Lesson 13
Spinal and head injuries
Minor head injuries
Signs and symptoms
Look for:
Any loss of responsiveness.
Scalp wound.
Dizziness or feeling sick.
Loss of memory of events before or during the injury.
headache.
Confusion.
What to do
If they are responsive, sit the casualty down and hold something cold against the injury to help reduce the swelling, like an ice pack or a frozen bag of vegetables wrapped in a tea towel.
While you do this, try and assess the casualty’s level of response using the AVPU scale:
A - Are they alert? Are their eyes open?
V - Can they respond to you if you talk to them? Can they answer simple questions?
P – Does the casualty respond to pain? If you pinch their ear lobe, do they move or open their eyes?
U - Are they unresponsive to all the above? If they are unresponsive or you are worried, call 999 or 112 for emergency help.
If they have any wounds, treat them by applying direct pressure to the wound. Secure with a dressing if needed.
Keep monitoring their level of response.
If they are alert and responsive and have always been so, their head injury is probably mild. You or another responsible adult should wait with them until they recover.
If they’re not alert or responsive or they appear to be confused, their head injury could be more serious. Call 999 or 112 for emergency help and explain the cause of the injury and give them details of the casualty’s response to the AVPU scale.
If they become unresponsive at any point, open their airway, check their breathing and prepare to treat someone who’s become unresponsive.
If their injury has been caused by a sporting incident, make sure they do not return to the sport until they have been fully assessed by a medical practitioner.
Advise the casualty to seek medical help if the head injury appears to get worse or if any of the following apply:
They are over the age of 65.
They had previous brain surgery.
They are taking anti-clotting medication.
They have been taking drugs or drinking alcohol.
There is no one responsible to look after them.
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Head injury management training course
If they are responsive, sit the casualty down and hold something cold against the injury to help reduce the swelling, like an ice pack or a frozen bag of vegetables wrapped in a tea towel.
While you do this, try and assess the casualty’s level of response using the AVPU scale:
A - Are they alert? Are their eyes open?
V - Can they respond to you if you talk to them? Can they answer simple questions?
P – Does the casualty respond to pain? If you pinch their ear lobe, do they move or open their eyes?
U - Are they unresponsive to all the above? If they are unresponsive or you are worried, call 999 or 112 for emergency help.
If they have any wounds, treat them by applying direct pressure to the wound. Secure with a dressing if needed.
Keep monitoring their level of response.
If they are alert and responsive and have always been so, their head injury is probably mild. You or another responsible adult should wait with them until they recover.
If they’re not alert or responsive or they appear to be confused, their head injury could be more serious. Call 999 or 112 for emergency help and explain the cause of the injury and give them details of the casualty’s response to the AVPU scale.
If they become unresponsive at any point, open their airway, check their breathing and prepare to treat someone who’s become unresponsive.
If their injury has been caused by a sporting incident, make sure they do not return to the sport until they have been fully assessed by a medical practitioner.
Advise the casualty to seek medical help if the head injury appears to get worse or if any of the following apply:
They are over the age of 65.
They had previous brain surgery.
They are taking anti-clotting medication.
They have been taking drugs or drinking alcohol.
There is no one responsible to look after them.
Additional training
Head injury management training course
If in doubt sit them out - NOV 2024
The greatest risk of someone who has a spinal injury is that their spinal cord will be either temporarily or permanently damaged. If this happens, they may lose sensation or power below the injured area.
Possible causes of a spinal injury:
Falling from a height, for example, from a ladder.
Falling awkwardly, for example, while doing gymnastics.
Diving into a shallow pool and hitting the bottom.
Falling from a motorbike or horse.
A collapsed rugby scrum.
Sudden deceleration in a vehicle.
A heavy object falling across their back.
An injury to the head or face.
Signs and symptoms
Look for:
Pain in the neck or back at the site of injury.
Irregular shape or twist in the normal curve of the spine.
Tenderness and/or bruising in the skin over the spine.
Movement of limbs may be weak or absent.
Loss of sensation, or abnormal sensations, e.g. burning or tingling.
Loss of bladder and/or bowel control.
What to do
If they are responsive:
Reassure the casualty. Do not move them and tell them not to move, unless they are in immediate danger. Call 999 or 112 for emergency help or ask someone else to call for you.
Steady and support their head, so that their head, neck, and spine are in a straight line to try and prevent further damage. To do this, kneel or lie behind their head, resting your elbows on the ground or on your knees to keep your arms steady. Hold each side of their head, spreading your fingers so that you do not cover their ears as they need to be able to hear you. Support their head in this neutral position.
If there is someone who can help you, ask them to put rolled-up blankets, towels, or clothes on either side of the head while you keep the casualty’s head in the neutral position. Continue to support their head until emergency help arrives and can take over, no matter how long it takes for them to come.
Keep monitoring their breathing and level of response while waiting for help to arrive.
What to do
If they are unresponsive:
Reassure the casualty. Do not move them unless they are in immediate danger. Call 999 or 112 for emergency help or ask someone else to call for you.
Steady and support their head so that their head, neck, and spine are in a straight line to try and prevent further damage. To do this, kneel or lie behind their head, resting your elbows on the ground or on your knees to keep your arms steady. Hold each side of their head, spreading your fingers so that you do not cover their ears as they need to be able to hear you. Support their head in this neutral position.
Open their airway using the jaw-thrust technique. To do this, put your fingertips at the angles of the jaw and gently lift the jaw to open the airway. Do not tilt their neck.
Check the casualty’s breathing. Place your ear above their mouth, looking down their body. Look, listen, and feel for 10 seconds.
If they’re breathing, continue to support their head, monitor their breathing, and level of response.
If they are unresponsive and not breathing, make sure you have called 999/112 for emergency help and start CPR straight away. Ask a helper to find and bring a defibrillator (AED).
Recovery position for spinal injury
If you suspect someone has a spinal injury but cannot maintain an open airway, you need to place them in the recovery position.