1. Inspect the patient’s LOC (level of consciousness):
This is accomplished by some routine questions that (if answered by the patient) can also fulfill the initial requirement of ABC’s (Airway, Breathing, and Circulation). A few of them are as such:
“What is your name?” “Where are you?” What is today’s date? (Specific)
The manner in which these questions are answered will be a good indicator of the severity/degree of the head trauma. Also, if the patient answers you clearly, you know that of the ABC’s, A-airway, and B-breathing can be checked off. Another thing to keep in mind: the questions can be changed up and asked again, but in a different order to continuously reassess the patient.
Continuously reassess the patient.
This concept is critical in all of the steps, because the LOC can decline in the blink of an eye.
2. Position the patient: This is very delicate! There is a rule that must be followed!
Rule: With any type of head trauma, you must suspect C-spine injury and take appropriate actions.
This pertains to the Cervical Spine, and the vertebral processes that form it (C1 through C7); transecting the spinal cord at this level can lead to complete paralysis. The C-spine must be immobilized prior to moving the patient. Immobilization means that the head must not be able to bobble from side to side and the head, neck, shoulders, and back must be kept in alignment and not allowed to move.
The way to do this is with a semi rigid (foam) C-spine collar, or a rigid collar. This is placed around the patient’s neck and secured. It prevents vertical and lateral movement of the head as well as padding the neck. I mentioned it in earlier articles where lists of first aid materials for one’s aidbag were provided. It is a must-have in your first aid toolkit.
Should the injury prove minor, have the patient sit up unless other injuries prevent it. If the patient is lying down, elevate the head slightly to prevent the accumulation of any fluids or saliva in the throat. If any blood is entering from the wound into the patient’s mouth, turn the head to the side or position the patient fully on their side to prevent accumulation of blood in the mouth or throat.
IF THE CASUALTY IS UNCONSCIOUS, TREAT HIM/HER AS A C-SPINE INJURY! DO NOT MOVE THE PATIENT UNLESS ABSOLUTELY NECESSARY! IF THE PATIENT IS CHOKING/VOMITING/BLEEDING INTO THE MOUTH, TURN THE PATIENT ON THEIR SIDE OPPOSITE THAT OF THE WOUND!
When turning such a patient as above, you must have assistance to keep the head, spine, and shoulders aligned before you turn them!
3. Apply a dressing to the wound: following the instructions of the “Do Not’s,” as such:
– Attempt to clean the wound or remove a protruding object (these tasks are best done in a healthcare facility or a hospital so as not to exacerbate the wound).
– Put unnecessary pressure on the wound
– Attempt to put brain matter (press it) back inside the skull
– Apply a pressure dressing
– Give the patient any food or drink
Regarding the dressing, never tie the tails of the dressing or its fastening points overtop of the wound. Make sure your dressing is secure and not moving around; however, tie it off on the side of the head (if a forehead or scalp wound, for example), or on a part of the head not directly on top of the wound.
4. Continuously monitor the patient for life-threatening conditions (especially shock)
5. Either transport the patient to the hospital (if possible) or summon help.
These are your steps to take for head trauma. Remember to also continuously monitor your ABC’s! Make sure your patient is breathing; answers the test questions periodically that were mentioned earlier, and that new injuries have not developed. Make sure that other injuries do not deteriorate and turn into bleeders. A head-to-toe examination is very important – actually critical – to rule out any area of bleeding.
Prevention should also be mentioned here. It is hard to prevent head injuries from occurring; however, when you are engaged in high-risk activities (such as whitewater rafting or mountain climbing), you should always wear a helmet. It may not look so “cool,” however, it is better than smashing your head against a rock. Manage your risks before an injury occurs. If one should happen, follow these first aid steps and get professional medical attention for the patient as soon as you are able. Enjoy your outdoor adventures and stay safe!
Disclaimer: The information presented here is not meant to, nor does it diagnose, treat, recommend, or prescribe any care or actions. Only a licensed, certified medical doctor is qualified and authorized to take such actions. Consult with your family physician prior to undertaking any and all activities as mentioned herein.