First Aid for Head Injuries
A head injury may consist of one or a combination of the following
conditions: a concussion, a cut or bruise of the scalp, or a fracture
of the skull with injury to the brain and the blood vessels of
the scalp. The damage can range from a minor cut on the scalp
to a severe brain injury which rapidly causes death. Most head
injuries lie somewhere between the two extremes. Usually, serious
skull fractures and brain injuries occur together; however, it
is possible to receive a serious brain injury without a skull
fracture. The brain is a very delicate organ; when it is injured,
the casualty may vomit, become sleepy, suffer paralysis, or lose
consciousness and slip into a coma. All severe head injuries are
potentially life-threatening. For recovery and return to normal
function, casualties require proper first aid as a vital first
A head injury may be open or closed. In open
injuries, there is a visible wound and, at times, the brain may
actually be seen. In closed injuries, no visible injury is seen,
but the casualty may experience the same signs and symptoms. Either
closed or open head injuries can be life-threatening if the injury
has been severe enough; thus, if you suspect a head injury, evaluate
the casualty for the following:
- Current or recent unconsciousness (loss of consciousness).
- Nausea or vomiting.
- Convulsions or twitches (involuntary jerking and shaking).
- Slurred speech.
- Sleepiness (drowsiness).
- Loss of memory (does casualty know his own name, where he
is, and so forth).
- Clear or bloody fluid leaking from nose or ears.
- Staggering in walking.
- A change in pulse rate.
- Breathing problems.
- Eye (vision) problems, such as unequal pupils.
- Black eyes.
- Bleeding from scalp/head area.
- Deformity of the head.
|a. General Considerations. The
casualty with a head injury (or suspected head injury) should
be continually monitored for the development of conditions which
may require the performance of the necessary basic lifesaving
measures, therefore be prepared to--
- Clear the airway (and be prepared to perform the basic lifesaving
- Treat as a suspected neck/spinal injury until proven otherwise.
(See Chapter 4 for more information.)
- Place a dressing over the wounded area. DO NOT attempt to
clean the wound.
- Keep the casualty warm.
- DO NOT attempt to remove a protruding object from the head.
- DO NOT give the casualty anything to eat or drink.
|b. Care of the Unconscious Casualty.
If a casualty is unconscious as the result of a head injury, he
is not able to defend himself. He may lose his sensitivity to
pain or ability to cough up blood or mucus that may be plugging
his airway. An unconscious casualty must be evaluated for breathing
difficulties, uncontrollable bleeding, and spinal injury.
(1) Breathing. The brain requires a constant supply of
oxygen. A bluish (or in an individual with dark skin--grayish)
color of skin around the lips and nail beds indicates that the
casualty is not receiving enough air (oxygen). Immediate action
must be taken to clear the airway, to position the casualty on
his side, or to give artificial respiration. Be prepared to give
artificial respiration if breathing should stop.
(2) Bleeding. Bleeding from a head injury usually comes
from blood vessels within the scalp. Bleeding can also develop
inside the skull or within the brain. In most instances bleeding
from the head can be controlled by proper application of the field
first aid dressing.
DO NOT attempt to put unnecessary pressure on the wound or
attempt to push any
brain matter back into the head (skull). DO
NOT apply a pressure dressing.
(3) Spinal injury. A person that has an injury above
the collar bone or a head injury resulting in an unconscious state
should be suspected of having a neck or head injury with spinal
cord damage. Spinal cord injury may be indicated by a lack
of responses to stimuli, stomach distention (enlargement), or
(a) Lack of responses to stimuli. Starting with the feet,
use a sharp pointed object--a sharp stick or something similar,
and prick the casualty lightly while observing his face. If the
casualty blinks or frowns, this indicates that he has feeling
and may not have an injury to the spinal cord. If you observe
no response in the casualty's reflexes after pricking
upwards toward the chest region, you must use extreme caution
and treat the casualty for an injured spinal cord.
(b) Stomach distention (enlargement). Observe the casualty's
chest and stomach. If the stomach is distended (enlarged) when
the casualty takes a breath and the chest moves slightly, the
casualty may have a spinal injury and must be treated accordingly.
(c) Penile erection. A male casualty may have a penile
erection, an indication of a spinal injury.
Remember to suspect any casualty who has a severe head
injury or who is
unconscious as possibly having
a broken neck or a spinal cord injury! It is better to
treat conservatively and assume that the neck/spinal cord is injured
rather than to
chance further injuring the casualty. Consider
this when you position the casualty. See
paragraph 4-9 for treatment procedures of spinal column injuries.
c. Concussion. If an individual receives a heavy blow
to the head or face, he may suffer a brain concussion, which is
an injury to the brain that involves a temporary loss of some
or all of the brain's ability to function. For example, the
casualty may not breathe properly for a short period of time,
or he may become confused and stagger when he attempts to walk.
A concussion may only last for a short period of time. However,if a casualty is suspected of having suffered a concussion, he
must be seen by a physician as soon as conditions permit.
d. Convulsions. Convulsions (seizures/involuntary jerking)
may occur after a mild head injury. When a casualty is convulsing,
protect him from hurting himself. Take the following measures:
(1) Ease him to the ground.
(2) Support his head and neck.
(3) Maintain his airway.
(4) Call for assistance.
(5) Treat the casualty's wounds and evacuate him immediately.
e. Brain Damage. In severe head injuries where
brain tissue is protruding, leave the wound alone; carefully
place a first aid dressing over the tissue. DO NOT remove
or disturb any foreign matter that may be in the wound.
