AVPU (Alert, Verbal, Pain, Unresponsive) – Explained

In this micro-lecture APC Hon. Snr. Lecturer Sam Willis talk about talk about the AVPU Patient Assessment (A-V-P-U mnemonic) in relation to when a Paramedic arrives on-scene and performs a patient assessment.

In today’s micro lecture we’re going to talk about the A-V-P-U or AVPU mnemonic.

Now the AVPU mnemonic is something you may have already read around, you may have already used it in practice, or it might be something you’ve never heard of before and it’s completely new to you.

Let’s take a situation where by you’re approaching a patient and they’re laying on the ground in an unconscious state. You do your danger, your response, airway breathing, circulation.

Now as part of the response you can use the AVPU. You say, hello, ambulance, can you hear me? If the patient turns around and looks at you and is awake, not only awake, but alert, they look at you and they start talking to you then that is an A on the AVPU scale.

The patient responds to verbal stimulation, so your patient is in a semiconscious state.

  • They’re not really fully alert.
  • They’re head is nodding.
  • Maybe they’ve had some trauma.
  • Maybe they’ve had alcohol and drugs.
  • Maybe they’re having some kind of hypoglycemic attack.
  • Maybe they’re having some kind of cerebral episode.

But you approach the patient and you say, “Hello, ambulance”, and they look at you and therefore they’re responding to verbal stimulus then that’s a V on the AVPU scale.

Then the patient responds to painful. Now we’re moving away from the word painful and we’re starting to use the word pressure. Instead of us trying to do a painful response whereby we get our knuckles and we push and lean deeply into the patient’s sternum, we’re moving towards pressure. Take your fingers and just give the trapezius muscle a bit of a pressure, a bit of a shake.

The reason we’re moving away from doing the sternum rub, if you guys were to just now take your knuckle and just very gently, and I say gently because you don’t need a lot of pressure, just gently rub it into your sternum you’ll realize you don’t need a lot of pressure to cause an injury.

Now there is a fine line between trying to generate a response, and trying to do what’s best for our patients. And leaving a mark on them, which will allow the patient to come back at you in a legal sense and sue you. I mean the reality is as paramedics we’re not trying to harm our patients.

But even if it’s unintentional and we leave a mark on our patients then we’ve basically just assaulted our patient.


You arrive, “hello, ambulance, can you hear me?”.

No response (from the patient).

They’re not awake, or alert. They’re not responding to voice.

You give them a gentle pressure.

“Hello, can you hear me?”

No pressure response. And then if they’re not responding to any of those things then they’re considered to be unresponsive.

Let’s just put that into diagrammatic form here on this Google Jam. I’m gonna use my fingers and just draw this. You have danger, check for danger. Sorry, my drawing is not that good today.

Check for a response. A, B, C, now there is D, and E as well. That’s where the AVPU comes in, A-V-P-U.

That’s the summary of the AVPU scale. I hope you’ve enjoyed this micro lecture. My name is Sam Willis (APC Hon. Snr. Lecturer), and I look forward to speaking to you again in other lectures.

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