Medical

AVPU

A rapid four-level mental status assessment scale used in prehospital and tactical settings. Alert, responds to Verbal stimuli, responds to Painful stimuli, Unresponsive. AVPU trades the precision of GCS for speed and reliability under stress, and is the TCCC-doctrine mental status tool documented on the DD Form 1380 prior to ketamine administration.

In the Field

AVPU works when GCS does not. Under fire, in low light, with a casualty whose verbal response is unclear because of language or noise, you can still establish whether they track movement, follow commands, or move only to pain. The four levels map cleanly to escalating concern, and the transition points have clinical meaning: Alert to Verbal is often subtle decline; Verbal to Painful suggests serious injury; Painful to Unresponsive is a hard signal requiring immediate intervention.

Common Mistake

Documenting AVPU once and not reassessing. Mental status is dynamic, especially in TBI and shock. TCCC doctrine requires documentation on the DD 1380 prior to ketamine and reassessment every 5 to 10 minutes for moderate or severe TBI. A single AVPU at scene without serial reassessment misses the deterioration that should drive intervention.

Technical Detail

AVPU scale: A (Alert) - eyes open spontaneously, follows commands, oriented; V (Verbal) - responds when spoken to but may not be oriented; P (Painful) - responds only to painful stimulus (trapezius squeeze, sternal rub, supraorbital pressure); U (Unresponsive) - no response to any stimulus. AVPU is faster to assess than GCS and validated for prehospital triage, though GCS provides more granular tracking of TBI severity over time. TCCC 2026 Guidelines require AVPU documentation on DD Form 1380 prior to ketamine administration to establish baseline mental status.

Related Terms

Altered Mental Status TCCC MARCH Algorithm

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