Adventure Medical Kits - Adventure Discussions

Dr. Weiss’s Tips for Treating Head Injuries

Excerpt from A Comprehensive Guide to Wilderness and Travel Medicine, by Dr. Eric A. Weiss.

Wilderness_Travel-Medicine-book-STRTHead trauma and brain injury can result from direct impact or from the shearing forces produced by rapid deceleration. When your head hits a hard object such as a boulder, the impact can fracture the skull, bruise the brain, or cause severe bleeding inside the brain from damaged blood vessels. Shearing forces from sudden deceleration of the brain against the inside of the skull can also tear blood vessels on the surface of the brain, leading to an expanding blood clot and pressure on the brain (intracranial pressure).

Rising intracranial pressure is bad for several reasons. The increased pressure makes it difficult for the heart to pump enough blood to the head. This is a major catastrophe for the brain, which depends on a constant supply of blood to bring it oxygen and other nutrients. If the pressure within the skull rises high enough, it can force parts of the brain downward through the base of the skull (herniation), causing damage to the brain structures and, ultimately, death. Compression of one of the nerves as the brain swells produces dilatation of one or both pupils, an important sign of a severe head injury.


1) Prolonged unconsciousness (more than five to 10 minutes).
2) Brief loss of consciousness.
3) No loss of consciousness.

Loss of consciousness for more than five to 10 minutes is a sign of significant brain injury. Assess the victim’s airway and perform rescue breathing if necessary. Because there is a potential for accompanying neck and spine injuries with severe head trauma, the victim’s spine should be immobilized. Immediately evacuate the victim to a medical facility. During transportation, maintain spine immobilization and keep the victim’s head pointed uphill on sloping terrain. Be prepared to log-roll the victim onto his side if he vomits. Continually monitor his airway for signs of obstruction (listen for noisy or labored breathing) and a decreasing respiratory rate.

Short-term unconsciousness, in which the victim wakes after a minute or two and gradually regains normal mental status and physical abilities, is evidence of a concussion. A concussion does not usually produce permanent damage, although confusion or amnesia about the event and repetitive questioning by the victim are common.

To be safe, evacuate the victim to a medical facility for evaluation. At a minimum in the backcountry, you should keep the victim under close observation for at least 24 hours, and not allow him to perform potentially hazardous activities. Normal sleep should be interrupted every three to four hours to check briefly that the victim’s condition has not deteriorated and that he can be easily aroused. If the victim becomes increasingly lethargic, confused or combative, is just not acting his normal self, or if he develops any of the other signs on the head injury checklist (see below), he should be evacuated to a medical center immediately.

If an individual hits his head but never loses consciousness, it’s rarely serious. He may have a mild headache, may bleed from a scalp wound, or a have a large bump on his head, but evacuation isn’t necessary unless he develops any of the problems listed on the head injury checklist.


Seek immediate medical attention if any of the following symptoms occur after a blow to the head:

  • Headache that progressively worsens.
  • Consciousness gradually deteriorates from alertness to drowsiness or disorientation; ask the victim if he knows his name, location, the date, and what happened. If he gets all four correct, he is oriented X 4.
  • Persistent or projectile (shoots out under pressure) vomiting.
  • One pupil becomes significantly larger than the other.
  • Bleeding from an ear or nose without direct injury to those areas, or a clear watery fluid draining from the nose.
  • Bruising behind the ears or around the eyes, when there is no direct injury to those areas.
  • Seizures.


Fracture of the skull is not life threatening unless associated with underlying brain injury or severe bleeding. Signs of a skull fracture include a sensation that the skull is uneven when touching the scalp, blood or clear fluid draining from the ears or nose without direct trauma to those areas, and black and blue discoloration around the eyes (raccoon eyes) or behind the ears (Battle’s sign).

Evacuate the victim to a medical facility as soon as possible.


Scalp lacerations are common after head injuries, and tend to bleed a lot because of their rich blood supply. Fortunately, bleeding can usually be stopped by applying direct pressure to the wound with your gloved hand. It might be necessary to hold pressure for up to 30 minutes.

Hair-tying a scalp wound closed

If you’re faced with a bleeding scalp wound and the injured person has a healthy head of hair, you can tie the wound closed using the victim’s own hair. Take a piece of heavy silk suture material (dental floss works well) and lay it on top of, and parallel to the wound. Twirl a few strands of hair on opposite sides of the wound and pull them together tightly, forcing the wound edges closed. Use the suture material to tie the opposing strands of hair together with a square knot.

One Response to “Dr. Weiss’s Tips for Treating Head Injuries”

  1. paracord wristband Says:

    Very nice article. I certainly love this website.

Leave a Reply