First Aid: Presyncope

Publication Date: November 14, 2019

Updated Recommendations

If a person experiences signs or symptoms of presyncope (including pallor, sweating, lightheadedness, visual changes, and weakness) of vasovagal or orthostatic origin, the priority for that person is to maintain or assume a safe position, such as sitting or lying down. Once the person is in a safe position, it can be beneficial for that person to use physical counterpressure maneuvers (PCMs) to avoid syncope.

If a first aid provider recognizes presyncope of suspected vasovagal or orthostatic origin in another individual, it may be reasonable for the first aid provider to encourage that person to perform PCMs until symptoms resolve or syncope occurs. If no improvement occurs within 1 to 2 minutes, or if symptoms worsen or reoccur, providers should initiate a call for additional help.

If there are no extenuating circumstances, lower-body PCMs are preferable to upper-body and abdominal PCMs.

The use of PCMs is not suggested when symptoms of a heart attack or stroke accompany presyncope.

Recommendation Grading




First Aid: Presyncope

Authoring Organization

Publication Month/Year

November 14, 2019

Document Type


External Publication Status


Country of Publication


Document Objectives

This focused update highlights the evidence supporting specific interventions for presyncope of orthostatic or vasovagal origin and recommends the use of physical counterpressure maneuvers. 

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Childcare center, Correctional facility, Emergency care, Hospital, Medical transportation, School

Intended Users

Paramedic emt, nurse, nurse practitioner, physician, physician assistant



Diseases/Conditions (MeSH)

D013575 - Syncope


neurocardiogenic syncope, Syncope, presyncope

Source Citation

2019 American Heart Association and American Red Cross Focused Update for First Aid: Presyncope: An Update to the American Heart Association and American Red Cross Guidelines for First Aid
Nathan P. Charlton, MD, Co-Chair, Jeffrey L. Pellegrino, PhD, MPH, Co-Chair, Amy Kule, MD, Tammy M. Slater, DNP, MS, ACNP-BC, Jonathan L. Epstein, MEMS, NRP, Gustavo E. Flores, MD, Craig A. Goolsby, MD, MEd, Aaron M. Orkin, MD, MSc, MPH, Eunice M. Singletary, MD, Janel M. Swain, ACP