Outdoor First Aid

The Cure: Head Injuries

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

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.