The first step when an unresponsive patient in respiratory distress is found is to perform a primary assessment.

What is the first step when assessing a patient in respiratory distress who is unresponsive?

• A. Check for a pulse
• B. Perform a primary assessment
• C. Begin CPR immediately
• D. Contact emergency services

Answer: (B)

The first step when assessing a patient in respiratory distress who is unresponsive is to perform a primary assessment. This initial assessment is crucial as it allows the EMT to evaluate the patient’s airway, breathing, and circulation quickly and effectively. In a situation where a patient is unresponsive, ensuring that the airway is clear and assessing their breathing status are vital to providing the appropriate care and intervention. Conducting a primary assessment helps to identify any immediate life threats, including potential airway obstruction or insufficient breathing, which can inform the next steps in management. This structured approach lays the groundwork for subsequent interventions, such as providing ventilatory support or calling for additional help. While checking for a pulse is an important part of the assessment, it is generally incorporated into the broader objective of the primary assessment, which focuses on more than just circulation. Starting CPR immediately without conducting an assessment could lead to a missed opportunity to clear the airway and initiate suitable treatment for respiratory failure. Contacting emergency services is also crucial, but before doing so, the immediate assessment of the patient’s condition must take priority to direct appropriate care.

When a patient in respiratory distress becomes unresponsive, there’s no time to waste on second-guessing. The first move isn’t CPR, and it isn’t simply checking a pulse. It’s a focused, brisk primary assessment that quickly tells you what’s wrong and what to fix first.

Let me explain why this matters, plain and simple.

Why the primary assessment comes first

In emergencies, every second counts. A patient who isn’t breathing well already has a compromised airway in play. If you jump straight to interventions without sizing up the situation, you might miss something crucial—like an airway blockage, inadequate breathing, or hidden signs of shock. The primary assessment acts like a quick-press, highlighter pass over the most life-threatening issues. It lays out a clear path: is the airway clear, is the patient ventilating, is circulation adequate, and what do you need to fix or support right now?

Think of it as triage within you—your own mental script that keeps you organized when stress climbs. When you perform this assessment, you’re not delaying care; you’re guiding care with purpose.

What the primary assessment really means

In EMT practice, the primary assessment is the ABCs: Airway, Breathing, Circulation. But it’s more than memorized letters. It’s a live, moment-to-moment check of the patient’s immediate needs, plus a quick read of the situation around you.

• Airway: Is the airway open and clear? If there’s any obstruction, can you safely remove it or position the head and neck to reduce the risk of blockage? A blocked airway is a life-threatening roadblock to effective breathing.

• Breathing: Is the patient actually breathing? Look for chest movement, listen for breath sounds, and feel for air on your cheek. If breathing is weak or absent, you know you must act to restore ventilation.

• Circulation: Is there a pulse? Is skin color changing, temperature rising or cooling, or is there signs that blood is not moving effectively? In this moment, you’re determining if a crisis in oxygen delivery is about to become a full-blown cardiac problem.

Together, these checks tell you where to intervene next—whether that’s opening the airway, providing breaths with a bag-valve-mask, or calling for more advanced help and equipment.

A practical, step-by-step flow you can picture

Let’s walk through a straightforward sequence you can imagine in real time. It’s not a rigid script—more like a reliable rhythm you can adapt as the scene evolves.

1. Scene safety and initial contact

• Make sure the area is safe for you and the patient.

• If there’s anyone else around, ask for help. Put a reminder in your head: “Call for backup now if you haven’t already.”

• Gently check responsiveness. A quick tap on the shoulder and a shout often tells you a lot.

2. Activate EMS and get the basics moving

• If you’re alone, activate EMS and grab an AED if you have access. If you’re with others, assign someone to call and someone to fetch equipment while you proceed.

• Time is a currency you don’t want to spend recklessly.

3. Open the airway with a smart choice

• If there’s any chance of spinal injury, use jaw-thrust to open the airway. If there’s no suspected neck injury, a head-tilt, chin-lift can work fine.

• Look for obvious obstructions. If you see something, remove it safely if you can do so without pushing it deeper.

4. Check breathing with a calm, thorough lens

• Watch the chest rise and fall. Listen near the mouth or nose for breaths. Feel for airflow.

