What is the first step when a patient is unconscious and does not have a pulse or breathing?

When a patient is unconscious and does not have a pulse or breathing, the immediate priority is to perform CPR. This is because the absence of a pulse indicates that the heart has stopped, and without breathing, the brain and vital organs are at risk of severe damage due to lack of oxygen. Performing CPR helps to manually circulate blood and provide oxygen to the body's tissues until emergency medical services arrive or the patient's heart can be restarted.

It’s important to initiate CPR as quickly as possible in this scenario to maximize the chances of survival. While assessing airway and calling for help are crucial steps in the emergency response process, they follow the immediate need to restore circulation and breathing through CPR. Ensuring the airway is clear and calling for assistance are integral components of the overall response, but they are secondary to the life-saving action of CPR in the presence of cardiac arrest.