Dealing with Head Injuries

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This leaflet is created from first aid advice provided by St John Ambulance, the nation's leading first aid charity. This advice is no substitute for first aid training - find a training course near you.

All head injuries are potentially serious because they can damage the brain and make someone lose responsiveness. The severity of a head injury depends on how someone hit their head and how hard the impact was.

A head injury may cause damage to the brain tissue or to blood vessels inside the skull, or even break the skull (a skull fracture). Clear fluid or watery blood leaking from the ear or nose, and a deteriorating level of response, are some of the signs of serious injury.

These are the most common things which may happen if someone has had a head injury:

  • Concussion is a brief period of unresponsiveness - someone with concussion may be confused, but only for a short time, followed by complete recovery.
  • Cerebral compression - a severe blow to the head can cause bleeding or swelling inside the skull that can press on the brain - this is called cerebral compression and is life-threatening.
  • Skull fracture - if there is a head wound this is a sign that there may be deeper damage within the head, like a crack or break in the skull (skull fracture), which may be serious.
  • Spinal injury - you should always assume that someone who has had a head injury may also have a neck (spinal) injury and treat them for this as well.

If you think someone has a head injury, there are six key things you should look for:

  1. Brief loss of responsiveness.
  2. Scalp wound.
  3. Dizziness or nausea.
  4. Loss of memory of events before or during the injury.
  5. Headache.
  6. Confusion.

For a severe head injury, you also need to look for:

  • Reduced level of response.
  • Loss of responsiveness.
  • Leakage of blood or watery fluid from the ear or nose.
  • Unequal pupil size.
  1. Sit them down and give them something cold to hold against the injury. You can use a cold compress, or a bag of ice or frozen peas wrapped in a cloth.
  2. Treat any scalp wounds like a bleed, by applying direct pressure to the wound.
  3. Check their level of responsiveness, using the AVPU scale below. Make a note of their reactions, especially any changes to their level of response, to pass on to the ambulance, in case you have to call one.

The AVPU scale - alert, voice, pain, unresponsive.

A - Alert: Are they alert? Are their eyes open and do they respond to questions?

V - Voice: Do they respond to voice? Can they answer simple questions and respond to instructions?

P - Pain: If they're not alert or they're not responding to your voice - do they respond to pain? Try pinching them - do they move or open their eyes?

U - Unresponsive: Do they respond to questions or a gentle shake?

If they are alert or responsive then they're responsive and their head injury is probably mild, but you should wait with them until they recover.

Encourage them to get medical help if they:

  • Are over 65.
  • Have been drinking or taking drugs.
  • Have been unresponsive for even a few seconds.
  • Or if you think they're getting worse.

If they're not alert or responsive then they may be partially or fully unresponsive and their head injury could be severe. Call 999/112 for an ambulance and explain their response to the AVPU test.

If they lose responsiveness at any point, open their airway, check their breathing and prepare to treat someone who's become unresponsive.

While you're waiting for an ambulance, keep checking their breathing, pulse and any changes in their level of response.

Note: these hints are no substitute for thorough knowledge of first aid. St John Ambulance holds first aid courses throughout the country.

Adapted from the St John Ambulance leaflet: head injuries. Copyright for this leaflet is with St John Ambulance.

Original Author:
St John Ambulance
Current Version:
Peer Reviewer:
St John Ambulance
Document ID:
28665 (v3)
Last Checked:
Next Review:
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