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First Aid for Head Injuries

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US Army First Aid Manual
Fundamental Criteria for First Aid
Basic Measures for First Aid
First Aid for Special Wounds
First Aid for Fractures
First Aid for Climatic Injuries
First Aid for Bites and Stings
First Aid in Toxic Environments
First Aid for Psychological Reactions
Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary

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 step.

3-2. Signs/Symptoms (081-831-1000)

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.

  • Confusion.

  • 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.

  • Dizziness.

  • A change in pulse rate.

  • Breathing problems.

  • Eye (vision) problems, such as unequal pupils.

  • Paralysis.

  • Headache.

  • Black eyes.

  • Bleeding from scalp/head area.

  • Deformity of the head.

3-3. General First Aid Measures (081-831-1000)

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 measures).

  • 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.

  • Seek medical aid.

  • 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.

CAUTION (081-831-1033)

    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 penile erection.

      (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
    Chapter 4, 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 airway.

  • Maintain the casualty's airway if necessary.

3-4. Dressings and Bandages (081-831-1000 and 081-831-1033)

*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 such as--

  • "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 earlier observations.

c. Position the Casualty (081-831-1033).

WARNING (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 the Casualty.

  • If the casualty is conscious or has a minor (superficial) scalp wound:

      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.

NOTE (081-831-1033)

    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.
    Avoid pressure on the wound; place him on his side opposite the side of the injury.

WARNING (081-831-1033)

    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
    assistance. Move him only if absolutely necessary, otherwise keep the casualty
    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 applied.


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
    protruding object 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--

    (1) Remove the dressing from the wrapper.

    (2) Grasp the tails of the dressing in both hands.

    (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 (Figure 3-3).

    (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--

    (1) Remove the dressing from the wrapper.

    (2) Grasp the tails of the dressing in both hands.

    (3) Hold it (white side down) directly over the wound.

    (4) Place it over the wound (Figure 3-5).

    (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 the apex.

    (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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