Head Injury (serious head injury)



Damage to the brain, scalp or the skull. External bleeding may be present.


Injuries to the head can lead to unconsciousness, which can dangerously compromise the airway. When an injury is sustained to the head there may also have been damage caused to the neck. In addition, permanent damage to the brain can also result from a head injury.


Types of head injury and possible causes:


Concussion. Where the brain is shaken and hits against the inside of the skull. This can be caused by a fall or a blow to the head. Concussion may also cause unconsciousness for a short period, but can be followed by an improvement in response and full recovery.


Compression. Swelling or bleeding in the skull puts pressure on the brain. This can occur from injury, a ruptured blood vessel, a tumour or infection (meningitis). There may be a history of a recent head injury with apparent recovery but then a deterioration in the patient’s level of consciousness (AVPU) can occur.


Fractured skull. Damage to the skull may cause bleeding within the skull causing compression. The broken bone may damage the brain or ‘brain shaking’ may have occurred causing concussion.


Signs & Symptoms:


  • Level of response (AVPU) worsens as the condition develops.
  • Intense headache.
  • Flushed, dry skin.
  • Deep, noisy, slow breathing.
  • Slow, strong pulse.
  • One or both pupils may dilate as pressure increases.
  • Condition worsens and fits may occur.



  • Short term memory loss, confusion, irritability.
  • Mild, general headache.
  • Pale, clammy skin.
  • Shallow/normal breathing.
  • Rapid, weak pulse.
  • Normal pupils, reacting to light.
  • Possible nausea or vomiting.


Fractured skull

  • Bleeding, swelling or bruising to the head.
  • A soft area or depression of the scalp.
  • Bruising around one or both eyes.
  • Bruising or swelling behind the ear.
  • Bleeding or fluid coming from the nose or an ear.
  • Deformity or lack of symmetry to the head.
  • Blood in the white of the eye.



  • Be aware – a casualty suffering a serious head injury could also have a neck injury.
  • Apply appropriate pressure to any wound to stop bleeding, cover the site to protect from infection.
  • With any casualty who is unconscious, has a reduced conscious level (AVPU), their conscious level deteriorates or you suspect a fractured skull ring 999/112.
  • Maintain airway and breathing; use the recovery position if you needed to protect the airway. Keep the head and body inline.
  • If the casualty is conscious help them lie down. Keep the head, neck and body inline in case of neck injury.
  • Look and treat any other injuries.



DO NOT allow a concussed sports player to 'play on' until they have been checked by a doctor.



We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.


You might also be interested in our blog about pitch-side first aid.


You can also sign-up to our newsletter here or at the bottom of our homepage.


First Response. Training for life. Training to save a life.

First Response Resuscitation & First Aid Training Ltd

9 Counterpool Road, Kingswood, Bristol BS15 8DQ

Tel: 0117 949 0944



Registered Office:

86 Shirehampton Road, Stoke Bishop, Bristol BS9 2DR

Company No. 06983048. Registered in England & Wales


Information Commissioner's Office (Data Protection Register): Registered Number Z1874 429


Terms & Conditions | Disclaimer

Cookies Policy | Privacy Policy | Coronavirus


© 2021 First Response. All rights reserved

Latest News

Resupply of Auto-injectors announced

Resupply of Auto-injectors announced Bausch & Lomb have announced that the 300 and 500 microgram...

Read More ...

Study of the quality of face masks

Study of the quality of face masks The quality of face masks healthcare workers wear makes a huge...

Read More ...

HPC reg logo CMYK    CPDcertified    CPDmember