Position the casualty so that his head is higher than his body.
Keep him warm and seek medical aid immediately.
- DO NOT forcefully hold the arms and legs if they are jerking
because this can lead to broken bones.
- DO NOT force anything between the casualty's teeth--especially
if they are tightly clenched because this may obstruct the casualty's
- Maintain the casualty's airway if necessary.
3-4. Dressings and Bandages (081-831-1000
|*a. Evaluate the Casualty (081-831-1000).
Be prepared to perform lifesaving measures. The basic lifesaving
measures may include clearing the airway, rescue breathing, treatment for shock, and/or bleeding control.
b. Check Level of Consciousness/Responsiveness (081-831-1033).
With a head injury, an important area to evaluate is the casualty's
level of consciousness and responsiveness. Ask the casualty questions
- "What is your name?" (Person)
- "Where are you?" (Place)
- "What day/month/year is it?" (Time)
Any incorrect responses, inability to answer, or changes in responses
should be reported to medical personnel. Check the casualty's
level of consciousness every 15 minutes and note any changes from
c. Position the Casualty (081-831-1033).
DO NOT move the casualty if you suspect he has sustained a
neck, spine or severe
head injury (which produces any signs or
symptoms other than minor bleeding). See
task 081-831-1000, Evaluate
- If the casualty is conscious or has a minor (superficial)
o Have the casualty sit up (unless other injuries prohibit or
he is unable); OR
o If the casualty is lying down and is not accumulating fluids
or drainage in his throat, elevate his head slightly; OR
o If the casualty is bleeding from or into his mouth or throat,
turn his head to the side or position him on his side so that
the airway will be clear. Avoid pressure on the wound or place
him on his side--opposite the site of the injury (Figure 3-1).
- If the casualty is unconscious or has a severe head injury,
then suspect and treat him as having a potential neck or spinal
injury, immobilize and DO NOT move the casualty.
If the casualty is choking and/or vomiting or is bleeding
from or into his mouth (thus compromising his airway), position
him on his side so that his airway will be clear.
on the wound; place him on his side opposite the side of the injury.
If it is necessary to turn a casualty with a suspected neck/spine
injury; roll the casualty
gently onto his side, keeping the head,
neck, and body aligned while providing
support for the head and
neck. DO NOT roll the casualty by yourself but seek
Move him only if absolutely necessary, otherwise keep
immobilized to prevent further damage to the neck/spine.
d. Expose the Wound (081-831-1033).
- Remove the casualty's helmet (if necessary).
- In a chemical environment:
o If mask and/or hood is not breached, apply no dressing to
the head wound casualty. If the "all clear" has
not been given, DO NOT remove the casualty's mask to attend
the head wound; OR
o If mask and/or hood have been breached and the "all
clear" has not been given, try to repair the breach
with tape and apply no dressing; OR
o If mask and/or hood have been breached and the "all clear"
has been given, the mask can be removed and a dressing
DO NOT attempt to clean the wound, or remove a protruding object.
If there is an object extending from the wound DO NOT remove
the object. Improvise
bulky dressings from the cleanest material
available and place these dressings around the
for support after applying the field dressing.
Always use the casualty's field dressing, not your own!
|e. Apply a Dressing to a Wound
of the Forehead/Back of Head (081-831-1033). To
apply a dressing to a wound of the forehead or back of the head--|
(3) Hold the dressing (white side
down) directly over the wound. DO NOT touch the white (sterile)
side of the dressing or allow anything except the wound to come
in contact with the white side.
(4) Place it directly over the wound.
(5) Hold it in place with one hand. If the casualty is able,
he may assist.
(6) Wrap the first tail horizontally around the head, ensure
the tail covers the dressing (Figure 3-2).
(7) Hold the first tail in place and
wrap the second tail the opposite direction, covering the dressing
(8) Tie a nonslip knot and secure
the tails at the side of the head, making sure they DO NOT cover
the eyes or ears (Figure 3-4).
|f. Apply a Dressing to a Wound
on Top of the Head (081-831-1033). To apply a dressing to
a wound on top of the head--|
(5) Hold it in place with one hand. If the casualty is able,
he may assist.
(6) Wrap one tail down under the chin
(Figure 3-6), up in front of the ear,
over the dressing, and in front of the other ear.
(Make sure the tails remain wide and close to the front of
the chin to avoid choking the
(7) Wrap the remaining tail under
the chin in the opposite direction and up the side of the face
to meet the first tail (Figure 3-7).
(8) Cross the tails (Figure 3-8),
bringing one around the forehead (above the eyebrows) and the
other around the back of the head (at the base of the skull) to
a point just above and in front of the opposite ear, and tie them
using a nonslip knot (Figure 3-9).
g. Apply a Triangular Bandage to the Head. To apply
a triangular bandage to the head--
(1) Turn the base (longest side) of the bandage up and center
its base on center of the forehead, letting the point (apex) fall
on the back of the neck (Figure 3-10 A).
(2) Take the ends behind the head and cross the ends over
(3) Take them over the forehead and tie them (Figure 3-10 B).
(4) Tuck the apex behind the crossed part of the bandage and/or
secure it with a safety pin, if available (Figure 3-10 C).
h. Apply a Cravat Bandage to the Head. To apply a
cravat bandage to the head--
(1) Place the middle of the bandage over the dressing (Figure 3-11 A).
(2) Cross the two ends of the bandage in opposite directions
completely around the head (Figure 3-11 B).
(3) Tie the ends over the dressing (Figure 3-11 C).
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