A bump to the head can cause anything from a minor injury to a serious medical emergency.

One of the difficulties for a first aider is that the seriousness of a head injury may not always be immediately obvious. Someone may initially appear alert and well but develop symptoms later.

A first aider does not need to diagnose concussion, a skull fracture or bleeding inside the skull. Your role is to assess the casualty, recognise warning signs, provide appropriate first aid and get medical help when necessary.

Knowing how to carry out a simple head injury assessment can help you make those decisions.

What Is a Head Injury?

A head injury is any injury involving the scalp, skull or brain.

Head injuries can result from incidents such as:

Slips, trips and falls
Falls from height
Road traffic collisions
Sports injuries
Being struck by an object
Workplace accidents
Assaults
Cycling accidents

Some injuries cause obvious wounds, swelling or bleeding. Others may cause injury inside the skull without much to see externally.

Never judge the seriousness of a head injury solely by its appearance.

Start With a Primary Survey

If you find someone who has suffered a significant head injury, start by checking for immediate threats to life.

Current Resuscitation Council UK first aid guidance recommends using a structured ABCDE assessment to identify and treat life-threatening problems. resus.org.uk

For a first aider, your initial priorities include checking that it is safe to approach, assessing the casualty’s response, making sure their airway is open and assessing their breathing.

If the casualty is unresponsive, call 999 immediately.

Follow the instructions from the ambulance call handler and deal with any immediate life-threatening problems before concentrating on the head injury.

What Should You Look for After a Head Injury?

Once you have dealt with immediate threats to life, try to establish what happened and assess the casualty.

Look for obvious signs of injury such as:

Cuts or wounds to the scalp
Bleeding
Swelling or bruising
Tenderness
An unusual depression or deformity of the skull

Also look at the casualty’s behaviour and neurological condition.

Ask simple questions and listen carefully to their answers.

Do they know where they are?

Can they remember what happened?

Are they confused?

Are they behaving normally?

Can they speak clearly?

A change in someone’s normal level of response or behaviour following a head injury can be an important warning sign.

Signs and Symptoms of a Serious Head Injury

Serious head injuries can produce a range of symptoms.

Warning signs can include:

Loss of consciousness
Reduced or deteriorating level of response
Difficulty staying awake
Confusion or unusual behaviour
Memory problems
A severe or worsening headache
Vomiting
Seizures
Problems with balance or walking
Difficulty speaking or understanding
Weakness or numbness
Problems with vision or hearing
Blood or clear fluid coming from the ears or nose
Bruising behind the ears
A black eye without an injury directly to the eye
An obvious skull wound or deformity

Some of these signs require immediate emergency medical help. Current NHS guidance advises calling 999 for serious signs including a casualty who has been knocked unconscious and has not woken, cannot stay awake, has a seizure, develops neurological problems, has clear fluid from the ears or nose, has bleeding from the ears or has sustained certain high-risk injuries. nhs.uk

Can Someone Seem Fine After a Serious Head Injury?

Yes.

This is one of the reasons head injuries need careful monitoring.

Symptoms from some internal head injuries may develop gradually rather than appearing immediately. For example, NHS guidance explains that symptoms from a subdural haematoma can sometimes develop gradually after the original injury. nhs.uk

Never assume that someone is fine simply because they remained conscious after hitting their head.

Pay attention to changes in their condition.

If they become increasingly confused, sleepy, unsteady, develop a worsening headache, start vomiting or develop another concerning symptom, seek medical help.

What Is Concussion?

Concussion is a temporary brain injury that can happen following a blow or other injury to the head.

A person does not have to lose consciousness to have concussion.

Symptoms can include:

Headache
Dizziness
Feeling sick
Problems concentrating
Memory problems
Tiredness
Irritability or changes in mood

Symptoms can sometimes continue for several weeks.

You should not try to diagnose concussion yourself following a significant head injury. If you are concerned about symptoms, seek medical advice.

The NHS guidance on head injuries and concussion provides current advice about when to call 999, contact NHS 111 or seek further medical assessment. nhs.uk

Should You Check the Casualty’s Pupils?

You may have heard that you should shine a light into someone’s eyes or repeatedly check whether their pupils are the same size after a head injury.

Changes to the pupils can occur with serious neurological injury, but a first aider should not rely on pupil assessment to decide whether a head injury is serious.

Concentrate on the casualty’s overall condition, particularly their level of response, breathing, behaviour and any deterioration.

If serious signs or symptoms are present, call 999.

Do not delay medical help while attempting to carry out a detailed neurological examination.

Should You Keep Someone Awake After a Head Injury?

You do not need to force someone with a minor head injury to stay awake simply because they have hit their head.

NHS guidance specifically states that someone recovering from a minor head injury does not need to stay awake if they are tired. nhs.uk

There is an important difference, however, between someone normally feeling tired and someone becoming abnormally drowsy or difficult to wake.

If the casualty cannot stay awake, cannot keep their eyes open or their level of response deteriorates following a head injury, call 999.

