Head Injury (Neurological)

This section covers two of the most common neurological incidents encountered in the field and hospital setting: concussions and seizures. Recognizing the signs early and administering proper assessments and care can prevent further complications.

Seizures

Seizures are sudden, uncontrolled electrical disturbances in the brain that can cause changes in behavior, movements, feelings, or consciousness.

At Scene

  • Do not restrain the patient or put anything in their mouth
  • Clear the area around the patient to prevent injury
  • Place a soft object (jacket, towel) under the head
  • Turn the patient on their side if possible (recovery position)
  • Time the seizure — if it exceeds 5 minutes, this is a medical emergency
  • Once the seizure ends:
    • Stay with the patient
    • Reassure them as they regain consciousness (postictal confusion is common)
    • Monitor airway, breathing, and vitals

At Hospital - Post-Seizure

  • Administer oxygen if oxygen saturation is low
  • Check blood glucose (hypoglycemia can trigger seizures)
  • Administer anticonvulsants if recurrent or seizure-prone (e.g., Phenytoin, Diazepam)
  • Document:
    • Duration of seizure
    • Physical observations (jerking, incontinence, biting of tongue)
    • Consciousness and orientation post-episode

Concussions (Mild Traumatic Brain Injury)

A concussion is caused by a blow to the head or a violent shaking of the head and body. It temporarily affects brain function and may not always involve loss of consciousness.

Common Symptoms

  • Slurred speech or delayed verbal response
  • Headache, dizziness, nausea, or vomiting
  • Sensitivity to light and sound
  • Blurred vision or ringing in ears (tinnitus)
  • Behavioral changes, such as irritability or confusion
  • Imbalance or coordination issues
  • Numbness or weakness in limbs (report immediately)

Field Cognitive & Neuro Checks

Assess orientation, memory, and focus. These can be done on scene or shortly after arrival.

  • Ask: “What day, month, year, and day of the week is it?”
  • Ask them to spell the word “world” backwards
  • Ask them to memorize a short list of 3–5 objects or words, and repeat them back
  • Ask them to repeat a sequence of numbers you give them (e.g., 3-8-1-4)
  • Ask them to recite the months of the year in reverse order
  • Perform a pupil response test using a penlight:
    • Shine light into each eye; pupils should constrict quickly and evenly
    • Delayed, unequal, or no response may indicate increased intracranial pressure

Treatment & Recovery

  • Rest and observation are key; avoid cognitive or physical exertion in the first 24–48 hours
  • Administer Acetaminophen (Tylenol) for headaches during the first 24 hours
    • Avoid NSAIDs initially (like ibuprofen or aspirin), as they may increase bleeding risk
  • After 24 hours, Ibuprofen can be introduced if symptoms persist
  • Encourage the patient to:
    • Avoid alcohol, caffeine, and stimulants
    • Limit screen time and avoid loud or bright environments
    • Sleep well and report any worsening symptoms

Discharge only if the patient is alert, oriented, and shows no signs of worsening. Otherwise, refer to neuro for observation or imaging.

Patients who experience their first seizure, multiple seizures, or seizures from trauma should be evaluated by neurology and may need imaging (CT or MRI).