An Alert Response to Head Injury

A small child playing on the sofa falls forward, hitting his head on the edge of the coffee table. He has a bump, almost immediately, but no cut.

A 12-year-old-boy, riding his bike with no helmet, hits a pothole and loses control, hurtling him headfirst into a pole. He is unconscious and bleeding from the scalp.

A soccer player, running toward the goal, loses his balance and falls into the goalpost, hitting his head. He is unconscious for a minute or two, but then insists he is fine. An hour later, on the sideline, he suddenly falls from the bench, unconscious, and cannot be awakened.

Leading Cause of Death

Accidental injury is the leading cause of death between the ages of 1 and 44; 50 percent of all accidental injuriesare related to motor vehicle accidents. Head injury is the primary cause of death in 70 percent of fatal auto accidents and 50 percent of fatal motorcycle accidents. Even more important, the age group most affected by head injuries is young adults. The three accidents described above are typical of the kind that occur most commonly. How can you as a first aider determine which are serious and which are minor?

If you are on the scene when a head injury occurs, you should do the following:

  • Survey the scene for immediate danger to you or the victim. In a car accident, for example, is traffic stopped? Is all danger of explosion eliminated and debris removed from around the victim? Also, try to determine what happened.
  • Have a primary check of the victim’s condition. Is the person breathing? Have a pulse? Do the pupils of the eye react to light? (Often they don’t, with serious head injuries.) Are both pupils the same? Is the victim bleeding from the nose or ear? This could be a dangerous sign if there is not a direct injury to the face.
  • Control any bleeding.
  • Ask the victim about any symptoms to deteermine if there is any need for professional medical help. Also try to determine if the victim is alert and fully aware of his or her surroundings.
  • Check for any neck injury before attempting to move or reposition the victim. Ask about paralysis or numbness in the extremities.
  • Keep constant watch on breathing and the level of consciousness. If the victim loses consciousness, record the length of time the person was unconscious and give this information, along with the time of the injury, to paramedics when they arrive.

Head injuries can be minor, requiring only an ice bag and bandage. But some can be life-threatening. One of your tasks as a first aider is to quickly determine the seriousness of a head injury. The following descriptions may help.

Lumps and Bumps

Bumps on the head that cause a lump to form are the most common minor head injuries. The cause of the lump, technically called a hematoma, is the leakage of fluid from broken blood vessels. The swelling is followed by a bruise, and the victim does not lose consciousness.

First aid for this type of head injury is ice for about 15 minutes to reduce swelling and pain. The best position for this victim is sitting up to reduce swelling.


A small shallow cut on the head, with no other symptoms such as blurred vision of dizziness, can be treated as a cut elsewhere on the body. To stop the bleeding, wash the wound, place a clean gauze pad over the cut, and apply gentle pressure. A pressure bandage is also effective. Keep the victim’s head and shoulders elevated. If, however, the cut appears long enough to need stitches or deep enough to cause heavy bleeding, the victim should have immediate medical treatment. When in doubt, check it out!

The are some symptoms that can signal a more serious head injury. If the victim starts vomiting, complains of dizziness or headache, has a sudden loss of memory, or becomes uncontrollably sleepy, medical attention is urgently needed.


Loss of consciousness is also a symptom of a serious head injury, and the longer the victim is unconscious, the more likely that the injury is serious. Unconsciousness from a concussion occurs when the soft tissue of the brain bangs into the hard surface of the inside of the skull. The victim may vomit, seem drowsy, become pale, or be unable to recall events leading up to the injury.

Victims of concussion may also develop seizures in which the brain sends out abnormal electrical signals that cause the muscles to twitch. First aid for this injury:

* Turn the victim on the side to open the airway and allow for drainage of blood, vomitus, or saliva.

* Remove nearby objects the victim could bump into.

* Project the head by using a pillow or other soft object to cushion contact with the ground.

* Do not restrain the victim’s movements.

* Do not put anything in the victim’s mouth.

* When the seizure stops, keep a close eye on breathing and protect the victim until help arrives.

It is usually advised thta victims of concussion have skull X-rays. There may also be damage to the neck; use caution in handling this victim–don’t move the person if you suspect a neck or back injury.

After medical treatment, the physician may suggest that the victim be kept awake for a few hours in order to monitor whether any new symptoms develop. These could include a plainful headache or difficulty moving the limbs. These symptoms may indicate serious brain damage or bleeding under the skull; quick medical treatment will be required.

Skull Fracture

Occasionally a blow to the head results in a crack in the skull, known as a simple fracture. Victims of skull fracture often develop dizziness, headache, vomiting, and memory loss. If symptoms persist, they should be taken to a hospital and may be kept there for a day of observation. Physicians want to be sure there is no bleeding into the brain, which could be life-threatening. Once released, rest at home for several days will be required, as well as avoiding exercise and contact sports for four to six weeks.

A com pound fracture of the skull involves a wound in addition to the crack. It is a very serious problem because germs may have entered the brain. Do not clean such a wound yourself; get medical attention immediately.

Now go back to the original three situations. Think through how you would handle each one. Which is most likely to be serious? How would you know that? Giving first aid for head injuries requires that you use your head to make the right decisions.

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