED-Q experts about the frequency of this occurrence. We have learned that it’s not uncommon. See Fig. 1.
Obviously, while “unconscious” is the layperson opposite of “conscious,” “asleep” can be interpreted as the opposite of “awake.” Importantly, however, the purpose of the question is to determine if the patient is conscious versus unconscious. If the caller answers the question with the term “asleep,” s/he has not answered the question as intended. Therefore, the question should be initially clarified with “conscious,” as directed by the scripted clarifier.
If the scripted clarifier doesn’t work, an attempt must be made to wake the patient to determine if the patient is conscious or not, for a few important reasons. First and foremost, as mentioned above, “asleep” does not answer the question as intended. Second, status of consciousness needs to be determined to select the appropriate protocol pathway, and it also has a heavy bearing on the potential for cardiac arrest and the prompt detection of same by the EMD. If the patient can be roused, and even if s/he decides to go back to sleep, s/he is not unconscious and is also not in cardiac arrest, and both factors are critical to the EMD’s subsequent decision-making process.
Furthermore, after asking a question, clarifying what is left unknown is compulsory in the ED-Q Standards Document. See Fig 2.
And, although in my mind this rationale needs no further support, it seems to me that if the patient is indeed only sleeping, an emergency call in the interest of the patient’s well-being warrants a nap interruption.
Thanks for the great question!
Brett A. Patterson Academics & Standards Associate Chair, Medical Council of Standards
International Academies of Emergency Dispatch®