Introduction: We retrospectively examined the grounds for judging the consciousness level as 1 on the Japan Coma Scale (JCS) made by emergency life-saving technicians (ELSTs).

Methods: The survey involved the sick and injured who were transferred to the hospital by ambulance during the 25-month period from July 1st, 2011, and who were able to respond to questions asked by hospital staff to make records after ELSTs had judged their consciousness level as 1 on the JCS.

Result: A survey involving 105 cases was conducted to examine grounds for judgment of consciousness level of the sick and injured as 1 on the JCS. "Vacant or blank expression", "delay in reactions" or "delay in responses" were cited as the grounds by 61.0 and 47.6%, respectively.

Conclusion: When ELSTs judged the consciousness level of the sick and injured as 1 on the JCS, they made the above observations of the patients. Although these factors are useful for evaluating the status of consciousness, they are not certain. In some cases, ELSTs may have judged the consciousness level as 1 when it should have been judged as 2 or 3 on the JCS. Therefore, it is suspected that some ELSTs may not recognize disorientation appropriately.