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Head injuries are a common problem and in some cases, they require little treatment, however, you should always be aware that problems can be difficult to identify for a first aider. Your brain is a very sensitive organ but it is surrounded by a solid bone skull and has fluid to protect the brain further. You should always suspect spinal injury with a head injury and you need to assess the way that the injury happened and make your decision if spinal injury could have happened.

When a head is damaged there are different conditions that can happen and these are from mild to serious.

People can be at different conscious levels where they can be fully alert, dazed, appear unconscious but be able to hear if fully unconscious.

When dealing with a head injury you need to find out what level of consciousness the patient has. You can use the AVPU scale t make an assessment.

A - Alert – This means are they alert, although not necessarily oriented. Are the eyes open and do they respond to questions?
V - Voice – Do they respond to voice, can they answer simple questions or commands.
P - Pain – Do they respond to touch or pinching. This could be you pinch them and they open their eyes.
U -Unresponsive – This is where the patient does not give any eye, voice or motor response to voice or pain.

You need to ideally record your findings and repeat your assessment so you can report if there is any improvement or deterioration in their condition.

If you have any concerns, activate the emergency services, as head injuries can be very serious.

When dealing with the patient take care of them and monitor them carefully. Sometimes they can act out of character, maybe in an aggressive manner, and there is not always an obvious injury site as it may be a result of shock through the spine from an impact on the feet when falling as the impact is transmitted up the spine to the base of the skull.

There are different types of head injury and the first one we will look at it is Concussion.

The brain can move a little and the shaking of the brain due to a blow to the head can cause a concussion. A concussion usually produces a temporary disturbance to the normal brain function.

Symptoms of concussion can be mild to severe and in some cases, emergency treatment may be needed.

The most common symptoms of concussion are:
• A headache and dizziness;
• Nausea and loss of balance;
• Confusion;
• Difficulties with memory
• Feeling dazed or stunned.

Cerebral Compression is where there is pressure on the brain caused by swelling or bleeding and is a serious condition. The swelling can be due to a build-up of blood within the skull or swelling of injured brain tissues.

Cerebral compression is usually caused by a head injury but it can also be caused by a stroke, brain tumour or infection.

Cerebral compression can occur immediately after a head injury or after a few hours.

Signs and symptoms:
• Change in personality;
• Deteriorating levels of consciousness;
• Noisy breathing which becomes slow;
• An intense headache;
• Vomiting;
• Drowsiness
• Pulse is slow but strong;
• Unequal pupils;
• Weakness or paralysis down one side of the body;
• Tiredness and evidence of injury.

Cerebral Contusion is when there is bruising on the brain. This happens in 20-30% of all serious head injuries. Blood vessels in the brain get damaged and leak causing a pressure build up. Signs and symptoms will depend on the location of the contusion on the brain but they include motor coordination, numbness and memory problems.

Skull Fractures are where the skull is fractured due to direct or indirect force. There is sometimes blood, which is straw coloured or clear fluid coming from ears and nose. Blood in whites of eyes and evidence of impact, depression or bruise.

The treatment for head injuries is basically the same.

• Be aware that there could be a spinal injury
• Treat for bleeding
• Activate EMS
• Lie patient down with head and shoulders raised
• Monitor the patient’s breathing
• Do not give them food or drink.

Finally, it is worth mentioning what to do if the patient is wearing a helmet. A helmet could be a cycle helmet, riding helmet or full motorcycle helmet. These are very good ways of reducing head injury and they are best left on as by removing them you may make things worse or put an extra strain on the neck. The reason for removing it would be if you cannot maintain an open airway or if they are not breathing.

If you do need to remove the helmet, you must do it slowly and carefully ideally with two people. First, make sure you remember to remove the strap and have a good look to see what you are going to do. Then one person holds the helmet and the other supports the neck as the helmet is removed. Keep the helmet close as that usually goes with the patient to hospital, as the marks on the helmet can be an indicator of what happened.