Fainting is a temporary loss of responsiveness due to a fall in blood supply to the brain. More often, the person does not become completely unresponsive and usually becomes fully responsive immediately after. Usually, a person will experience a short period of feeling faint before they faint. This is the ideal time to provide first aid – before they collapse. Feeling faint and fainting are common occurrences and may happen as a response to a variety of conditions including stress, pain, hunger or exhaustion. It can also occur if a person stands still for a long time, especially in warm temperatures.
Guidelines
- First aid providers should assist the person who is feeling faint in doing physical counterpressure manoeuvres. **
- While in a safe and comfortable position, a person feeling faint can perform counterpressure manoeuvres on their own to lessen the feeling. *
- Lower-body physical counterpressure manoeuvres (such as leg crossing and tensing, or squatting), rather than upper-body and abdominal physical counterpressure manoeuvres, should be used to lessen the faint feeling. *
Good practice points
- A person who is feeling faint should be helped into a safe and comfortable position, such as sitting or lying on the floor, so they cannot fall.
- If counterpressure manoeuvres are not possible, the first aid provider may ask the person to lie down and raise the person’s legs (30-60 degrees) which may increase blood flow to the person’s brain and may improve the person’s condition.
- If the person faints, it should be brief with almost immediate recovery. If the person becomes unresponsive, the first aid provider should immediately check their breathing. See Unresponsiveness.
- The first aid provider should speak to the person to find out why they may feel faint (e.g., low blood sugar or fatigue) and address their needs (once they have recovered from feeling faint).
- Water may be offered to the person if they are responsive and able to swallow.
Chain of survival behaviours
Prevent and prepare
- Take precautions to avoid the conditions that may cause you or others to feel faint. Ensure you have enough to eat and drink, get enough rest and avoid standing for long periods.
- Stay hydrated. (See Dehydration.)
- Maintain a regular temperature.
Early recognition
The person may have just experienced something shocking or painful. They may be hungry, tired or have been standing for a long time.
Suddenly the person may become pale or ashen. They may tell you that they feel faint.
First aid steps
- Help the person to sit or lie down in a safe and comfortable position, where they cannot fall.
- Ask the person to do physical counterpressure manoeuvres to improve blood flow to their brain (see below). Alternatively, you could offer to raise their legs for them if they lie down.
- Reassure the person and observe them closely for changes in their level of response or breathing. If possible, try to establish why they feel faint and whether there is anything further you can do to help them.
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CAUTION
- A person who recovers from feeling faint should resume their activity only gradually as they may feel faint again.
- If the person faints and falls, be alert to potential injury they may sustain. (See Head injury or Fractures, sprains and strains.)
- A person who faints should become responsive again very quickly. If the person is unresponsive, check their breathing and provide first aid accordingly. (See Unresponsiveness.)
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NOTE
Physical counterpressure manoeuvres include:
Lower-body counterpressure manoeuvres may be more effective than upper-body manoeuvres.
- Squatting: Have the person squat.
- Leg tensing: Have the person cross their legs and tense the leg, abdominal and buttock muscles. The person can also try raising their legs if seated or lying down.
If squatting or leg exercises are not possible, arm tensing may be used.
- Arm tensing: Have the person tense and release their arm muscles by gripping one hand with the other and pulling their arms in opposite directions.
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Access help
- Feeling faint and fainting does not usually require medical care.
- If the person does not become responsive immediately after fainting, they may be experiencing something more severe (e.g., a heart attack). Access help immediately.
- In a public place, you could ask bystanders to help you to protect the person’s dignity for example, by blocking the view of people passing by.
Recovery
- The person should get some fresh air.
- After the first episode, the person should try to recognise the signs of fainting as early as possible. In that way, in the future, they can quickly get into a comfortable and safe position and consider using counterpressure manoeuvres.
Education considerations
Context considerations
- Feeling faint is a common occurrence, particularly in warm temperatures or in areas with little fresh air. Ask learners for examples of when they felt faint. What was the temperature? Were they hungry? Tired? Stressed?
