Blackout: Handling fainting
Fainting or blacking out (known medically as syncope) is not infrequent in a play setting, especially when bondage is involved. In most cases, the person who has fainted will recover quickly. Don’t panic! At an event or a venue where medical staff is available, immediately call them if someone faints.
In 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, ideally on their side.
We recommend taking a first-aid and CPR class.
This quick guide is intended to supplement and review that content, not replace it.
If you have no medical background or training:
If the person is conscious (awake), always get explicit consent to touch them or to assist in any manner. If you are in a situation where you are called to help but don’t have established consent with the person, and they aren’t able to give it, seek consent from a partner if available.
If the person is having signs of being near fainting (which can include nausea, seeing black spots or tunnel vision, ringing in the ears, and feeling dizzy or lightheaded) and is not already lying down, get them to lie down.
Fainting is caused by decreased blood flow to the brain. Lying down may keep someone from fainting.
Sometimes fainting (or near-fainting) can cause someone to shake or startle in a way that may appear to be a seizure but probably is not. This can especially happen if they are held upright, and the initial response is the same—have the person lie down.
If the person appears to have already fainted, check for responsiveness.
Loudly ask, “Are you OK?” If there is no response, consider gently tapping the shoulder.
If the person is unresponsive and not already lying down (for example, sitting up, slumped over, or being held up by a partner), gently and safely lay them down.
Get help if needed—unconscious people are heavy!
In many cases, just the time and action of laying them down is all it will take for them to start waking up.
Once the person is lying down, if they are not responding, check for breathing. If there is no breathing (or no normal breathing—only gasps, for example), call 911*. Start chest compressions if you know how, or wait for emergency operator instructions.
If they remain unresponsive and an Automatic External Defibrillator (AED) is available, get it and follow the instructions on the unit. AEDs are intended for layperson use. They will not shock someone who doesn’t need it!
If the person is breathing normally but is still not responsive, and was lowered/assisted to the ground without trauma, place them in the recovery position (on their side).
Loosen or remove any restrictive clothing or items, such as corsets, collars, rope, or belts. If a chest or upper body harness is in place, consider cutting it off.
If the person fell or otherwise had trauma when they fainted, do not move them. Monitor for responsiveness, watch for vomiting, keep them still, and call 911.
We would not recommend smelling salts/ammonia, especially if there was trauma.
If the person does not wake up within one minute, call 911 and continue to monitor breathing.
As a layperson in the field, you have no way of knowing why someone has fainted or if it is serious. Calling 911 is not necessary in every case, but it is OK to err on the side of caution and call. If the person wakes up 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 (booooooooo).
When the person wakes up, they should remain lying down for at least 15 minutes. After that time, consider giving them juice or Gatorade to drink (start with small sips), especially if they have diabetes or have not eaten recently. They should rest and not undertake any strenuous activities. They should also consider consulting their doctor or seeking emergency room evaluation, especially if they have repeated episodes.
Special notes for fainting during suspension
If assistance is available, get help (ideally from four or more people) and fully support the suspended person before releasing the uplines.
Remember that if you panic, cut the uplines, and drop the person on their head, you have not helped the situation. Often, untying critical support lines and lowering them in a controlled way is a much safer choice.
Bringing the body into as horizontal a position as possible, taking weight off the suspended person’s chest, and protecting the head/neck/back while lowering them to the ground should be a priority.
If someone has fainted in suspension and you have concerns about getting them down safely, don’t hesitate to call for help.
These situations are tough to handle at the moment, with high emotions. Practice can help—consider setting up a scenario where a person pretends to faint and rehearsing steps. Have a qualified teacher help you.
Special notes for unconscious people with diabetes
Assume a person who has diabetes and who is passed out or confused has low blood sugar. Do not give insulin.
Check their blood sugar, if possible. Other signs of low blood sugar include weakness, shaking, sweating, cool and clammy skin, anxiety, and dizziness.
If they are awake enough to drink something safely, give them a sugar-containing drink, such as Gatorade or juice.
Some diabetic people carry a glucose gel that can be rubbed on their gums.
Low blood sugar is dangerous and potentially fatal—call 911.
Additional notes on fainting for folks with medical training:
While there are many factors that you can take into account, I would be inclined to call 911 if:
The person does not wake up within a minute.
The person who fainted is older and has a medical condition such as heart disease.
The person fainted while in a seated or lying-down position, there was no particular “reason” for them to faint (see list below).
The person has any lasting symptoms (confusion, weakness on one side, difficulty speaking, etc.).
There was trauma.
The person’s pulse is abnormal in any way (thready, irregular, slow, fast, and so on).
…just to name a few.
I would be inclined to wait on calling 911 and would monitor the person closely and advise them to follow up with their doctor if they have a strong and steady pulse and:
They woke up within a minute and were completely back to normal.
They fainted while standing (especially if they were doing something strenuous or had suddenly changed position).
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).
I would consider a person in any of these cases to likely have experienced vasovagal syncope, the most common cause of fainting.
Note that many prominent and usually reliable first-aid resources 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. Many medical articles on the Trendelenberg position (which follows similar principles) show no benefit.
Aspiration of vomit or airway occlusion by the tongue is documented risk to an unconscious victim on their back. There is limited to no evidence that lowering the head/raising the legs increases cerebral perfusion (blood flow to the brain) or helps a person with low blood pressure or 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 that of resources 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.”
References:
1. http://www.bestbets.org/bets/bet.php?id=1710
2. American Heart Association, 2005 Guidelines
