Head Injuries

Head injury is a term used to describe any trauma to the head. A head injury may cause loss of consciousness, damage to the brain, eyes, ears, teeth, airways and mouth or other structures. All injuries to the head should be treated seriously as they can cause permanent brain damage and are potentially life-threatening.
Once a head injury has been sustained, signs and symptoms associated with the injury may not develop for several hours or even days. In many instances, a casualty who appeared initially unaffected suddenly collapses with life-threatening symptoms some hours after the incident. This is often due to the trauma of the incident resulting in a small bleed in the brain. This bleeding along with swelling gradually worsens applying pressure to the brain. The extent of the injury will be determined by the amount of bleeding and/or swelling inside the brain/skull.
Head injuries are generally classified as:
Open – a head injury with an associated head wound.
Closed – a head injury with no obvious sign of injury.
In some instances, serious head injury is readily identified by certain signs peculiar to the injury. Cerebrospinal fluid (CSF) is a clear fluid that surrounds the brain. When a fracture occurs, usually at the base of the skull, the pressure causes CSF to leak from the nose or ears.

A strong blow to the head will cause kinetic energy to be forced through the brain and skull into the soft tissue of the face e.g. the eyes and behind the ears. Bruising in these areas indicate that the head has suffered exposure to considerable force. Just because a casualty has ‘raccoon eyes’ does not mean they have been struck in the face. It may indicate they sustained a strong blow elsewhere on the head.

A casualty with a concussion commonly has blurred or double vision. It indicates that the brain has been dealt a blow that has temporarily affected its ability to correctly process the sight senses.

Change in level of consciousness; drowsy, vague, becomes unconscious.

Anxious, irritable, irrational, uncooperative.

Memory impairment.

Blood or clear fluid coming from the ears, eyes, nose or mouth (suspect a base of skull fracture).

Changes in the size and shape of pupils, blurred vision.

Head wound or deformity to the skull (complicated skull fracture).

Difficulty in breathing.

Headaches and/or dizziness.

History of trauma.

Nausea or vomiting.


Slurred speech.

Swelling around one or both eyes.

Follow the DRSABCD emergency action plan.

Call 000 for an ambulance urgently.

Always suspect a spinal injury – apply a cervical collar to immobilise the neck only if trained to do so.

If drowsy or unconscious and breathing normally; place in recovery position while supporting the neck.

Control bleeding and treat wounds.

Allow any fluid coming from the ear to drain freely. If in recovery position put injured side down with a pad placed over the affected ear.

Reassure the casualty and monitor pulse, respirations and level of consciousness closely for any deterioration.

While regaining consciousness the casualty may vomit, have blurred vision, be irrational and uncooperative, be dizzy and have memory loss and be unable to recall events surrounding the accident.

The casualty should never be left alone and if consciousness returns, the casualty should be given reassurance and kept lying down at rest while awaiting the arrival of the ambulance.

If a casualty has a suspected skull fracture, DO NOT place any pressure on the area, as this can put direct pressure onto the brain and cause brain damage.


A concussion is a temporary loss or altered state of consciousness resulting from a head injury, followed by a rapid recovery. It is caused by a traumatic injury to tissues of the brain as a result of a violent blow, shaking, or spinning.

History of an injury.

A temporary loss of memory.

A temporary loss or decreased level of consciousness.



Nausea and/or vomiting.

Follow the DRSABCD emergency action plan.

Call 000 for an ambulance urgently.

Reassure the casualty.

Complete the secondary survey and treat any subsequent injuries.

Monitor the casualty’s pulse, respirations and level of consciousness.