Why Ask If The Patient is Awake First?

Brett Patterson

Brett Patterson

Best Practices


As someone who works in EMS dispatch, I have run into this question a lot. Why do we ask in Key Questions “Is the patient awake” and then “Is the patient breathing”? Why is the order of those questions not reversed? It would save a lot of frustrations for callers in making them think you are not listening to them. A lot of callers will respond with “I just told you they are awake.”

Although the patient being awake is important, the more important question is are they breathing. If a caller is not breathing you will still ask the question if they are awake or not, which could detect choking vs. a cardiac arrest. You may already be able to indicate due to the question “Okay, tell me exactly what happened.”

Like we do now, both questions are mandatory to ask but it would make more sense to ask them in opposite order to what they are.

Thank you for your time!!!

Chloe Deck, Emergency Communications Officer Central Communications Centre for EMS dispatch Alberta, Canada

Hello Chloe,

Although the potential for a choking patient to be conscious but not breathing is often cited as rationale for the order of these questions, the truth is that evaluating consciousness first is the standard of care in all of medicine.

The first thing a clinician does when approaching a patient is to look at them. A patient’s state of consciousness is not only a strong predictor of acuity, it gives us a heightened state of awareness when it’s abnormal and moves us toward the secondary survey rather than immediate intervention. Think about your CPR class and approaching the mannequin, i.e., “Annie, Annie! Are you okay?!” Shake and shout. If the patient is unresponsive, check for breathing.

In the non-visual realm of dispatch, the unconscious patient immediately gets us thinking about the potential for cardiac arrest. In essence, it piques our interest to the point of immediate suspicion, which then enables faster arrest recognition.

Additionally, responses to the breathing question are not nearly as reliable as the awake question, which then becomes less predictive following an unsure or uncertain answer.

Finally, I would add that this sequence actually does work and has done so for decades. While the anecdotes about frustrated callers are common, it
only happens occasionally. We at the Academy listen to hundreds of calls. Personally, this is a primary component of my job. And when these questions are delivered appropriately, with compassion and concern, callers generally answer appropriately. And when we look at the time spent in Case Entry, the data simply do not support the anecdotes, at least with regard to frequency.

Thank you for the question.