Ahhh the embattled sternal rub. Revered, reviled … the sternal rub is the Ann Coulter  of medical interventions. Abrasive, annoying, loved by many, hated by many more. The subject of the usefulness of the sternal rub is bound to cause controversy in any EMS forum. In other words … it’s a great subject for The Spot. Like many controversial assessments and treatments, the sternal rub (sometimes referred to as the sternum rub) got its bad-boy reputation more from its misuse than from its own shortcomings. Never-the-less, the technique does have its shortcomings. Like so many other tools, it has its place when used appropriately and it has its potential for misuse. So let’s make sure you understand its uses and limitations. If you’ve never encountered this technique, the sternal rub is a test for unconsciousness. It’s a popular form of painful or noxious stimuli designed to illicit a response from a conscious or semi-conscious person. Establishing an unresponsive patients ability to respond and remove noxious stimuli is perfectly medically appropriate. Note that on your Glasgow Coma Score , establishing best eye response and best motor response both require the ability to administer and observe the patients reaction to pain. Having said that, I’m not the biggest fan of the sternal rub. i think there are other more appropriate tests like the face flick and the hand drop that, when done correctly, render more valuable information. To perform the sternal rub, the care provider makes a fist and places his knuckles against the patients mid- sternum . Applying firm downward pressure the provider then rubs up and down across the sternum. To the uninitiated, this is surprisingly uncomfortable. With even a moderate pressure, the sternal rub is unbearable to most folks. On the surface (pun intended) the stenal rub seems simple enough.

Original Source of Test For Unconsciousness: The Sternal Rub