Recognising shock and caring for the person
Shock in the medical sense is life-threatening circulatory failure, for example after heavy blood loss, large burns or a severe allergic reaction. Signs are pallor, cold sweat, shivering, restlessness, anxiety and later apathy. Call the emergency number (112 in the EU), treat the cause where possible (for example stop bleeding), lay the person down, cover them, reassure them and give nothing to drink. Only raise the legs if no injuries speak against it. This text does not replace a first-aid course.
- Immediately; care until help takes over
Explained simply
When doctors talk about shock, they do not mean a fright. They mean that the circulation no longer brings enough blood and oxygen to the organs – for example because someone has lost a lot of blood, has large burns or is having a severe allergic reaction. That is life-threatening.
You recognise shock when the person turns pale, has cold sweat on the forehead, shivers, is restless or anxious. Then you call the emergency number at once (112 in the EU), lay them down, cover them and stay with them. They get nothing to drink, even if they are thirsty.
You may raise their legs a little – but only if the legs, pelvis, back and head are not injured and the person can breathe well. This text does not replace a first-aid course.
How it works
The circulation needs enough blood in the vessels and a heart that pumps. If blood or fluid is missing, or the vessels widen greatly, the pressure in the system drops. The body tries to save what it can: it pulls blood from the skin, arms and legs to the core so the heart and brain stay supplied.
That is why the skin turns pale, cold and clammy and the heart beats faster. When that is no longer enough, the person becomes apathetic and finally unconscious. Only the ambulance service and hospital can treat the cause.
What really matters
Call the emergency number early – even if the person is still talking. Then tackle the cause where possible: stop bleeding with pressure, cover burns, help with their own emergency kit in an allergic reaction.
Lay them down, insulate from ground cold and cover them. Talk calmly with the person, give nothing to eat or drink and monitor consciousness and breathing. If they become unconscious and breathe normally: recovery position.
Safety and limits
Do not raise the legs with injuries to the legs, pelvis, spine or head, with breathing difficulty, or if a heart attack or stroke is suspected. Someone who cannot get enough air may sit in whatever position feels best.
Internal bleeding after a fall or accident cannot be seen from outside. Anyone who turns pale and shivers afterwards always needs the ambulance service. If the person stops breathing normally: resuscitation as the dispatcher instructs.
Shock and fright
In everyday speech people also say someone is "in shock" when they are frozen after a terrible experience. That is a psychological reaction, not circulatory shock. Calm, warmth, attention and not being left alone help then too.
Because both can occur at the same time, after accidents it is better to call the emergency number once too often. On a first-aid course you practise how to position, cover and look after casualties.
Step by step
- 1
Recognise the signs
Look for pallor, cold and clammy skin, cold sweat on the forehead, shivering, restlessness, anxiety, thirst and a fast pulse. Later, apathy and clouding of consciousness may follow.
- 2
Call
Call the emergency number or have it called (112 in the EU) and say what happened and which signs you see.
- 3
Tackle the cause
Treat the cause where possible: stop heavy bleeding with direct pressure, cover burns. With a severe allergic reaction, help the person use their own emergency kit prescribed by a doctor.
- 4
Lay down
Lay the person flat. If no injuries and no breathing difficulty speak against it, raise the legs slightly, for example on a backpack.
- 5
Cover
Insulate from the ground and cover the person, for example with an emergency blanket. Do not actively heat them.
- 6
Reassure and monitor
Stay with the person, talk to them calmly, give nothing to drink and monitor consciousness and breathing. If they become unconscious and breathe normally: recovery position. If they are not breathing normally: resuscitation as the dispatcher instructs.
Common mistakes
- Delaying the call because the person is still talking
- Giving something to drink
- Raising the legs despite a leg, pelvis or spinal injury
- Letting the person stand up or walk around
- Leaving the person alone
Quick view
Materials
Emergency blanket
To cover and protect against ground cold
Tears easily once punctured; short-term shelter only.
Conductive – keep away from power lines.
Wool blanket / duvet
Keep away from candles, stoves and heaters.
