Fainting: Emergency Physicians Say Call 911

Lower them to the floor, face up, check breathing, raise the legs — and call 911. That is the American College of Emergency Physicians’ instruction for a faint, and it is a lower bar than most people apply. Do not give anything to eat or drink.

Most people file fainting under embarrassing rather than medical. The specialty body does not.

The American College of Emergency Physicians:

“If someone faints or appears to be fainting, call 911 or your local emergency number.”

No qualifier about how long, how bad, or whether they got up smiling. And a second, narrower instruction on the same page — “If the person doesn’t regain consciousness within a minute, call 911” — is best read as the absolute floor rather than the standard. This page publishes the broader instruction, because a faint is a loss of consciousness and the reasons for it are not distinguishable in a living room.

Why the bar is that low

ACEP’s definition explains it: “Fainting is a loss of consciousness caused when the blood supply to the brain is momentarily interrupted.”

Something interrupted the blood supply to a brain. The list of things that can do that runs from entirely benign to immediately life-threatening, and ACEP names low blood pressure, an abnormal heart rhythm, low blood sugar and stress among the possibilities.

An abnormal heart rhythm is on that list, in the same sentence as stress. That is the whole argument: at the moment it happens, the harmless version and the dangerous version look the same — somebody on the floor who then sits up and apologises.

The trap this page has to close

“It was just the heat.” “I stood up too fast.” “I had not eaten.”

Those explanations are common, frequently correct, and the single commonest reason a faint goes unassessed. A page listing benign causes hands you a reason to move on, so this page will close that door itself:

You cannot tell which kind of faint you had by how you feel afterwards. Feeling fine afterwards is what almost everybody does, including the people whose faint mattered most. The assessment is the point, and feeling well is not a substitute for it.

What to do for somebody who has fainted

ACEP’s sequence:

Get them down safely — “Assist the person by lowering him or her to the ground or other flat surface, while facing up in a horizontal position.”

Check them — “Check for breathing and injuries.” Somebody who fainted while standing may have hit their head on the way down, and that injury can be the more urgent problem.

Raise the legs, and loosen restrictive clothing.

Nothing to eat or drink. Not water, not sugar, not anything — until they are fully alert and somebody qualified has said so. A person who is not fully conscious cannot protect their airway.

And call 911.

If you feel it coming

ACEP gives a specific instruction and the second half is the part people skip:

“If you feel faint, either lie down or sit down immediately. If you sit down, bend forward with your head between your knees.”

Lying down is better than sitting. If you sit, get your head down. And do it where you are — the injuries from fainting come from the fall, and walking to somewhere more dignified is how people end up going down a staircase or against a hard edge.

The associated symptoms that change everything

ACEP lists these as reasons to take a faint further. Any of them, with a faint, and this is an emergency room tonight rather than a conversation next week:

• Irregular heartbeat
• Chest pain
• Shortness of breath
• Blurred vision
• Confusion
• Trouble talking
• Fainting upon turning the head
• Fainting more than once in a month

Two of those are worth pausing on.

“Fainting upon turning the head” is oddly specific and easy to dismiss as coincidence. It is on the list for a reason — mention it exactly like that if it describes you.

And “more than once in a month” means a pattern counts even when each individual episode seemed minor. Three trivial faints is not three trivial events; it is one thing that has happened three times.

Chest pain or breathlessness with a faint should be treated as cardiac. What to do about chest pain applies, and it means 911 rather than a drive.

Where to go

Call 911 for anybody who has fainted — and without hesitation for anybody who does not come round promptly, who has chest pain or breathlessness, who is confused, who had a seizure-like episode, who hit their head, who is pregnant, or who has a known heart condition.

Come to an emergency room for any faint that has not been assessed, and particularly for a first faint, a faint during exertion, a faint with no warning at all, or a faint in somebody over 65.

Our emergency rooms are open every hour of every day and are walk-in, with an ECG, CT, X-ray and a full laboratory in the building — which is most of what working out the cause of a faint requires. Go to the nearest one, and if another emergency department is closer to you, that one is the right answer tonight.

If you are unsure, come in — this list is not exhaustive and you are not expected to work out why you lost consciousness.

Questions people actually ask

I fainted, came round in seconds, and feel completely normal. Really 911? That is ACEP’s instruction, and coming round quickly does not identify the cause. If you decide against an ambulance, be seen today rather than deciding it was nothing — and do not drive yourself.

It happens to me when I have blood taken. A recognised and usually benign pattern. It is still worth having been assessed once, and worth mentioning to whoever is about to take blood so you can be lying down.

I fainted while running. Fainting during exertion is the one to act on fastest. Be seen, and say that it happened during exercise.

Should I give them something sugary? Not until they are fully alert. ACEP says avoid food and drink, and low blood sugar is only one of several possible causes.

My teenager faints at the sight of blood. Common, usually benign, and still worth one assessment — partly to confirm it is what everyone assumes, and partly because the injuries come from the fall.

I felt dizzy but did not actually pass out. Dizziness without loss of consciousness is a different question, and ACEP’s fainting guidance does not cover it. If it is severe, new, recurrent, or comes with any symptom on the list above, be seen.

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Lower them, check breathing, raise the legs, nothing to eat or drink — and call 911. Both of our emergency rooms are open 24 hours a day, every day of the year — walk in, no appointment and no referral. Find your nearest emergency room →

Related reading: which door do you need · chest pain and when to go

Sources

49. Fainting — Know When To Go — American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/fainting

This article is general information, not a diagnosis. It gives no doses. If you are unsure, come in — this list is not exhaustive and you are not expected to assess a loss of consciousness yourself. If it might be an emergency, treat it as one and call 911.