The method to use for assessing the level of a patient’s disability or mental capacity is a system called AVPU or A-V-P-U. When using this acronym properly, you can accurately assess how alert a patient is. If done early on, you can give yourself an indication of how the patient is doing at that moment, but if carried out the assessment again later on, you can compare their condition to when you arrived. Are they getting better, worse or staying the same? I.e. Is the patient improving or is the patient deteriorating?

A – Alert

When approaching a casualty, you should immediately be able to tell, are they alert? When you ask them a question, are they actually answering the question without any confusion? In other words, is their brain function alert?

V – Voice

If they are not alert, then check their voice. If they drop down to this level, they may not be fully conscious, they may be unconscious or they may even be asleep.  While when you were checking “Alert”, you were seeing if they could formulate an answer properly, in this section you are checking to see if they are able to make any vocal response at all.

P – Pain

If they cannot or do not give any vocal response whatsoever, move on to their response to pain. Pain stimulus is created with a little squeeze at the back of the nail or into the earlobe itself. These are both very sensitive areas, and although you want to induce some pain, do not do anything that will cause them to deteriorate further. The response you get may not be vocal, it could simply moving away from the source of pain. They may wince or grimace. Any of these show that they are responding to pain.

U – Unresponsive

If when checking for pain, the patient does not react at all, you would then classify them as totally unresponsive. The unresponsive patient now falls into the field of a seriously ill or dangerous situation. In other words, you have to maintain and monitor that patient very closely, because otherwise, more serious complications may ensue, such as the patient’s tongue blocking their airway, or their airway fills with fluid. This patient’s life is now in your hands, and you have to take the reins and control what is going on.

AVPU scoring system

Monitoring and Handover


If you carry this assessment out on arrival at the scene, you can use their original levels as a landmark. After you have carried out the necessary First Aid, whatever that may be, keep going back and repeating the assessment. Note down any changes, whether that may be up or down, as it will be very helpful to tell the Emergency Medical Services when they arrive.

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  2. Felisia Profit

    Hello! I will be using this scale for a nursing school project. Do you know who developed the AVPU scale?

    1. Keith Sleightholm Article Author

      The APUV is a simplification of the Glasgow Coma Scale, which assesses a patient response in three measures: Eyes, Voice and Motor skills.

  3. Felisia Profit

    Thanks Keith!
    I’m trying to find out who developed it in case I need permission to use the scale.

    1. Keith Sleightholm Article Author

      It is an international scale that is a standard one used. You would not as far as we know need permission to use it and I am not sure who you would contact to ask.