In case a victim of an accident or gun shot or other trauma of that sort is heavily bleeding, does it increase survival chances to tell them to stay awake? And if it does, why?

I can imagine it might prevent the patient from passing out, but why would that be a good thing?


1 Answer 1



With brain injuries, it is not recommended anymore to keep patients awake because

people with a concussion need to sleep to recover. In the days before head CT scanning was widely available, the only way to know if someone had life-threatening brain bleeding (which occurs in less than 0.1 percent of those with concussion) was to observe him for a decrease in his level of alertness that resulted from the blood pressing on vital brain structures. This usually happened within six hours of injury. It was thought that if you could keep someone awake you could prevent him from lapsing into coma, which of course did not work.

While some people on the internet claim that someone awake with a higher blood pressure and a faster pulse will have better survival chances, (actually, this would mean that they bleed more, not less), there is no scientific evidence that this will indeed improve survival chances.

Emergency services usually check whether the patient is still able to stay awake to assess his situation based on the Glasgow Coma Scale (GCS). Saying "Stay with me, buddy" will then be used to asses the verbal response.

However, this is only used to assess the current life-threatening dangers (for example in the various Triage systems). Keeping someone awake will not benefit their survival chances.

Mostly, trying to keep someone awake only creates very dramatic scenes for movies.

  • 3
    EMS uses AVPU only casually and generally only on initial assessment. They almost always use GCS subsequent to that.
    – Carey Gregory
    Jul 11, 2017 at 14:34
  • @CareyGregory Edited the answer. Thanks for pointing that out!
    – Narusan
    Jul 12, 2017 at 8:30
  • 1
    I used to moderate an EMS forum with worldwide membership so I'm fairly familiar with practices worldwide and GCS is pretty much a standard everywhere, not just US/Canada. AVPU simply isn't adequate in the prehospital setting. You can't triage a patient to a trauma center based on AVPU. Honestly, I would just strike the whole AVPU thing with regard to EMS.
    – Carey Gregory
    Jul 13, 2017 at 2:14

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