Disposable gloves
Consider latex allergies – prefer latex-free gloves (e.g. nitrile).
Suitable for
- Injured people after accidents, falls or heavy bleeding
- People with large burns or a severe allergic reaction until the ambulance arrives
Not suitable for
- A substitute for the emergency call – shock is always an emergency
- Treating the cause with medication or infusions – that is the ambulance crew's job
Prerequisites
- The scene is safe
- The emergency number has been or is being called
Safety
- This text does not replace a first-aid course. First aid is learned through hands-on practice under instruction. In an emergency always call professional help – via the local emergency number (112 in the EU) – and follow the dispatcher's instructions.
- Do not raise the legs with injuries to the legs, pelvis, spine or head, with breathing difficulty, or if a heart attack or stroke is suspected. With breathing difficulty let the person adopt the position they find most comfortable, often sitting.
- Give nothing to eat or drink – even if the person is thirsty. They may need surgery later or could choke.
How it works
In shock the circulation is no longer sufficient to supply the organs with enough oxygen – for example because too much blood or fluid has been lost or because the vessels widen greatly during an allergic reaction. The body tries to compensate: it pulls blood from the skin, arms and legs towards the core, so the skin turns pale, cold and clammy and the heart beats faster. First aiders cannot cure shock, but they can tackle the cause, relieve the body, conserve warmth and call the ambulance early.
Advantages
- Simple measures that greatly help how the person feels
- An early call shortens the time to treatment
Disadvantages
- Internal bleeding cannot be seen from outside
- Signs sometimes develop gradually
Deep knowledge
Background
The ERC first-aid guidelines recommend lying people with signs of shock on their back and calling the ambulance; raising the legs is described there as a possible short-term measure if no injury speaks against it. German-language first-aid courses additionally teach keeping warm, reassurance and not giving anything to drink.
Someone who is "only" pale and shivering after an accident may have internal injuries. So: signs of shock are always a reason to call the emergency number.
Variants
- "Being in shock" in the everyday sense
- In everyday speech, people also say someone is "in shock" when they are frozen or distraught after a terrible experience. That is a psychological reaction, not circulatory shock – but calm, warmth, attention and not being left alone help then too. When in doubt whether there are physical causes as well, call the emergency number.
Common mistakes
- Delaying the call because the person is still talking
- Giving something to drink
- Raising the legs despite a leg, pelvis or spinal injury
- Letting the person stand up or walk around
- Leaving the person alone
Limits and risks
- Does not replace a first-aid course
- No medication, no infusions
- Does not treat the cause – only the ambulance service or hospital can
Material alternatives
Derived from material properties: a substitute must have all relevant properties. Observe the notes on the substitute.
- Wool blanket / duvet
- Sleeping pad, Dry leaves, grass or conifer boughs (Collect only where allowed; no protected plants. Check for ticks and insects.), Backpack, Dry spare clothing (Carry it in waterproof packaging – wet clothing barely insulates.), Insulated cool box (Keeps cold only for a limited time; without ice packs or ice it is not a fridge.), Sleeping bag (Do not store compressed long-term; do not pack away damp.), Newspaper and cardboard (Flammable – keep away from candles, stoves, heaters and embers.), Insulated cooking box (hay box, thermal cooker) (Never put open flame or embers inside – only the hot, closed pot.), Long-stemmed thatch (reed, grass, rushes) (Extremely flammable – no open fire and no sparks nearby.)
Results come exclusively from structured entries. No improvised instructions are generated.
Sources
European Resuscitation Council – Resuscitation (journal) (2021): European Resuscitation Council Guidelines 2021: First Aid
Positioning for shock, leg raise without injury, emergency call
Deutsches Rotes Kreuz (DRK): Erste Hilfe – Informationen und Kurse
Signs of shock, keeping warm, nothing to drink
International Federation of Red Cross and Red Crescent Societies (IFRC) – Global First Aid Reference Centre (2020): International First Aid, Resuscitation, and Education Guidelines 2020
Lay recognition and first care of shock