Blackout: What to do when someone faints

Fainting or blacking out (known medically as “syncope”) is not infrequent in a dungeon/play setting. In a majority of cases, the faint-ee will recover quickly. Don’t panic! At an event/venue where there are medical staff available, IMMEDIATELY call medical staff if someone faints.

Brief summary – Fainting is your body’s way of saying LIE THE FUCK DOWN. Within the more detailed guidelines below, the priority when someone has fainted (or is close to fainting) is to LAY THEM THE FUCK DOWN on their side.

 

If you have no medical background/training, here are some guidelines on what to do if someone faints:

  • Take a first aid/CPR class! This quick guide is intended to supplement and review that content, not replace it.
  • Fainting is caused by decreased blood flow to the brain. Often people have symptoms such as being lightheaded, dizzy, nauseated, or seeing black prior to actually passing out. Laying down may keep them from fainting.
  • As a lay person in the field, you have no way to know for sure why someone has fainted or if it is serious. 911 activation is not *necessary* in every case, but it is ALWAYS OK to err on the side of caution and call. If the person comes around and doesn’t want medical care, they can refuse transport. Note that they *may* be billed for the ambulance call, even if they don’t go to ER.
  • If the person who fainted (or is feeling faint) is not already laying down, lay them down. GET HELP – unconscious people are heavy.
  • If they are restrained, be sure they are adequately braced so they will not fall when you remove/cut off their restraints. Bracing one of your legs between theirs can be a good way to do this.
  • Check for responsiveness. Tap them on the shoulder or chest/back and loudly ask “are you OK?” In many cases, just the time and action of laying them down is all it will take for them to start coming around.
  • If they are not responding, check for breathing. If there is no breathing (or no normal breathing – only gasps, for example), call 911. Start CPR if you know how, or wait for 911 operator instructions.
  • If they are breathing normally but are still not responsive, and were lowered/assisted to the ground without trauma place them in the recovery position (on their side).
  • Loosen or remove any restrictive clothing like corsets, collars, or belts.
  • If the person fell or otherwise had trauma when they fainted, do not move them. Monitor for responsiveness (tap them on the shoulder or chest/back and loudly ask “are you OK?”), watch for vomiting, keep them still, and call 911.
  • Continue to try to get the person to respond to you by tapping them on the shoulders/chest and talking loudly to them. I would not recommend using smelling salts/ammonia, especially if there was trauma.
  • If the person does not “wake up” within 1 minute, call 911 and continue to monitor breathing.
  • When the person wakes up:
    • Keep them laying down for at least 15 minutes.
    • Consider giving them juice to drink, especially if they are diabetic or have not eaten recently.
    • They should consider consulting their doctor, especially if they have repeated episodes.

 

Special notes for unconscious diabetics: Always assume a passed out or confused diabetic has LOW blood sugar. DO NOT give insulin. If they are awake enough to safely drink something, give juice. Check their blood sugar, if possible. Other signs of low blood sugar include weakness, shaking, sweating, cool and clammy skin, anxiety, and dizziness. Some diabetics carry a glucose gel that can be rubbed on their gums, still others carry a glucagon for injection (note that giving glucagon requires training, as the drug needs to be mixed and given as a shot). Low blood sugar is dangerous and potentially fatal– call 911.

Special notes for fainting during suspension: If assistance is available, get help (ideally of 4 or more people) and fully support the bottom prior to releasing the standing lines. Taking weight off the bottom’s chest should be a priority (as constriction on the chest could have contributed to the faint). In a situation where at least 4 people are available to help and trained in the use of a backboard, it can be very effective and quick to lift the bottom on a backboard while the rig is cut/unclipped, then lower them slowly to the ground (credit to Jay Wiseman, who as far as I know came up with this procedure). However, as the rigger, you are ultimately responsible to be able to safely get your bottom down. Keep in mind that dropping an unconscious bottom while trying to get them out of a rig is far worse than supporting/positioning them in the rig and taking extra time to consider how to go about getting them down safely. Consider practicing how you would handle an emergency like this. Of course call for help (911) if needed.

 

Further discussion for those with medical training:

  • While there are many factors that you can take into account, I would certainly call 911 if: The person does not wake up within a minute, the person who fainted is older and has medical conditions like heart disease, the person fainted while in a seated or laying down position, there was no particular “reason” for them to faint (see list below), the person has any lasting symptoms (like confusion, weakness on one side, difficulty speaking, etc), there was trauma, or if I check a pulse and find it to be abnormal in any way (thready, irregular, slow, fast, etc)… just to name a few.
  • I would be likely to wait on calling 911, monitor the person closely, and advise them to follow up with their doctor if: They woke up within a minute and are completely back to normal, they fainted while in a standing position (especially if they were doing something strenuous or had just changed position suddenly), there was a “reason” for them to faint (too hot, hadn’t eaten, possible mild dehydration, emotional upset/stress/arousal, coughing, anal stimulation, neck stimulation, severe pain), and they now have a strong and steady pulse. These are people I would consider to likely have experienced vasovagal syncope, which is the most common cause of fainting.
  • Note that many prominent and usually reliable first aid sources (like this one, and this one) still recommend putting an unconscious person on their back with their legs raised. However, there is limited to no evidence that doing this is helpful. For discussion on the medical studies on this subject, see this article on the trendelenberg position (the principals are the same) as one example. Aspiration of vomit or airway occlusion by the tongue are documented risks to an unconscious victim on their back (see: this article, this article, and this article). There is limited to no evidence that lowering the head/raising the legs increases cerebral perfusion or in any way helps a person with low blood pressure or who is unconscious recover faster. The fact that it intuitively seems like it should is not evidence. This is why I recommend the recovery position in this article, even though this advice is contrary to prominent sources like the Mayo Clinic and WebMD. Some prominent organizations do recommend the recovery position: “The American Heart Association recommends the recovery position be used on any person who is breathing on their own and does not need CPR, but has an altered level of consciousness.” American Heart Association, 2005 Guidelines

About the author: This article was written by me (Shay Tiziano)- I’m an ER nurse and ACLS (Advanced Cardiac Life Support) instructor who has spent WAYYY too much time geeking out over BDSM safety. I also got input on the ideas in this post from two kinky MDs (Dr_Who and MietteRouge). I would, however, note that nurses (and doctors!) can and do say idiotic/incorrect things, so using your own judgement no matter how “qualified” the source is always a good thing. This is intended as a quick (rather than exhaustive) guide, was specifically made as succinct as possible.

Disclaimer: Nothing in this article is a substitute for using your judgement, consulting with a medical professional who is on scene, and calling 911. I am simply offering some thoughts and discussion on this subject. Please don’t sue me.

You are more than welcome to reproduce this article for use in your organization. Please do not make any changes to the content and give attribution as above. 🙂

 

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