A head injury is any trauma to the scalp, skull, or brain, ranging from a minor bump to a severe blow causing a traumatic brain injury (TBI). The immediate response is time-sensitive because the brain, encased within the rigid skull, has little room for swelling or bleeding. Internal damage, such as a hemorrhage, may not be visible externally but can rapidly increase pressure on the brain tissue, leading to permanent disability or death. Understanding the difference between a mild injury requiring observation and a severe one demanding emergency services is paramount.
Immediate Emergency Indicators
Certain symptoms following a head impact are universal red flags indicating a life-threatening situation and necessitate an immediate call to 911. Any loss of consciousness, even if momentary, signals a significant disruption in brain function and requires emergency medical intervention. Seizures or convulsions after the injury point to abnormal electrical activity, often caused by irritation, bleeding, or swelling, and are an automatic emergency.
A severe headache that progressively worsens is a symptom of rising intracranial pressure, often caused by internal bleeding. Clear fluid or blood draining from the ears or nose suggests a basilar skull fracture, where the bone at the base of the skull is broken, and the fluid may be cerebrospinal fluid (CSF). Obvious signs of severe skull trauma, including a visible dent, a penetrating wound, or a large, deep laceration that bleeds profusely, indicate an open injury or a depressed fracture.
If the person becomes increasingly drowsy, difficult to wake up, or cannot be roused, their level of consciousness is deteriorating, a sign of severe TBI. Significant confusion, slurred speech, or a rapid change in behavior, such as agitation or inability to recognize people, are neurological deficits requiring urgent transport. Weakness or numbness affecting the limbs, or pupils of unequal size (anisocoria), suggests localized brain damage.
Symptoms Requiring Urgent Evaluation
Some symptoms warrant prompt medical assessment but may not require an automatic 911 call if the person remains stable, alert, and can be safely transported. A persistent, mild headache that does not rapidly worsen and is manageable with rest is a common symptom of a concussion or mild TBI. Nausea or non-projectile vomiting that occurs only once or twice often falls into this category, though continuous vomiting signals a more serious issue.
Mild dizziness, imbalance, or trouble with coordination after the injury suggests vestibular or cerebellar involvement and should be evaluated quickly. Temporary confusion, such as difficulty remembering events surrounding the impact (post-traumatic amnesia), or a mild sensitivity to light or noise are common signs of a concussion. If these milder symptoms do not escalate to the emergency indicators, a trip to the nearest emergency room or urgent care facility may be appropriate via self-transport. If any symptoms intensify or new severe symptoms develop, the situation transitions to a 911 emergency.
Immediate Actions While Waiting for Assistance
Once 911 is called, the focus shifts to stabilizing the injured person and preventing further harm. The person should be kept as still as possible, lying down with the head and shoulders slightly elevated, to minimize the risk of exacerbating a potential spinal or neck injury. Movement of the head or neck must be avoided, and if the person is wearing a helmet, it should not be removed.
For external bleeding, use clean cloth or sterile gauze to apply light, firm pressure to the wound. Direct pressure must be avoided if a skull fracture is suspected (e.g., a dent or bone fragments). Continuous monitoring of the person’s consciousness, breathing, and responsiveness is necessary until emergency medical personnel arrive. Do not give food, drink, or pain medication, as this could interfere with potential emergency procedures or mask worsening symptoms. If the person is unconscious, ensuring the airway remains open and clear is a priority, and CPR should be initiated if they stop breathing.