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In assessing the levels of consciousness of a casualty, indicating that an individual is alert involves demonstrating clear awareness of their surroundings and the ability to respond appropriately. The option that states patients are fully awake and responsive fits this description perfectly.

When someone is fully awake, they can engage with their environment, answer questions, and respond to stimuli in a normal manner. This alertness is characterized by the ability to interact, follow directions, and exhibit cognitive functions that demonstrate awareness.

The other choices reflect varying degrees of unresponsiveness or altered levels of consciousness. For example, eyes closed and unresponsive suggests a lack of awareness and engagement, while sleeping but not disturbed implies they are not in a state conducive to alertness. Being responsive only to painful stimuli indicates a significant level of sedation or confusion, rather than alertness. In contrast, the fully awake and responsive state is what clearly signifies an alert individual.