While providing first aid, you might hear EMTs, paramedics and other emergency healthcare personnel talk about Glasgow Coma Scale. As a first aider, it would be best to have some knowledge about this assessment tool.
The Glasgow Coma Scale (GCS) is a universal tool used by medical professionals throughout the world in assessing the level of consciousness of a patient. It is often used by health care professionals in the healthcare setting (such as in ICU, emergency department, and medical wards) to assess and evaluate the brain function of individuals with head injury or suspected head injury. Paramedics and EMTs may also use GCS to facilitate fast communication and reporting between the rescuer and the receiving emergency department.
The Glasgow Coma Scale is an efficient way of monitoring the progress of a patient. The GCS score can be plotted in a chart which makes it easier for health care professionals to track the patient’s progress. The GCS assesses three aspects: motor response (6 levels), verbal response (5 levels), and eye opening (4 levels). The patient’s best response is taken and the total of all these three aspects is taking as the score. GCS scores are interpreted as follows:
15 – highest possible score; patient is awake and alert.
<8 – severe reduction in consciousness; patient may have difficulty maintaining spontaneous and require emergency intubation and mechanical ventilation.
3 – lowest possible score; indicates coma.
A severe reduction in the level of consciousness, a GCS score of 8 or lower, almost always requires intubation, supplemental oxygenation, and fluid resuscitation. This can be done by paramedics and EMTs at the scene of accident or as soon as the patient reaches the emergency department. The patient need to be resuscitated fully before other medical procedures and treatments are performed.
But since the Glasgow Coma Scale is more intensive and time consuming, a simpler assessment tool is often used at the scene of accident. The 4-point AVPU Scale is used by first aiders, first responders, doctors, nurses, and ambulance crews for faster assessment of the victim’s consciousness level. In AVPU, the patient is given a letter score (A, V, P, U) based on the following elements:
- A (Alert) – the patient is able to maintain spontaneous eye opening, verbal response and coordinated motor functions.
- V (Voice) – the patient is able to respond when spoken to (such as actual speech or grunt).
- P (Pain) – the patient responds when pain stimulus is applied (such as withdrawing limb from pain or extension/flexion or extremities).
- U (Unresponsive) – the patient does not show any response to voice or pain.
AVPU scale is used initially and if the patient’s score is below ‘A’, a formal Glasgow Coma Scale score is taken. This assessment tool can help first aiders decide quickly whether to call an ambulance.
However, AVPU has some downsides. It may not be effective in the 
assessment and management of a patient with prolonged reduction in consciousness. It is also less accurate in assessing victims of poisoning and patients under the influence of prohibited substances or alcohol.