What Should You Do If the Casualty Becomes Unresponsive?

If the casualty becomes unresponsive, reassess them immediately.

Call 999 if this has not already been done and check their breathing.

If they are not breathing normally, follow the instructions from the ambulance service and start CPR.

If they are breathing normally, you need to maintain their airway and continue monitoring their breathing.

A significant head injury can also involve an injury to the neck or spine, particularly after a fall, collision or other high-energy incident.

Avoid unnecessary movement.

However, maintaining the casualty’s airway and breathing takes priority over concerns about a possible spinal injury.

What About a Suspected Spinal Injury?

A serious impact that injures the head may also injure the neck or spine.

Suspect a spinal injury particularly where the casualty has experienced a significant fall, road traffic collision, diving accident, sporting collision or other substantial force.

Encourage a conscious casualty to remain still.

Support their head in a comfortable neutral position if appropriate and avoid unnecessary movement while waiting for professional help.

Do not attempt to straighten the casualty’s neck if doing so causes pain or resistance.

If their airway or breathing becomes compromised, however, maintaining life takes priority.

What Should You Do About Bleeding From the Head?

Scalp wounds can bleed heavily because the scalp has a good blood supply.

For a straightforward scalp wound, control bleeding using an appropriate dressing and pressure.

However, if you suspect a skull fracture, do not press forcefully over an obvious depression, deformity or suspected fracture.

Do not remove an object embedded in a head wound.

Instead, call 999, protect the area from further injury and follow the ambulance service’s instructions.

When Should You Call 999 After a Head Injury?

Call 999 for serious head injuries and potentially life-threatening symptoms.

Examples include someone who:

Has been knocked unconscious and has not woken up
Cannot stay awake or keep their eyes open
Has a seizure
Develops weakness or numbness
Has problems speaking, understanding, walking or balancing
Has clear fluid coming from their nose or ears
Is bleeding from their ears
Has a significant skull wound or depression
Has suffered a high-risk mechanism of injury, such as a serious road collision or substantial fall

NHS guidance also identifies other circumstances where emergency assistance is appropriate. If you are uncertain about a casualty’s condition, tell the 999 call handler exactly what has happened and what you can see. nhs.uk

When Should You Seek Other Medical Advice?

Not every head injury requires an ambulance, but some casualties still need urgent medical assessment.

The NHS advises seeking urgent help after a head injury for symptoms or circumstances including vomiting, dizziness, concerns about symptoms, taking blood-thinning medication or having a condition that affects blood clotting. nhs.uk

If you are unsure what level of care someone needs, NHS 111 can provide advice.

Never allow concerns about “wasting someone’s time” to prevent you from seeking help when someone’s condition worries you.

Looking After a Minor Head Injury

If medical professionals have determined that a head injury is minor, or the casualty does not need hospital treatment, they should still be monitored.

NHS advice includes having a responsible adult stay with the injured person for at least the first 24 hours.

Rest is important. The casualty does not need to stay awake simply because they have suffered a minor head injury.

They should avoid alcohol and recreational drugs while recovering and should not drive until they feel fully recovered.

The NHS also advises avoiding contact sports for at least three weeks following a minor head injury. nhs.uk

If symptoms worsen or new warning signs appear, seek medical help.

Head Injuries in Babies and Children

Assessing babies and young children can be more difficult because they may not be able to explain how they feel.

Look for changes from their normal behaviour as well as physical signs of injury.

These could include unusual irritability, excessive crying, becoming unusually quiet, problems staying awake or changes in feeding or interaction.

The threshold for seeking medical advice should be low if you are concerned about a baby or young child after a head injury.

NHS guidance specifically includes additional emergency criteria for babies under one year, including a large cut, bruise or swelling on the head. nhs.uk

Our Paediatric First Aid courses cover the assessment and treatment of injuries and medical emergencies involving babies and children.

Head Injury Assessment: What Should a First Aider Remember?

A first aider does not need to determine exactly what has happened inside the casualty’s skull.

Instead, concentrate on the things you can assess.

Check for immediate threats to life.

Find out what happened.

Look for injuries.

Assess the casualty’s level of response.

Listen to what they tell you.

Watch for changes.

Recognise serious warning signs.

And get appropriate medical help.

Head injuries can change over time, so deterioration is particularly important. Someone becoming less responsive, more confused, increasingly drowsy or developing new neurological symptoms needs urgent attention.

Learn How to Assess an Injured Casualty

Knowing what signs to look for is useful, but practical first aid training gives you the opportunity to practise structured casualty assessment and learn how to respond when someone is seriously injured.

First Aid and Safety Training provides regulated first aid training courses across the North East, including Emergency First Aid at Work, First Aid at Work and Paediatric First Aid.

You can book a first aid course or contact First Aid and Safety Training to discuss training for your workplace, school or organisation.

You can also find First Aid and Safety Training on Google to view our business information and customer reviews.