Head Injuries and Concussion: First Aid for Trauma

Head injuries range from minor bumps to life-threatening traumatic brain injuries. The CDC reports that approximately 2.5 million emergency department visits, 282,000 hospitalizations, and 56,000 deaths related to traumatic brain injury occur annually in the United States. Correct first aid can prevent secondary brain injury and improve neurological outcomes. This guide covers head injury assessment, concussion recognition, scalp wound management, and clear criteria for emergency care.

Understanding the Types of Head Injuries

Head injuries fall into two broad categories: closed and open. Closed head injuries involve a blow to the head that does not penetrate the skull. The brain impacts the inside of the skull, potentially causing bruising (contusion), bleeding (hematoma), or diffuse axonal injury — damage to the brain’s white matter tracts. Open head injuries involve penetration of the skull and dura mater, exposing brain tissue to the environment and creating high risk for infection.

Concussion, also called mild traumatic brain injury, is the most common type of head injury. The CDC defines concussion as a temporary disruption of brain function caused by a blow or jolt to the head. Despite the mild classification, concussions are serious and require proper evaluation and rest. The American Academy of Neurology estimates that between 1.6 and 3.8 million sports-related concussions occur annually in the United States.

Initial Assessment and Danger Signs

When assessing a person with a head injury, check for the following danger signs that indicate the need for immediate emergency care:

• Loss of consciousness at any point
• Severe headache that worsens
• Repeated vomiting or nausea
• Seizures or convulsions
• Unequal pupil size or abnormal eye movements
• Clear fluid or blood draining from the nose or ears
• Confusion, agitation, or unusual behavior
• Slurred speech or difficulty speaking
• Weakness or numbness in the arms or legs
• Inability to wake the person

The American College of Emergency Physicians advises that anyone with any of these signs should be evaluated in an emergency department, ideally with CT imaging to rule out intracranial hemorrhage.

Traumatic Brain Injury Severity

Traumatic brain injury is classified as mild, moderate, or severe based on the Glasgow Coma Scale, duration of loss of consciousness, and post-traumatic amnesia. The CDC defines mild TBI (concussion) as a GCS of 13 to 15 with loss of consciousness under 30 minutes and amnesia lasting less than 24 hours. Moderate TBI involves GCS 9 to 12 with loss of consciousness between 30 minutes and 24 hours. Severe TBI involves GCS 8 or below with loss of consciousness exceeding 24 hours.

The long-term consequences of TBI are a major public health concern. The CDC estimates that 5.3 million Americans are living with a TBI-related disability. Common long-term effects include cognitive impairment (memory, attention, executive function), mood disorders (depression, anxiety, irritability), and increased risk of neurodegenerative disease. Early recognition and proper initial management — including avoiding hypoxia and hypotension — significantly improve neurological outcomes.

The Glasgow Coma Scale

The Glasgow Coma Scale is a standardized tool for assessing consciousness level after head injury. It evaluates three responses: eye opening (score 1 to 4), verbal response (1 to 5), and motor response (1 to 6). Scores range from 3 (deep unconsciousness) to 15 (fully awake and oriented).

A GCS of 13 to 15 indicates mild brain injury, 9 to 12 indicates moderate injury, and 8 or below indicates severe injury requiring immediate intubation and neurosurgical intervention. While the full GCS assessment is performed by trained medical professionals, lay rescuers should note whether the person opens their eyes spontaneously or only to pain, speaks coherently or only moans, and moves all limbs equally.

Scalp Wound Management

Scalp wounds bleed profusely because the scalp is highly vascular. Apply direct pressure with sterile gauze or a clean cloth for 10 to 15 minutes. Do not apply excessive pressure if you suspect a skull fracture — look for deformities or depressions before applying pressure.

Wash minor scalp abrasions with mild soap and water, apply antibiotic ointment, and cover with a sterile bandage. For deeper lacerations, control bleeding with pressure and transport for evaluation. Scalp lacerations longer than 1 centimeter often require sutures or staples.

Concussion Signs and Symptoms

Concussion symptoms may appear immediately or develop over hours to days. The CDC’s HEADS UP initiative categorizes symptoms into four domains:

Physical: headache, dizziness, balance problems, nausea, sensitivity to light or noise, blurred vision, fatigue.

Cognitive: confusion, difficulty concentrating, feeling foggy, memory problems, slowed thinking.

