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Backpacker Magazine – June 2008

The Cure: Head Injuries

To tell the difference between a bad bump and a life-threatening blow, follow these crucial steps.

by: Tom Wilmes

Serious head injuries are rare in the wilderness. But get hit square on the melon by a falling rock, and the resulting brain swelling can cause dangerous intracranial pressure. Unlike skin gashes and broken bones, traumatic brain injuries don't always bleed or even cause pain, making early diagnosis tricky.

  • Since brain injuries can occur without exterior wounds, the best indicator of serious trauma is a person's level of consciousness, says Jeffrey Isaac, curriculum director at Wilderness Medical Associates.
  • Use the AVPU scale to establish a person's alertness and monitor any deterioration in brain function. The farther down the scale (A is the best, U the worst) the person registers, the more serious the brain injury.
    • (A) Victim is Alert and oriented; he knows who he is, where he is, and what happened.
    • (V) You get a response to Verbal stimuli, but victim is confused and disoriented. 
    • (P) Victim responds only to Painful stimuli, like pinching his arm or rubbing his breastbone.
    • (U) Victim is Unresponsive to all of the above.
  • Record any periods of unconsciousness. Blackouts lasting longer than two to three minutes indicate a serious head injury, especially if accompanied by persistent disorientation.
  • Because brain swelling can develop slowly, evaluate the victim's mental state for 24 hours after the injury.
  • Watch for behavioral indicators like combativeness, restlessness, or acting drunk, as well as severe headache, nausea, and persistent vomiting.


  • Move the victim to a safer location if necessary. Don't leave a victim in a dangerous place or where you can't treat life-threatening injuries just because you are unable to stabilize the spine, says Isaac. Recent studies have shown that cervical spine damage occurs in a tiny percentange of victims with traumatic head injuries. As a result, new first aid protocols recommend spine "protection" over stabilization when hazardous conditions require moving the victim.
  • Monitor a victim's breathing and pulse rate, and keep him hydrated and warm. Treat for shock by raising the legs while you gauge his level of consciousness.
  • Initial disorientation or confusion can improve in a short period. The duration a person remains unconscious isn't as important as how quickly he returns to normal brain functioning, says Isaac.
  • Contrary to popular belief, the victim of a head injury can doze or sleep as long as he is monitored and woken up every few hours to check alertness.
  • Initiate immediate evacuation for victims whose alertness or memory remains severely altered, or worsens over time. Even if a victim recovers enough to walk out, he should still seek medical attention.

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Oct 31, 2010

my dad met with an road accident and he had an head injury. he is just able to open his eyes and can sense the pain and all. can u please suggest any good treatment which can cure him and make him talk and walk. he is right now not able to talk,walk and recognize.

Ahmed Adam
Dec 13, 2008

My brother had a head injury 10 years back, he always sleeping, he he is forgeting what you told him, he can eat and drink by himself, but can't urinate by himself, he need somebody to remind him always .

is there any treatment for him .

Thanks ,

Jim Brown
Sep 01, 2008


Good article on an important topic and all you can do is do is make a fool of yourself worrying about the author using proper English rather PC speak.

Then you wonder why the real issues of gender equality are ignored and turned off by many listeners to your recommendations.

Sep 01, 2008

Jim Lewis-You are right of course. The difference between city/wilderness first aid, is that in the wilderness one must not only be preparedto deliver immediate first aid, but also continue to provide care during what may be a delayed or lengthly evac-extended care.

ian sandmeyer
Aug 30, 2008

Nice use of the sexist word him. Quite ancient writing if you ask me. Why is it so hard to remember to use both him and her? Her's hike to. And get head injuries?

Lyn Greenhill
Aug 28, 2008

I experienced a concussion in a bike crash. According to my fellow riders, I was out for a few minutes before coming to. I was completely disoriented and was taken to the ER for a CAT scan and to clean up the road rash. During this entire procedure, I was only partially aware of what was going on. My full awareness didn't really return for a couple of days (some say it still hasn't returned). So, my opinion is that if anyone is knocked out, they are in no position to continue an outdoor event, and should be evaced to the nearest ER for observation.

Wm Fred Baty
Aug 28, 2008

Nice article for the layperson. I'd also point out that drug intoxication of any type (alcohol, marijuana, prescribed psycho-active drugs) can mask the effects of TBI, and should thus elevate one's level of suspicion when dealing with these victims.

Camille Pierce
Aug 28, 2008

Excellent article about "Head Injuries"! (I'm a person with a seizure disorder/epilepsy. So I have a personal interest with this! No one wants to have a "Head Injury". But it really helps when the issue is discussed so that others can better understand issues which need caution. Thank you!
Camille Pierce
California USA

Jim Lewis
Aug 08, 2008

In my semi-professional opinion (im an urban paramedic) if your pt. is anything worse than a V on the AVPU scale, get them evaced. Same goes with unconciousness lasting longer than one minute.


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