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Scenario: It's been a full-on day. It's getting dark and time for home. As you are locking up you hear someone snoring in the lane! It's hard to see but you can just make out the figure of a person slumped against the wall of the building. You call out: 'You all right, mate?' On approaching you notice the person's head is bent forward and the shirt collar is wet from secretions trickling down the chin. The smell of alcohol is not present. You shake the person, pleading: 'Mate, wake up. You can't stay here. Hey mate, you okay?' There's no response. The person is a woman who appears to be in her thirties. She looks a very poor colour.
This could be due to:
Loosen any tight clothing around the neck; clear the mouth; place in the 'coma' position (on the side with a clear airway, see 'The ABC of life support (1)'). Even if alcohol can be detected, never assume that this is the only cause of drowsiness.
Psychiatric conditions can be distinguished by lack of physical features of illness (for example, the person would be rousable, able to converse, and would not look sick or drowsy), and by the presence of bizarre behaviour, or strange beliefs, statements or accusations. However, the other conditions listed above would first need to be ruled out.
Note: the psychiatric service should not be your first call option in this situation.
Treat this as an urgent case. See the 'ABC of life support' sections. Secure the airway. Have someone ring the ambulance service on '000', requesting a MICA (Mobile Intensive Care Ambulance).