Req 6 — Fainting, Seizures & Drowning

When someone loses consciousness, it’s immediately alarming — and a whole range of different causes require different responses. This requirement covers seven causes of loss of consciousness:

• 6a — Fainting
• 6b — Hypoglycemia (low blood sugar)
• 6c — Seizure
• 6d — Drug overdose and alcohol poisoning
• 6e — Underwater hypoxic blackout
• 6f — Cold water shock and drowning
• 6g — Lightning strike and electric shock

Requirement 6a: Fainting

What it is: Fainting (syncope) is a brief loss of consciousness caused by temporarily reduced blood flow to the brain. It’s usually harmless — but the fall can cause injury, and it sometimes signals something more serious.

Common triggers: Standing up too quickly, prolonged standing in heat, emotional shock (seeing blood, receiving bad news), pain, dehydration, or standing in a hot shower.

Warning signs before fainting: Dizziness or lightheadedness; nausea; pale, clammy skin; visual changes (tunnel vision or spots); ringing in the ears; weakness in the legs.

If someone is about to faint: Help them lie down or sit down with head between knees. This restores blood flow to the brain before loss of consciousness.

After fainting:

1. Lay them on their back with legs elevated (unless injured from the fall).
2. Loosen any tight clothing.
3. Ensure the airway is open and check for breathing.
4. Most people recover within 1–2 minutes.
5. Don’t give anything by mouth until fully conscious.

When to call 911: No regaining of consciousness within 1–2 minutes; fainting during exertion (a warning sign for cardiac problems); accompanying chest pain, shortness of breath, or heart palpitations; head injury from the fall.

Requirement 6b: Hypoglycemia

What it is: Hypoglycemia (low blood sugar, below 70 mg/dL) occurs most commonly in people with diabetes who take insulin or certain diabetes medications. It can also occur in people who haven’t eaten in a long time and have been exercising heavily.

The brain runs almost exclusively on glucose. When blood sugar drops, brain function deteriorates rapidly.

Signs and symptoms (mild to moderate):

• Shakiness, trembling
• Sweating, pale skin
• Rapid heartbeat
• Hunger
• Headache
• Dizziness
• Confusion, irritability, or unusual behavior

Signs and symptoms (severe): Seizures, unconsciousness.

First aid for a conscious patient: Give 15–20 grams of fast-acting sugar (the “15-15 rule”):

• 4 oz of fruit juice or regular soda (not diet)
• 3–4 glucose tablets
• A tablespoon of honey or sugar Recheck symptoms in 15 minutes. Repeat if still symptomatic. Follow with a snack containing protein and carbohydrates.

If unconscious: Do NOT give anything by mouth. Call 911. If the person carries a glucagon kit and you are trained to use it, administer it.

Requirement 6c: Seizure

What it is: A seizure is caused by abnormal electrical activity in the brain. Most seizures in Scouts with epilepsy are familiar and expected. But seizures can also result from head injury, high fever, low blood sugar, poisoning, or cardiac arrest.

Generalized (tonic-clonic) seizure signs: Sudden loss of consciousness; rigid body (tonic phase); rhythmic jerking of limbs (clonic phase); possible frothing at the mouth; possible loss of bladder or bowel control. Usually lasts 1–3 minutes.

What to do during a seizure:

1. Keep them safe: Move objects that could cause injury.
2. Ease them to the floor if standing.
3. Protect the head: Place something soft under it.
4. Roll them on their side (recovery position) after convulsive movements stop — this prevents choking on saliva or vomit.
5. Note the time — duration matters.
6. Stay with them and reassure them as they regain consciousness; a postictal (post-seizure) state of confusion is normal.

What NOT to do:

• Do NOT restrain the person
• Do NOT put anything in their mouth — the “swallowing their tongue” belief is a myth
• Do NOT give water or food until fully conscious

When to call 911:

• Seizure lasts more than 5 minutes
• No return to consciousness between seizures
• Injury during the seizure
• First seizure (no known epilepsy)
• Breathing problems after the seizure
• Seizure in water

Requirement 6d: Drug Overdose and Alcohol Poisoning

Opioid Overdose

Opioids (heroin, fentanyl, oxycodone) suppress the brain’s drive to breathe. An opioid overdose victim stops breathing and dies of hypoxia (oxygen deprivation).

Signs: Unresponsive or unconscious; slow, shallow, or stopped breathing; pinpoint (very small) pupils; blue lips.

