Spot shock early and keep someone steady until help arrives

Quick answer: If someone is hurt or suddenly sick and their skin goes pale, cool and clammy, treat it as shock. Call 911, stop any bleeding, lay them flat, keep them warm, give nothing to eat or drink, and watch their breathing until help arrives.

This is general education, not a substitute for training. A certified first aid course from the Red Cross or a similar provider is worth a Saturday. Take it before you need it.

What shock actually is

Not the emotional kind. Medical shock means the body isn't getting enough blood flow to keep the organs working. Heavy bleeding causes it. So do severe burns, serious infections, allergic reactions, heart trouble and bad dehydration.

It's an emergency because it feeds on itself. Organs starve, the body gets worse at coping, and a person who looked rough but stable can slide quickly. You can't fix it in a driveway. Your job is to slow the slide and get professionals there.

Spot it before they admit it

The trap is that people in shock often say they're fine. Men especially. A guy comes off a ladder, gets up, waves you off, and sits down on the tailgate.

Watch him instead of listening to him. The signs:

• Skin pale, gray or bluish around the lips and fingernails, and cool and damp to the touch
• Fast, shallow breathing
• A fast, weak pulse at the wrist
• Dizziness, weakness, or feeling faint when he sits up
• Confusion, anxiety, or an odd glassy calm
• Nausea, or thirst out of proportion to the situation
• Getting drowsy or going quiet

You don't need all of them. Pale, clammy and fast-breathing after an injury is enough to act on. If you're unsure, act anyway. Treating shock that turns out to be nothing costs you a few awkward minutes. Missing it can cost far more.

The wound you can see is also a distraction. A scraped hand gets all the attention while the guy holding it's turning gray from a hit he took to the ribs. Look at the person first.

Step one: call 911

Do it first, before the blanket and before the questions. If there's a second person, send them to call while you stay with the patient. If you're alone, put the phone on speaker and set it down next to you.

Tell the dispatcher what happened, how many people are hurt, exactly where you are, and that the person has signs of shock. Give them the street address, the cross street, or the mile marker. Then stay on the line. The dispatcher can walk you through the next steps and will tell you if things change.

Step two: make the scene safe, and stop the cause

Don't become the second patient. If it was electrical, kill the power at the source before you touch anyone. If you'd rather leave a panel alone, our piece on the wiring jobs worth doing yourself and the ones that aren't is a good reason to know where your main breaker is. If it's a road, get out of traffic's way. If it's a fire or a fall hazard, stay clear of it.

Then deal with what's causing it:

• Bleeding: Press directly on the wound with a clean cloth or gauze and keep pressing. Don't peek. If it soaks through, add more on top. Bleeding from an arm or leg that won't stop is where a tourniquet comes in, but only use one if you've been trained.
• Allergic reaction: If the person has a prescribed epinephrine auto-injector, help them use it as directed. Still call 911.
• Burns: Cool them gently and cover them loosely with something clean and dry.

Step three: lay them down

Get them flat on their back, on the ground, even if they argue. Standing and sitting make a weak circulation work harder against gravity.

If there's no sign of injury to the head, neck, back or legs, raising their feet about a foot is common advice, and it's harmless if it doesn't cause pain. Some current first aid guidance has dropped the leg raise, so don't sweat it. Flat on the back is the part that matters.

Don't move them if you suspect a neck or spine injury. A fall from height, a car wreck, or a hard blow to the head means they stay put unless the scene itself is dangerous.

Two exceptions to lying flat:

• If they're having trouble breathing, let them sit semi-upright, because that's easier on the lungs.
• If they're vomiting or bleeding from the mouth, roll them onto their side so they can't choke.

Step four: keep them warm, not hot

Shock makes the body lose heat. Throw a coat, blanket or sleeping bag over them. Put something under them too if they're on cold concrete or wet ground, because the ground steals heat faster than the air does.

Loosen anything tight, like a belt, collar or tie. But don't pile on layers until they're sweating. Warm is the goal.

Step five: nothing by mouth

No water, no sips, no "just a little juice." If they need surgery, a full stomach is a problem, and a person who's drowsy can choke. They'll ask. Tell them the paramedics can sort it out, and wet their lips with a damp cloth if they're miserable.

Also, don't give them anything to "settle" them. No pills from your cabinet, and no alcohol. Ever.

Step six: watch, talk, and stay put

Now your job is simple. Stay with them. Talk in a low, steady voice. Tell them help is coming and that they're doing fine, and be honest about it only to the extent that you can be.

Every minute or two, check:

• Are they awake and answering?
• Is the breathing steady?
• Is the skin color changing?

If they stop responding and aren't breathing normally, tell the dispatcher and begin CPR as they direct. If you haven't been trained, the dispatcher will coach you through hands-only compressions. Do it. A bad attempt beats none.

Don't leave to fetch things unless somebody else can sit with them. And don't let well-meaning bystanders crowd in or start giving advice. Pick one calm voice, yours, and keep the circle small.

Step seven: the handoff

When the ambulance gets there, step back and be useful. Paramedics will want four things, quickly:

1. What happened, and when.
2. What you saw change since.
3. What you did, including any bleeding control or medication given.
4. What you know about the person: allergies, medications, medical conditions.

If you can, glance at the clock when you start, so you can give a time. It's a small thing and professionals appreciate it.

Then do the decent thing afterward. Put the gear back, replace the gauze you used, and wash the blanket before it goes home. If the person's family isn't there yet, call them. Stay until someone relieves you.

For the ten minutes that follow the call itself, our companion piece on what to do in the ten minutes before the ambulance arrives goes through the clock in more detail.

The one thing to remember

The calm one in the room decides how this goes. You don't have to be a medic. Most of this takes a coat, a clear head and a phone. Notice early, call early, and don't leave.