Head injuries, even minor ones, have the potential to cause significant internal damage to the brain. Following a blow to the head, internal bleeding or swelling can begin, creating pressure within the skull that can quickly become life-threatening. Therefore, knowing the circumstances and symptoms that demand emergency medical services is paramount for a positive outcome. This guide provides clear criteria for determining when a head injury requires an automatic 911 call to ensure the fastest possible intervention.
Immediate Warning Signs Requiring Emergency Services
Any symptom indicating a severe compromise of brain function or rising intracranial pressure must trigger an immediate call to emergency services. A loss of consciousness, even if momentary, is a serious indicator of traumatic brain injury requiring urgent medical evaluation. An inability to wake the person or unusual drowsiness that makes them difficult to rouse signals a profound neurological concern.
Neurological deficits such as seizures or convulsions after the injury are reasons to call 911. Other signs of significant brain trauma include slurred speech, confusion, or severe disorientation where the person cannot recognize familiar people or places. Weakness, numbness, or a lack of coordination affecting one side of the body may point to localized brain injury or a stroke-like event.
Signs of potential skull fracture or internal bleeding also require an immediate emergency response. These include the discharge of clear or watery fluid (potentially cerebrospinal fluid) or blood leaking from the ears or nose. Bruising behind the ears (Battle sign) or bruising around the eyes without direct impact (“raccoon eyes”) are serious indicators of a basilar skull fracture. A change in pupil size, where one pupil is noticeably larger than the other or pupils react unequally to light, is a direct sign of pressure on the brain.
A persistent or rapidly worsening headache or repeated episodes of vomiting signal rising pressure inside the skull. While a single instance of vomiting can occur with minor concussions, repeated or forceful vomiting suggests a more serious problem. If any of these symptoms are present, do not attempt to drive the person to the hospital; keep them still and wait for emergency medical personnel.
High-Risk Injury Mechanisms and Vulnerable Populations
The mechanism of injury or the patient’s underlying health status can elevate the risk of severe complications, even if immediate symptoms are absent. Injuries resulting from high-velocity or high-energy trauma warrant an emergency call because the force involved is likely to cause significant internal damage. Examples include motor vehicle accidents, being struck by a car or bicycle, or a severe impact during a sport.
Falls from a significant height also require immediate emergency evaluation. A fall greater than the person’s own height, or a fall of three feet or more for a child, can generate enough force to cause severe trauma. The impact force in these scenarios creates a high probability of skull fracture or intracranial hemorrhage.
Certain populations have a higher risk of severe complications following even a minor head injury. Older adults (generally those over 60 or 65) have a greater likelihood of complications due to age-related brain atrophy and fragile blood vessels. This atrophy creates more space within the skull, allowing internal bleeding to accumulate before symptoms appear, making their presentation dangerously delayed.
Individuals who take blood-thinning medications, such as anticoagulants like warfarin or apixaban, are also vulnerable. These medications interfere with the body’s clotting ability, meaning even a small head trauma can lead to uncontrolled or rapid internal bleeding, resulting in a large hematoma that compresses the brain. For anyone in these high-risk categories, an emergency medical assessment must be sought immediately after any head impact.
Specific Concerns for Infants and Young Children
Assessing head trauma in infants and young children is difficult because they cannot articulate their symptoms, necessitating a lower threshold for calling emergency services. Parents and caregivers must look for subtle behavioral and physical changes indicating neurological distress. Any sign of listlessness, tiring easily, or a dazed appearance following an impact should be treated as an emergency.
A refusal to feed, difficulty nursing, or a significant change in normal sleeping patterns (such as excessive sleepiness or difficulty waking) are important red flags. Persistent, inconsolable crying that lasts longer than usual after the initial shock can signal underlying pain or neurological irritation. Since an infant’s skull is not fully fused, a bulging or tense soft spot on the top of the head (the fontanel) is a physical sign of increased pressure within the skull that demands immediate attention.
Home Monitoring and When to Go to Urgent Care
For a minor head bump that does not involve any immediate 911 warning signs or high-risk factors, home observation is appropriate. The injured person should be monitored closely for at least 24 to 48 hours for the delayed onset of symptoms. It is recommended to wake the person up every few hours during the first night to ensure they can be easily roused and are not slipping into unresponsiveness.
If a person experiences mild symptoms such as a headache that does not worsen, slight dizziness, or brief nausea without repeated vomiting, a visit to an urgent care facility or primary care provider is appropriate instead of an emergency room. Urgent care centers can evaluate for a concussion and provide management advice, especially if the person remained conscious throughout the event.
If symptoms that were initially mild begin to escalate hours after the injury, a transfer to an emergency room is warranted. This includes a headache that starts to worsen significantly, increasing confusion, or difficulty with memory or concentration not present immediately after the injury. These delayed “red flag” symptoms suggest the possibility of a slow-developing complication that requires advanced imaging and observation.