Assessing head injuries

Your colleague has had a fall and banged their head - is it serious or not? How do you know?

As it is difficult to diagnose a serious head injury in the field, we asked BGA sponsor, Medi-K Training to tell us what range of signs and symptoms we can look out for to help us recognise the severity of a head injury.

"Think about the ‘mechanism of injury’ and what other damage may have occurred.  Always be alert to the potential of internal head injuries, not just the obvious ones on the face. 

Injuries to the brain itself can get worse over time, so a first aider should be especially alert to the impact of time on any head injury. Changes in or new signs and symptoms will alert you to this.

Head injuries may be:

• Concussion – a mild or severe Traumatic Brain Injury
• Cerebral Compression – also known as a ‘bleed on the brain’
• Skull fracture

All of these can be fatal especially if the blow to the head has been traumatic or severe. 

There are 3 main forms of trauma that can negatively affect the brain:

Direct impact against the skull during a sudden force (such as a head knock),

A shaking where the brain impacts the skull in multiple places (this can happen alongside complex falls and whiplash type injuries),

Rotational forces (these are common in activities where participants travel at high speed and their head may hit the ground at an oblique angle during a fall)

Signs and symptoms of head injuries

Below we have listed some of the factors that would be a cause for concern for someone who has banged their head. How do we assess a bang to the head? What are we looking for?

• History of, or witnessing an impact leads you to suspect the increased probability of a head injury
• Change in personality of the casualty, perhaps irritability
• Suspicion of a skull fracture – you may find a soft boggy depression (don’t prod it – note it and report it)
• A change from normal alertness in the casualty
• Persistent headache since the incident
• Nausea or vomiting since the incident
• Memory loss about the incident or before the incident
• Unusually sleepy
• Any seizure since the accident
• Clear fluid from the ears or nose
• Bleeding from one or more ears, new deafness in one or more ears
• Bruising behind one or more ears
• Black eye with no associated damage around the eyes (sometimes called ‘panda eyes’)
• Blurred vision or double vision
• Different reactions to light on the pupils known as the PEARL test – Pupils should be: Equal And Reactive to Light

How long would it be before we any of these signs and symptoms?

We could see signs quite quickly if it is a major injury. However, if the injury is small then it could be up to a few days before we see anything. In this case, ‘small’ does not always mean minor! The best way to spot any of these changes is to monitor the casualty closely and regularly. If we have any suspicions, the casualty should be taken to hospital as soon as possible.

Will my helmet prevent head injuries? Should I remove it?

Wearing a properly fitted helmet will help protect the skull from damage but brain and skull injuries can still occur underneath a helmet.  A helmet may need to be removed to properly assess the casualty and avoid pressure on their airway. You should also send the helmet to the hospital with the casualty so they can assess to potential injury site based on helmet damage.

You can watch a video on how to safely remove a helmet from a casualty on our YouTube channel.

After the injury

When someone has a serious fall or impact, they may be more focussed on another injury such as a limb or a bleed. Always consider the ‘mechanism of injury’ and check the whole casualty, not just the obvious injuries. With head injuries , you should also be alert to the possibility of a neck or spinal injury.

Remember, regular monitoring of your casualty is advised for all head injuries to detect any change in their condition. If in doubt, get them checked out.

Even if you have had some form of first aid training in the past, can you be confident that if an accident occurred you would be able to apply the skills you learnt? Whether you are new to first aid or looking to brush up on your knowledge, first aid training is essential for anyone who works with horses."

Need training?

Medi-K run Equestrian specific first aid courses throughout the UK, including privately organised workshops.

The Medi-K trainers are horse riders and owners themselves enabling them to provide equine specific, practical guidance.

Book a course

Find out more about Medi-K’s range of courses; firstaidtrainingcooperative.co.uk/equestrian

E-Learning

Did you know BGA members have access to a bespoke online first aid course? This 'First Aid Essentials' e-learning course is FREE for BGA members, log into your account and find the course within the 'Training and careers' section.

Insurance

If you get injured and you are unable to work your income is likely to be reduced, or disappear completely if you are a freelancer.

Protecting yourself is important, trust us, we hear about accidents all the time.

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