An assessment of the level of consciousness (LOC) should be carried out during the primary survey of all patients, using the ABCDE approach Cole (2009: 28). Any initial or subsequent reduction in the LOC of the patient may be caused by hypoxia; hypovolaemia; head injury; drug or medicine use; hypoglycaemia; hypothermia or alcohol ingestion (Cole, 2009:44).

An assessment of the LOC of the patient is vital for an accurate pain assessment and the administration of analgesia, and the subsequent assessment of its efficacy (Rose, et al. 2011). Regular evaluation of a patient’s LOC helps detect the onset of hypothermia and hypovolaemia. Muehlberger, et al. (2010) state that the development of pre-hospital hypothermia is a directly negative …show more content…

One such rapid assessment tool is the AVPU scale, which consists of four basic categories: A for Alert; V for a patient who responds only to voice; P for a patient who responds only to pain; or U for a patient that is unresponsive to all stimuli (Palmer & Knight, 2006).

During time-critical incidents the AVPU scale may be more appropriate to use as an alternative to the GCS as it allows for an immediate and rapid assessment of a patient’s neurological state (Coyne, 2010).

Although no relationship between GCS and AVPU scores has been defined, McNarry & Goldhill (2004) suggest that a GCS of 13 is the dividing point between alert and responsive to voice, while a GCS of 9 was the dividing point between responsive to voice and responsive to pain. They also point out that, while AVPU appears simpler to use, in practice it may not be able to identify subtle changes in consciousness.

Kelly, et al. (2004) agreed that nursing staff found the AVPU scale easier to use than GCS for rapid assessments, but still found a degree of difficulty assessing alcohol-intoxicated patients. The authors also felt that, due to the lack of guidance provided to clinicians on exactly how to use the AVPU tool, it was still difficult to achieve a high level of consistency in recording.

McNarry & Goldhill (2004) suggest an alternative tool: the alert, confused, drowsy, unresponsive (ACDU) scale as a variation to the AVPU scale. Their