Drinking too much, too fast increases blood alcohol concentration (BAC). Too much alcohol in the bloodstream is called alcohol poisoning. It can cause a person to pass out.

While your first instinct may be to let a friend who’s passed out sleep it off, know that things can go from bad to worse quickly when someone drinks enough to lose consciousness.

Acting fast could save their life.

It’s true that some people will crash after a few drinks, but someone who’s just sleeping it off will be fairly easy to wake.

To try to wake them up:

  • Call their name.
  • Shake their shoulders.
  • Pinch them — hard.
  • Rub their sternum with your knuckles.

If you’re trying to wake up someone who’s passed out and they’re not responding, call 911 (or your local emergency number) right away.

A person’s BAC can continue to rise even when they’ve stopped drinking and are unconscious. This could lead to permanent brain damage or death if they don’t get help fast enough.

Alcohol depresses the central nervous system, which controls basic bodily functions like breathing and heart rate. It can also affect a person’s gag reflex.

As a result, the intoxicated person is at risk of choking on their vomit or having their heart rate and breathing turn dangerously slow or stop.

While you wait for help to arrive

  • Don’t leave them alone. They could fall over or choke on their vomit and stop breathing.
  • Gently roll them on their side with one ear to the ground to prevent them from choking if they start to vomit.
  • Be ready to provide the emergency responders with as much information as possible, including what kind of alcohol they had and how much, other substances they took, and any health information you have, like medications they’re taking or allergies they have.
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While being responsive is definitely better than being unresponsive, your friend isn’t out of the woods just yet. Remember, their BAC can keep rising and the situation can change quickly.

If you’re able to wake them up, don’t leave them alone. Alcohol affects muscle coordination and judgement, increasing the chances of injury, like falling.

There’s also still a chance that their symptoms can worsen, and they can lose consciousness or choke if they vomit.

If possible, have them sit on the ground so they can’t fall. Keep them upright or partially upright in case they do start to vomit. If they need to lie down, make sure they lie on their side.

Try to keep your friend warm, still, and calm. Avoid giving them anything to eat or drink.

Contrary to popular belief, black coffee won’t help them sober up, and neither will taking a cold shower or walking it off. Doing these things actually increases their risk of choking or falling.

Try to keep them awake. If they do fall asleep, wake them frequently to make sure they haven’t lost consciousness. If at any time you have trouble waking them or they start choking, call 911 right away.

Watch for these symptoms

Here are the signs of alcohol poisoning to watch out for.

Don’t wait for them to develop all the signs. Call 911 if your friend — or anyone, for that matter — exhibits any of these symptoms:

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You might question whether someone is drunk enough to call 911 (or worry that others will see your reaction as overkill). But it’s always better to err on the side of caution.

You might be afraid of getting yourself or your friend in trouble, especially if you’re underage or if there are illegal substances involved.

But the consequences of not getting help could be far worse. Alcohol poisoning is serious business. Without quick treatment, it can lead to permanent organ damage or death.

As for getting in trouble, keep in mind that first responders are more concerned with helping the person in need than busting someone for underage drinking or using illegal substances.

To help further put your mind at ease about the possibility of getting in trouble, many states have what’s called medical amnesty legislation. It’s also sometimes referred to as the 911 Good Samaritan Law or 911 Lifeline Law.

These laws were put in place to protect people in these very circumstances. They guarantee limited immunity for underage or intoxicated people who seek help for themselves or someone else in need of immediate medical attention.

You can see if your state has a medical amnesty law and learn more about it on the Medical Amnesty Initiative’s website.

If your friend is passed out drunk, don’t just assume they’re sleeping it off or didn’t drink enough to overdose.

Everyone processes alcohol at a different rate. Their BAC could be a lot higher than yours even if you drank the same amount.

Don’t let doubt or fear stop you from getting them the help they need and potentially saving their life.

Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.