Contact us today
Shock – recognising and supporting a seriously unwell casualty
What is shock?
In simple terms, shock happens when the circulation cannot deliver enough oxygenated blood to vital organs because of severe bleeding, fluid loss or other serious illness or injury, and if not treated quickly it can lead to organ failure and death. First aid does not ‘fix’ shock but focuses on treating the cause where possible, positioning and reassuring the casualty, keeping them warm and calling 999 without delay.
Hypovolaemic shock is commonly caused by major external or internal bleeding, severe burns, major trauma or serious diarrhoea and vomiting, and early signs may be easy to miss unless first aiders deliberately look for cold, clammy skin, fast, shallow breathing, a rising pulse and dizziness. Prompt recognition and treatment greatly improve the casualty’s chances because medical teams can intervene before the circulation collapses completely.
Shock in first aid usually refers to hypovolaemic shock, where there is not enough circulating blood volume to supply the body’s tissues with oxygen, leading to pale, cold skin, fast breathing and a rapid pulse.
Who needs this skill?
Health & Social Care
In health and social care, staff should be alert to deteriorating patients or residents who become increasingly pale, clammy, short of breath, confused or drowsy after surgery, trauma, infection or fluid loss, and escalate urgently using local early warning score or sepsis pathways. CQC expects providers to have systems for recognising and responding to acutely unwell people, not just managing single symptoms in isolation.Licensed venues & nightlife
In nightlife and licensed venues, casualties with shock may initially be assumed to be intoxicated, but cold, clammy skin, rapid breathing and collapse after assault, falls, glass wounds or medical emergencies should trigger concern and an immediate 999 call rather than simply removing the person from the area.Schools
Pupils and staff who look pale, clammy and confused after illness or injury need prompt recognition and escalation; school staff who understand shock are less likely to dismiss serious deterioration as anxiety or nerves.Workplaces
In workplaces, first aiders must not only treat visible injuries but also watch for signs of shock after falls from height, crush injuries, major burns, heavy bleeding or prolonged illness, and call 999 if they suspect the casualty is seriously unwell. A suitable first aid needs assessment should consider whether particular tasks or environments increase the risk of shock, such as work with machinery, hot processes or remote locations.How to manage shock
- 1Recognise key signs of shockUse your primary survey to assess the casualty's overall condition and look for pale, cold, clammy skin, fast, shallow breathing, a rising pulse, dizziness, confusion or collapse when they try to sit or stand, which are classic signs of hypovolaemic shock.Do not wait for every sign to appear; a combination of worrying features should prompt you to call 999 early.
- 2Call 999 and treat the causeAs soon as you suspect shock, call 999 or 112, explain what has happened and describe the casualty's symptoms, then do what you can within your training to treat the underlying cause, such as controlling external bleeding, cooling serious burns or helping them use prescribed inhalers.Recognising that someone is seriously unwell is more important than labelling the exact type of shock; focus on getting urgent help.
- 3Position the casualty safelyIf there is no suspected spinal, chest or breathing problem, help the casualty to lie down on their back and, if appropriate, consider raising their legs slightly to improve blood flow to the vital organs, following current local guidance.If injuries or breathing problems make leg elevation unsafe or uncomfortable, keep them lying flat or in a position of greatest comfort while you monitor closely.
- 4Keep them warm and reassuredCover the casualty with a coat or blanket to reduce heat loss, without overheating or covering their face, and loosen tight clothing such as belts or collars so they can breathe more easily.Stay calm, explain what you are doing and provide continuous reassurance, as anxiety can worsen shock and people may feel frightened or confused as their condition deteriorates.
- 5Monitor and be ready to start CPRContinue to monitor breathing, pulse and responsiveness while you wait for the ambulance, watching for any changes such as slowing breathing, reduced responsiveness or loss of consciousness.If the casualty becomes unresponsive and is not breathing normally, call 999 again if necessary and start CPR in line with your training.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Qualsafe Level 3 Award in Paediatric First Aid (RQF)
2 days
3 years
Common questions
Practical answers for employers, venue managers, and healthcare teams about shock training.
Can't find your answer? Contact us.
Many first aid sources still recommend raising the legs slightly if there are no suspected spinal, pelvic or lower limb injuries and it does not cause pain or breathing difficulty, to help blood flow to the core. However, some trauma experts advise against routine leg elevation in all cases, so you should follow the current guidance and training provided by your organisation or course provider.
You should not give a casualty in suspected shock anything to eat or drink because they may need anaesthesia or surgery and there is a risk of vomiting and aspiration if their consciousness level changes. Instead, focus on treating the cause, keeping them warm, comfortable and monitored until the ambulance arrives.
A simple faint is usually a brief, self-limiting episode where blood flow to the brain temporarily drops, often improving quickly once the person lies flat and circulation returns to normal. Shock is a more serious, ongoing failure of the circulation caused by significant blood or fluid loss, heart problems or severe infection and will not resolve without urgent medical treatment.
Consider internal bleeding if a casualty shows signs of shock after major blunt trauma, falls, crush injuries, serious abdominal or chest pain, or if they have large bruises or swelling with no obvious external wounds. In these cases, call 999 immediately, treat any visible injuries, keep the casualty still and warm, and be prepared for rapid deterioration while waiting for advanced care.