1 – Head injuries range from minor abrasions or cuts on the scalp to severe brain injuries that may result in unconsciousness and sometimes death. Head injuries are classified as open or closed wounds. An open wound is one that is visible, has a break in the skin, and usually has evidence of bleeding. A closed wound may be visible (such as a depression in the skull) or the first aid provider may not be able to see any apparent injury (such as internal bleeding). Some head injuries result in unconsciousness; however, a service member may have a serious head wound and still be conscious. Casualties with head and neck injuries should be treated as though they also have a spinal injury. The casualty should not be moved until the head and neck is stabilized unless he is in immediate danger (such as close to a burning vehicle).
2 – Prompt first aid measures should be initiated for casualties with suspected head and neck injuries. The conscious casualty may be able to provide information on the extent of his injuries. However, as a result of the head injury, he may be confused and unable to provide accurate information. The signs and symptoms a first aid provider might observe are—
- Nausea and vomiting.
- Convulsions or twitches.
- Slurred speech.
- Confusion and loss of memory. (Does he know who he is? Does he know where he is? Does he know what day it is?)
- Recent unconsciousness.
- Drowsiness. Blurred vision, unequal pupils, or bruising (black eyes).
- Paralysis (partial or full).
- Complaint of headache.
- Bleeding or other fluid discharge from the scalp, nose, or ears.
- Deformity of the head (depression or swelling).
- Staggering while walking.
Neck injuries may result in heavy bleeding. Apply pressure above and below the injury, but do not interfere with the breathing process, and attempt to control the bleeding. Apply a dressing. Always evaluate the casualty for a possible neck fracture/spinal cord injury; if suspected, seek medical treatment immediately.
NOTE: Establish and maintain the airway in cases of facial or neck injuries. If a neck fracture or spinal cord injury is suspected, immobilize the injury and, if necessary, perform basic life support measures.
Soft tissue injuries of the face and scalp are common. Abrasions (scrapes) of the skin cause no serious problems. Contusions (injury without a break in the skin) usually cause swelling. A contusion of the scalp looks and feels like a lump. Laceration (cut) and avulsion (torn away tissue) injuries are also common. Avulsions are frequently caused when a sharp blow separates the scalp from the skull beneath it. Because the face and scalp are richly supplied with blood vessels (arteries and veins), wounds of these areas usually bleed heavily.
General First Aid Measures
1 – General Considerations. The casualty with a head injury (or suspected head injury) should be continually monitored for the development of conditions that may require basic lifesaving measures. After initiating first aid measures, request medical assistance and evacuation. If dedicated medical evacuation assets are not available, transport the casualty to an MTF as soon as the situation permits. The first aid provider should not attempt to remove a protruding object from the head or give the casualty anything to eat or drink. Further, the first aid provider should be prepared to—
- Clear the airway.
- Control bleeding (external).
- Administer first aid measures for shock.
- Keep the casualty warm.
- Protect the wound.
2 – Unconscious Casualty. An unconscious casualty does not have control of all of his body’s functions and may choke on his tongue, blood, vomitus, or other substances. (Refer to Figure 2-39.)
- Breathing. The brain requires a constant supply of oxygen. A bluish (or in an individual with dark skin—grayish) color of skin around the lips and nail beds indicates that the casualty is not receiving enough oxygen. Immediate action must be taken to clear the airway, to position the casualty on his side, or to initiate rescue breathing.
- Bleeding. Bleeding from a head injury usually comes from blood vessels within the scalp. Bleeding can also develop inside the skull or within the brain. In most instances visible bleeding from the head can be controlled by application of the field first aid dressing.
CAUTION: DO NOT attempt to put unnecessary pressure on the wound or attempt to push any brain matter back into the head (skull). DO NOT apply a pressure dressing.
- Concussion. If an individual receives a heavy blow to the head or face, he may suffer a brain concussion (an injury to the brain that involves a temporary loss of some or all of the brain’s ability to function). For example, the casualty may not breathe properly for a short period of time, or he may become confused and stagger when he attempts to walk. Symptoms of a concussion may only last for a short period of time. However, if a casualty is suspected of having suffered a concussion, he should be transported to an MTF as soon as conditions permit.
- Convulsions. Convulsions (seizures/involuntary jerking) may occur even after a mild head injury. When a casualty is convulsing, protect him from hurting himself. Take the following measures:
- Ease him to the ground if he is standing or sitting.
- Support his head and neck.
- Maintain his airway.
- Protect him from further injury (such as hitting close-by objects).NOTE: DO NOT forcefully hold the arms and legs if they are jerking because this can lead to broken bones. DO NOT force anything between the casualty’s teeth—especially if they are tightly clenched because this may obstruct the casualty’s airway. Maintain the casualty’s airway if necessary.
- Brain Damage. In severe head injuries where brain tissue is protruding, leave the wound alone; carefully place a loose moistened dressing (moistened with sterile normal saline if available) and also a first aid dressing over the tissue to protect it from further contamination. DO NOT remove or disturb any foreign matter that may be in the wound. Position the casualty so that his head is higher than his body. Keep him warm and seek medical assistance immediately.
NOTE: If there is an object extending from the wound, DO NOT remove the object. Improvise bulky dressings from the cleanest material available and place this material around the protruding object for support, then apply the field dressing.