First aid:

1. Call 911.
2. Administer naloxone (Narcan) if available — it reverses opioid effects in 2–5 minutes. It is available without a prescription in most states. First responders, schools, and many pharmacies stock it.
3. If not breathing, begin rescue breathing or CPR.
4. Place in recovery position if breathing but unconscious.
5. Stay until EMS arrives — naloxone wears off in 30–90 minutes, and the overdose can return.

Alcohol Poisoning

Alcohol is a central nervous system depressant. High blood alcohol levels can cause unconsciousness, breathing suppression, choking on vomit, and cardiac arrest.

Signs: Unconscious or minimally responsive; cold, clammy, pale or blue skin; slow or irregular breathing; strong alcohol odor; vomiting.

First aid:

1. Call 911.
2. Roll to the recovery position (on their side) — people who are drunk and unconscious can vomit and aspirate (inhale) it.
3. Monitor breathing continuously.
4. Do NOT give coffee or food; do NOT put in a cold shower; do NOT leave them alone.

Requirement 6e: Underwater Hypoxic Blackout

What it is: Shallow water blackout (more accurately, underwater hypoxic blackout) kills swimmers — including fit, athletic, competitive swimmers — every year. It is completely preventable once you understand the mechanism.

The mechanism: Some swimmers hyperventilate (take many rapid deep breaths) before an underwater swim to extend their breath-hold time. This works by lowering CO₂ levels — but CO₂ is what triggers the urge to breathe. The swimmer can stay underwater until oxygen levels drop to the point of unconsciousness, all without feeling any warning urge to surface.

Why it’s uniquely dangerous: Unlike most drownings, there are often no signs of struggle. The swimmer simply stops moving and sinks.

First aid: Rescue from the water immediately; begin CPR if not breathing; call 911.

Prevention: Never hyperventilate before underwater swimming. Never swim alone. Never do breath-holding contests. Swim with a buddy who knows what to look for.

Requirement 6f: Cold Water Shock and Drowning

Cold Water Shock

Sudden immersion in cold water (below 59°F / 15°C) triggers an immediate, involuntary gasp reflex and hyperventilation. This gasp can happen before you have a chance to take a breath — meaning you can inhale water in the first seconds.

Cold water shock can also trigger cardiac arrhythmias in susceptible individuals, causing sudden death in the water unrelated to drowning.

Response: If you fall into cold water, fight the urge to swim hard immediately. Float on your back, breathe, and wait for the cold shock response to subside (1–3 minutes). Then assess your situation before attempting to swim to safety.

Drowning

A drowning person is often silent — they don’t have the breath to yell for help. True drowning is vertical, with mouth at or near the water surface, arms pressing down at the sides, head tilted back.

Rescue priority: Reach, throw, don’t go. Reach with a paddle or rope; throw a flotation device; only enter the water as an absolute last resort (a panicking drowning victim can push you underwater).

First aid after removal from water:

1. Call 911 immediately.
2. Begin CPR if the person is not breathing — do NOT wait for the person to “wake up” on the way to shore.
3. Drowning victims are often hypothermic — protect from further heat loss after CPR is established.
4. All near-drowning patients need hospital evaluation even if they seem fine — secondary drowning (delayed pulmonary edema) can occur hours later.

Requirement 6g: Lightning Strike and Electric Shock

Lightning Strike

Lightning strikes carry 100 million to 1 billion volts — but they’re extremely brief (a few milliseconds). Most lightning deaths are from cardiac arrest caused by the massive current disrupting the heart’s electrical system.

Contrary to common myth: Lightning strike victims are NOT electrically charged after the strike. You can touch them safely.

Signs: Burns at entry and exit points (often the top of the head or shoulders and the feet); cardiac arrest; confusion or loss of consciousness; keraunoparalysis (temporary paralysis of limbs); flash blindness.

First aid:

1. Ensure the scene is safe — move to shelter if lightning is still active.
2. Begin CPR immediately if the victim is unresponsive and not breathing.
3. Call 911.
4. Treat burns with cool water and sterile dressings.

Prevention: If caught outside in a storm, avoid the tallest trees, open fields, and ridgelines. Spread out (don’t huddle together — ground current can injure multiple people). Crouch low with feet together and hands over ears if no shelter is available.

Electric Shock

See also Req 3d for electrical burns. Cardiac arrest and respiratory arrest are the primary life threats from electric shock. Begin CPR if needed; call 911; do not touch the victim until the power source is confirmed off.

Now that you know how to respond when someone loses consciousness, you’ll learn the most famous — and most important — first aid skill of all: CPR.