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.
What to look for - Head injuries
If you think someone has a head injury, there
are six key things you should look for:
- Brief loss of responsiveness
- Scalp wound
- Dizziness or nausea
- Loss of memory of events before or during the injury
For a severe head injury, you also need to
• reduced level of response
• loss of responsiveness
• leakage of blood or watery fluid from the ear or nose
• unequal pupil size
What you need to do - Head injuries
- 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.
- Treat any scalp wounds like a bleed, by
applying direct pressure to the wound.
- 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
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.
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
If they lose responsiveness at any point, open their airway,
check their breathing and prepare to treat someone who’s become
While you’re waiting for an ambulance, keep checking their
breathing, pulse and any changes in their level of response.
Other factors to look for
• 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
encourage them to get medical help.