Levels of Response

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Levels of Response AVPU:


The AVPU scale (Alert, Voice, Pain, Unresponsive) is a system which is taught to healthcare professionals and first aiders on how to measure and record the patient's level of consciousness. It is a simplification of the GCS Scale (Glasgow Coma) which assesses a patient's response using Eyes, Voice and Motor skills as measures.


The AVPU has only one of four possible outcomes


These four outcomes are:


  • Alert - Patient is fully awake (though not necessarily orientated), will have spontaneously open eyes, and will respond to voice (thought may be confused). They will have bodily motor function


  • Voice – The patient makes some sort of response when you talk to them. This could be through the eyes which open when you speak to them, or by voice which may only be as little as a grunt. Or, it could be by moving a limb when prompted to do so by the rescuer.


  • Pain - A patient may respond by using any of the three components when pain stimulus is used on them (Eyes, Voice, Movement). Recognised methods for causing pain are pinching the ear or pressing into the bed of a fingernail. A fully conscious patient will locate the pain and push it away, whereas a patient who is not alert and not responded to voice may only manifest involuntary flexion or extension of a limb. Performing pain stimulus should be used with caution as in extreme circumstances this could be considered assault.


  • Unresponsive - This outcome is noted if the patient does not give any Eye, Voice or Motor response to voice or pain.


In first aid, an AVPU score less than A is a good indication of the need to get further help.



  • If patient conscious level is below 'A' seek medical help.
  • Monitor patient's level of response until medical help arrives.
  • An unconscious patient is serious and the priority here is the patients airway.
  • Place in recovery position.
  • Dial 999.
  • Treat any bleeding or cover open fractures.
  • If first aiders have oxygen therapy, place pulse oximeter on patients finger and take reading, if below 94% place patient on oxygen therapy.


We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.


You might also be interested in our blog. In this post, Clive talks about when you should or shouldn't call an ambulance.



First Response. Training for life. Training to save a life.



Read 44665 times Last modified on Wednesday, 29 January 2014
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Clive Haddrell Cert Ed LIQA MSET

NHS Paramedic Tutor, NHS Ambulance Emergency Driving Tutor, FAETC 1&2, Cert/Ed, D32, D33, LIQA. Manual Handling Tutor (RoSPA) and Member of the Society for Education and Training. I have over thirty years experience with the former Avon Ambulance Service NHS Trust, and recently with Great Western Ambulance Service NHS Trust. My experience includes the role of paramedic tutor, rapid response motorcycle paramedic. For the last 25years paramedic advisor to the well-known BBC television program "Casualty".

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