Learner considerations
- Individuals who regularly interact with pregnant women should learn how to support and lay the woman on her left side if she is feeling faint.
Facilitation tips
- Brainstorm situations where someone might feel faint. For example, if facilitating a group of teachers, their students may be at a greater risk of fainting if doing physical activity or standing for a long period of time on a hot day.
- Emphasise the difference between someone feeling faint or becoming unresponsive and breathing normally. That someone who is feeling faint (or faints) should be able to tell you that they feel faint. If they can’t do this, then they should be treated as unresponsive.
- Encourage learners to consider what might happen to someone who faints and how they can respond. For example, what should they do if the person faints and hits their head on a hard surface?
- The science behind fainting could be explained to learners by putting a little bit of soy sauce in a clear bottle of water. The soy sauce will sink to the bottom. Explain this is what happens in the body – the blood goes down toward the feet. Then lie the bottle down and then raise the bottom of the bottle and the soy sauce will start to flow up to the ‘head’ of the bottle. Explain this is also what happens in the body – that sitting or lying down and using counterpressure movements helps the blood to move up the body again to the brain.
Learning connections
- Feeling faint may be caused by a health condition to which first aid providers should be alert, such as Diabetic emergency, heart attack (see Chest pain), Stroke, Head injury, Dehydration or Hyperthermia or Poisoning.
- Feeling faint can lead to Unresponsiveness.
Scientific foundation
Systematic reviews
A systematic review was carried out by ILCOR (Jensen et al., 2020; Soar et al., 2019; Singletary et al., 2020). Two randomised controlled trials and six prospective cohort studies were included in the analysis regarding the use of physical counterpressure manoeuvres compared with no use of these manoeuvres in adults and children with signs and symptoms of faintness or presyncope of suspected vasovagal or orthostatic origin.
For prevention of fainting, one randomised controlled trial demonstrated benefit with the use of handgrip physical counterpressure manoeuvres, while the observational studies failed to show benefit of handgrip and arm-tensing manoeuvres. Two randomised controlled trials showed benefit in symptom improvement when using handgrip manoeuvres. One observational follow-up study found symptom improvement in association with the use of squatting and abdominal tensing. One randomised controlled trial reported improvements in systolic blood pressure and heart rate using handgrip manoeuvres. Four observational studies did not report consistent changes in heart rate, and two pooled observational studies reported increased systolic and diastolic blood pressures when using lower-body manoeuvres. No adverse events were reported in any of the included studies. Overall, the level of certainty of the evidence was judged to be low or very low across all outcomes.
One observational study and one randomised controlled trial compared upper-body to lower-body physical counterpressure manoeuvres. In the observational study, benefit was found for the use of lower-body manoeuvres (lower body muscle tensing) compared with control or no use of counterpressure manoeuvres. The randomised controlled trial did not find greater improvement in symptoms of presyncope with the use of lower-body compared with upper-body manoeuvres.
References
Systematic reviews
Jensen, J. L., Ohshimo, S., Cassan, P., Meyran, D., Greene, J., Ng, K. C., Singletary, E., Zideman, D. (2020). Immediate interventions for presyncope of vasovagal or orthostatic origin: A systematic review. Prehospital Emergency Care, 24(1), 64–76. DOI 10.1080/10903127.2019.1605431
Soar J., Maconochie I., Wyckoff M. H., Olasveengen T. M., Singletary E. M., Greif R., Aickin R., … Hazinski M.F.., (2019). 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2019;145:95–150. DOI 10.1016/j.resuscitation.2019.10.016
Singletary, E. M., Zideman, D. A., Bendall, J. C., Berry, D. C., Borra, V., Carlson, J. N., … & Douma, M. J. (2020). 2020 International Consensus on First Aid Science With Treatment Recommendations. Circulation, 142(16_suppl_1), S284-S334. DOI 10.1161/CIR.0000000000000897
Singletary, E.M., Zideman, D.A., Bendall, J.C., Berry, D.C., Borra, V., Carlson, J.N., Cassan, P., …Lee, C.C. (2020). 2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation, 156:A240-A282. DOI 10.1016/j.rResuscitation.2020.09.016
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