Head wounds are often alarming because the scalp is extremely vascular, causing even minor cuts to bleed profusely and rapidly. These injuries are frequently superficial, but the immediate goal of first aid is to control the bleeding and protect the injury site until medical help arrives. All head injuries, regardless of apparent severity, require medical evaluation to rule out underlying brain or skull damage.
Safety Assessment and Initial Preparation
Before approaching an injured person, first responders must confirm the scene is safe from any ongoing hazards that could cause further injury. Once the environment is secure, check the injured person’s level of consciousness using a simple scale, such as the Alert, Verbal, Pain, Unresponsive (AVPU) scale. If the individual is not alert or does not respond to verbal commands, immediately call for emergency medical services.
Effective first aid begins with preventing infection for both the injured person and the responder. Put on disposable gloves before touching the wound or blood to establish a barrier against bloodborne pathogens. If sterile gloves are unavailable, use the cleanest barrier material possible, such as a thick plastic bag or multiple layers of clean cloth, to protect your hands. Ensure you have a clean dressing material, such as sterile gauze or a thick cloth, ready to apply to the wound.
Controlling Blood Flow
Applying firm, direct pressure to the wound site is the primary way to stop bleeding from a scalp laceration. Place a thick, clean dressing directly over the injury and press down steadily with the palm or several fingers. This constant pressure helps compress the damaged blood vessels and encourages clotting.
Maintain this firm, continuous pressure for a minimum of 15 minutes without lifting the dressing to check the wound. Lifting the dressing prematurely can disrupt forming clots and restart heavy bleeding. If blood soaks completely through the initial dressing, do not remove it; instead, place a fresh dressing on top of the saturated material and continue pressure. If the bleeding is severe or does not slow down after 15 minutes, continue pressure while waiting for emergency medical personnel.
Step-by-Step Bandaging Techniques
Once bleeding is controlled, a bandage is applied to secure the dressing, keep the wound clean, and maintain gentle pressure. A triangular bandage, folded into a wide cravat or used as a full head wrap, is highly adaptable for securing dressings on the head.
To use a triangular bandage as a full head wrap, place the center of the base across the forehead just above the eyebrows, allowing the point to hang down over the back of the head. Bring the ends of the base around the head above the ears, crossing them over the point at the back. Continue bringing the ends back around to the front and tie them in a square knot over the forehead.
The knot should be positioned away from the wound for comfort and to avoid focused pressure directly on the injury. Gently tuck the excess point of the bandage hanging at the back into the crossed material to create a neat, secure cap.
Alternatively, a roller bandage can be used by anchoring it with two circular turns around the forehead. The technique involves a series of overlapping spiral turns that cover the dressing entirely. Ensure the wrap is firm enough to prevent the dressing from slipping. The bandage should not be wrapped so tightly that it causes pain, throbbing, or restricts blood circulation. Always secure the end of the roller bandage with tape or a clip at a point away from the wound.
Recognizing Signs of Severe Injury
While controlling bleeding is the first step, certain signs indicate a severe underlying injury requiring a modified approach. Avoid applying direct pressure if you suspect a skull fracture, which may be indicated by a visibly depressed or sunken area in the skull or exposed bone fragments. In such cases, apply a dressing with very light pressure around the edges of the wound to collect blood without pressing on the fracture.
Watch for clear or straw-colored fluid leaking from the ears or nose, which may be cerebrospinal fluid and a sign of a serious skull base fracture. Bruising around the eyes (“raccoon eyes”) or bruising behind the ear (Battle’s sign) are also delayed indicators requiring urgent medical attention. If an object is embedded in the wound, never attempt to remove it, as this can cause further damage or uncontrollable bleeding. Instead, stabilize the object by placing bulky dressings around it before securing them gently with a wrap.