Head Injuries, Concussion and First Aid Treatment

Head injuries are common, but they should never be ignored. Even when an injury appears minor, symptoms can develop or worsen over time.

The brain is protected by the skull and surrounding fluid, but it can still be injured by a blow, fall, impact or sudden movement. First aiders must also remember that not all serious problems are immediately visible.

Why Head Injuries Must Be Taken Seriously

A head injury can affect the brain, behaviour, level of consciousness and physical condition. There may be a visible wound, swelling or bruising, but in some cases there may be no obvious external injury.

With any significant head injury, always consider the possibility of a spinal injury. Look at how the incident happened and try to minimise unnecessary movement to reduce the risk of further harm.

Assessing Consciousness Using ACVPU

One of the first priorities when assessing a head injury is to check the casualty’s level of consciousness using the ACVPU method.

ACVPU stands for:

• Alert
• Confusion
• Voice
• Pain
• Unresponsive

Alert

Check whether the casualty is fully alert, has their eyes open, responds appropriately and can hold a normal conversation.

Confusion

Assess whether the casualty appears confused or is behaving differently from normal. New confusion after a head injury is a serious warning sign and may indicate deterioration.

Voice

If the casualty is not fully alert, check whether they respond to your voice. They may open their eyes, speak or follow a simple instruction.

Pain

If there is no response to voice, check whether they respond to a painful stimulus. This may include movement or abnormal posturing.

Unresponsive

If the casualty does not respond to voice or pain, this is a medical emergency. Use the ABCDE approach and call for emergency help immediately.

Reassessing a Head Injury

Always record your findings and continue to reassess the casualty. A change in their level of consciousness may suggest that their condition is getting worse.

If you have any concerns about a head injury, call 999 without delay.

Behavioural Changes After a Head Injury

Head injuries can affect how a person behaves. A casualty may become:

• Confused
• Drowsy
• Agitated
• Unusually quiet
• Out of character

These changes should always be treated seriously, even if there are no visible signs of injury.

What is Concussion?

Concussion is a common type of head injury caused by a blow, impact or sudden jolt to the head.

It causes a temporary disturbance in brain function. Symptoms of concussion may include:

• Headache
• Dizziness
• Nausea
• Confusion
• Memory problems
• Feeling dazed

Cerebral Compression

Cerebral compression is a more serious condition where pressure builds up on the brain because of swelling or bleeding.

Warning signs may include:

• Worsening level of consciousness
• Severe headache
• Vomiting
• Unequal pupils
• Weakness on one side of the body

This can occur immediately after the injury or develop several hours later.

Signs of a Possible Skull Fracture

A skull fracture may be suspected if there is:

• Blood or clear fluid coming from the ears or nose
• Bruising around the eyes
• Visible deformity of the skull
• A serious blow or impact to the head

Any suspected skull fracture requires urgent medical assessment.

First Aid Treatment for Head Injuries

First aid treatment for a head injury should focus on preventing further harm and monitoring the casualty carefully.

Key actions include:

• Consider spinal injury
• Control any bleeding
• Call emergency services if needed
• Keep the casualty still
• Monitor breathing and level of response
• Do not give food or drink
• Keep the casualty warm

If appropriate, the casualty may be laid down with the head and shoulders slightly raised, but movement should be kept to a minimum.

Helmet Removal After a Head Injury

If the casualty is wearing a helmet, it should usually be left in place. Removing a helmet can make a neck or spinal injury worse.

Only remove a helmet if it is not possible to maintain the airway or if the casualty is not breathing.

If helmet removal is essential, it should be done carefully by two people. One person should support the head and neck, while the other slowly removes the helmet after undoing the strap.

Key First Aid Message

Head injuries can change quickly. Early recognition, careful handling, regular reassessment and prompt emergency action can make a significant difference to the casualty’s outcome.