• If the patient is not breathing or is breathing inadequately, you’re in the zone where ventilation matters most.

5. Decide about ventilation and circulation

• If there’s a pulse but no adequate breathing, provide rescue breaths. If there’s no pulse, you’re moving into CPR territory.

• If you can access a bag-valve-mask, deliver breaths at a rate that matches the situation (typically about one breath every 5–6 seconds for adults when a pulse is present; compressions (and breaths) follow if the pulse is absent).

6. Reassess quickly and adjust

• After your first pass, reassess airway, breathing, and circulation. Are you seeing improvement in color, chest movement, and responsiveness? If not, adjust with additional breaths, suction if needed, or prepare for more advanced care.

What not to confuse this with (and why)

Sometimes people mix up the steps in the heat of the moment. Here are common slip-ups and why they’re not the right first move:

• Don’t begin CPR immediately without an assessment. If you start chest compressions before you’ve checked the airway and breathing, you might miss a fixable problem, like a reversible airway obstruction or a need for ventilation.

• Don’t wait to call for help until you’ve done a full minute of assessment. You want to coordinate with others as soon as you can, but your primary assessment should drive your next moves. Early communication helps bring in the teams and equipment you’ll rely on.

• Don’t linger on one element. The primary assessment is a quick triage that moves you forward. If you spend too long on one piece, you risk missing a bigger issue.

Real-world flavor: what your instincts should feel like

In the field, you’ll notice that this approach isn’t stiff or clinical in a way that makes you lose your humanity. It’s practical and human. You’re improvising with a plan. You’re listening for breath sounds like a rain-reader listening for a distant thunder, and you’re watching for subtle color shifts in the skin. You’re not just following a script; you’re translating symptoms into actions that keep someone alive while you stabilize the situation.

A few quick, concrete reminders

• Airway first, but not at the expense of oxygen delivery. Clearing the airway helps breathing, which is the immediate bridge to stabilizing circulation.

• Use the tools at hand. A bag-valve-mask or pocket mask is a lifeline when breaths aren’t getting through. If an AED becomes available, follow its prompts when you’re ready.

• Don’t fear the uncertainties. The adult body can be surprising in distress. If you’re unsure, treat the patient as if every system could fail and move to protect life in the moment.

• Keep the bedside presence. A calm voice, steady hands, and clear explanations to bystanders can make a world of difference in a tense scene.

Putting it all together: a mental checklist you can trust

• Is the area safe? Do I have help or backup? Is an AED nearby?

• Is the patient responsive? If not, I’ll act quickly to open the airway and check breathing.

• Is there a pulse? If there is a pulse but no adequate breathing, I provide ventilation. If there’s no pulse, I initiate CPR with the appropriate rate and depth.

• Is the airway clear or made clear? If I can fix an obstruction safely, I do so; if not, I escalate to suction or advanced airway support as available.

• What does the chest tell me about breathing? If the chest isn’t rising normally, I adjust ventilation or position to improve it.

• How do I keep everyone informed? I call for help, describe the patient’s status succinctly, and follow the AED prompts when they appear.

A quick note on the broader picture

The primary assessment isn’t a lonely moment; it’s the launchpad for every subsequent intervention. Once you’ve established airway and breathing, you can move toward stabilizing circulation, managing shock, and preparing for transport. In many settings, the scene changes as a river does when a dam is opened — you adapt your plan to the new currents, while keeping your core objective in sight: preserve breathing, protect the airway, support circulation.

If you’re ever unsure, count on this simple idea: the most important first step is to get a clear read of the airway, breathing, and circulation. Everything else flows from there. It’s a practical, humane approach that keeps you focused on the patient rather than the protocol.

A final thought to carry forward

Respiratory distress can feel overwhelming, especially when the person you’re helping isn’t talking back. The adrenaline can surge, and the urge to “do something big” is real. But in those high-stakes seconds, clarity matters more than bravado. A solid primary assessment—fast, focused, and flexible—gives you a reliable map through chaos. It helps you decide what to fix now, what to monitor, and what resources to summon.

If you ever find yourself on a scene where someone isn’t breathing well and is unresponsive, you’ll know what to do next. Start with the primary assessment, listen to what the body is saying, and let that read guide your steps. In the end, that careful approach is what keeps people breathing and hopeful long after the sirens fade.