Emotional: irritability, sadness, anxiety, mood swings.

Sleep: drowsiness, sleeping more or less than usual, difficulty falling asleep.

The acronym CRS (Concussion Recognition Symptoms) from the American Academy of Neurology helps bystanders remember to watch for Change in behavior, Regression of abilities, and Sensitivity to stimuli.

If a concussion is suspected, the person should stop all physical and cognitive activity immediately. The principle of physical and cognitive rest remains the cornerstone of acute concussion management, according to the CDC Pediatric mTBI Guideline.

Head Injury in Children

Children are at particular risk from head injuries. Their heads are proportionally larger and heavier relative to their bodies, and their developing brains are more vulnerable to injury. The CDC advises that any child with a suspected head injury who is under 2 years old, has any loss of consciousness, vomits more than once, or is acting abnormally should be evaluated immediately.

Infants with head injuries may not show classic symptoms. Instead, look for persistent crying, refusal to eat, bulging fontanelles (the soft spot on top of the head), and excessive sleepiness from which they cannot be easily awakened.

When to Call 911

Call 911 for any head injury involving loss of consciousness longer than 30 seconds, a seizure, suspected skull fracture, penetrating injury, clear fluid from the nose or ears, unequal pupils, repeated vomiting, or confusion that is not improving. Also call if the person is on blood-thinning medication such as warfarin, apixaban, or rivaroxaban, as these increase the risk of intracranial bleeding.

Even if the person initially seems fine, anyone with a dangerous mechanism of injury — a fall from height, high-speed motor vehicle collision, or assault — should be evaluated. See our first aid guide for general emergency response protocols.

Frequently Asked Questions

Should I let someone with a head injury fall asleep? The old advice to keep someone awake after a head injury is outdated. If the person can hold a normal conversation, is not confused, and shows no danger signs, they can sleep. Wake them every 2 to 3 hours to check if they can be roused normally. If you cannot wake them, call 911.

How long do concussion symptoms last? Most concussion symptoms resolve within 7 to 10 days in adults and within 2 to 4 weeks in children. Prolonged symptoms lasting more than a month may indicate post-concussion syndrome. The CDC recommends follow-up with a healthcare provider for any persistent symptoms and a gradual return to normal activities.

What is second impact syndrome? Second impact syndrome occurs when a person sustains a second concussion before the first has healed. This rare but often fatal condition causes rapid brain swelling and herniation. The risk is highest in adolescents. Anyone with a suspected concussion must be cleared by a medical professional before returning to sports or high-risk activities.

Can you have a head injury without hitting your head? Yes. Rapid acceleration-deceleration injuries, such as whiplash from a car accident, can cause the brain to strike the inside of the skull without direct impact. This mechanism can still produce concussion and diffuse axonal injury.

What is a subdural hematoma? A subdural hematoma is bleeding between the dura mater and the brain surface. It can develop rapidly (acute) or slowly over days to weeks (chronic). Older adults and people on blood thinners are at highest risk. Symptoms include headache, confusion, drowsiness, and one-sided weakness. Subdural hematomas are a life-threatening emergency requiring surgical evacuation.

Preventing Head Injuries in Children and Older Adults

The CDC’s HEADS UP initiative provides age-specific prevention strategies. For children, ensure appropriate car seat and booster seat use until the child fits adult seat belts properly, use properly fitted helmets for biking, skating, and contact sports, and install window guards to prevent falls from windows. For older adults, reduce fall risk by removing tripping hazards, improving home lighting, installing grab bars in bathrooms, reviewing medications that cause dizziness, and encouraging balance-strengthening exercises like tai chi. Falls are the leading cause of TBI in older adults, accounting for over 50 percent of TBI-related emergency department visits in this population.

Conclusion

Head injuries require careful assessment and a conservative approach to management. The rule is: when in doubt, err on the side of caution. The CDC’s HEADS UP program provides free training modules for parents, coaches, and healthcare providers to recognize and respond to head injuries. Understanding the difference between a minor bump and a brain-threatening emergency empowers you to make the right call when every minute matters. Whether you are a parent, coach, teacher, or simply a bystander, knowing the signs of concussion and the danger signals of intracranial hemorrhage equips you to act decisively when someone’s brain health hangs in the balance.

For a comprehensive overview, read our article on Allergic Reactions.