Head Injury and Concussion First Aid: How to Recognize and Respond

Understanding Head Injuries and Concussions

Head injuries are among the most concerning emergencies a first aider can encounter. The brain is protected by the skull, but a forceful impact can still cause bruising, bleeding, or swelling of the brain tissue inside. A concussion is a type of mild traumatic brain injury caused by a bump, blow, or jolt to the head that temporarily disrupts normal brain function.

Concussions are extremely common, particularly in contact sports like hockey, football, and soccer, but they also occur frequently in falls, car accidents, and workplace incidents. While most concussions are not life-threatening, they require proper recognition and management. Ignoring a concussion or returning to activity too soon can lead to prolonged symptoms, second-impact syndrome, and in rare cases, permanent brain damage.

How Concussions Happen

The brain floats inside the skull, cushioned by cerebrospinal fluid. When the head is struck or the body experiences a sudden jolt, the brain can shift and bounce against the inside of the skull. This impact causes chemical changes in the brain and can stretch and damage brain cells.

Importantly, you do not have to lose consciousness to have a concussion. In fact, the majority of concussions occur without any loss of consciousness. A concussion can also result from a blow to the body that transmits force to the head — for example, a tackle in football or a whiplash injury in a car accident.

Signs and Symptoms of a Concussion

Concussion symptoms can appear immediately after the injury or develop over the following hours and days. They fall into several categories:

Physical symptoms: Headache is the most common symptom, reported in the vast majority of concussions. Other physical symptoms include dizziness, nausea or vomiting, balance problems, blurred or double vision, sensitivity to light and noise, fatigue, and feeling sluggish or foggy.

Cognitive symptoms: The person may have difficulty concentrating, feel mentally slow, have trouble remembering what happened before or after the injury, give delayed responses to questions, or appear confused about their surroundings, the time, or the date.

Emotional symptoms: Irritability, sadness, anxiety, and mood swings are common after a concussion. The person may seem more emotional than usual or react disproportionately to minor frustrations.

Sleep disturbances: The person may sleep more or less than usual, have difficulty falling asleep, or feel drowsy during the day.

Red flag symptoms: Some symptoms indicate a more severe head injury that requires immediate emergency care. Call 911 if the person experiences worsening headache that does not go away, repeated vomiting, seizures, slurred speech, increasing confusion, one pupil larger than the other, weakness or numbness in limbs, loss of consciousness lasting more than a minute, or inability to recognize people or places.

First Aid for a Head Injury: Step-by-Step

Step 1: Assess the Scene and the Person

Make sure the area is safe before approaching. If the injury occurred during a sport or physical activity, stop the activity immediately. Ask the person what happened — can they describe the event clearly? Do they know where they are, what day it is, and what they were doing? Confusion about any of these questions suggests a concussion.

Step 2: Keep the Person Still

If there is any possibility of a neck or spinal injury (for example, after a fall from height, a collision, or a diving accident), do not move the person. Keep their head and neck stabilized in the position you found them and call 911. Moving someone with a spinal injury can cause permanent paralysis.

Step 3: Monitor Level of Consciousness

A person with a concussion should be monitored closely for the first 24 to 48 hours. Check on them regularly — if they are sleeping, wake them every few hours to confirm they are responsive and coherent. Any deterioration in their level of consciousness is a sign of a potentially more serious injury and requires immediate medical attention.

Step 4: Manage Bleeding from Scalp Wounds

Scalp wounds bleed heavily because the scalp has a rich blood supply. Apply firm, direct pressure to the wound with a clean cloth or gauze. If you suspect a skull fracture (depressed area of the skull, clear fluid draining from the ears or nose), apply pressure around the wound rather than directly on it and call 911 immediately.

Step 5: Apply Ice for Swelling

A cold pack wrapped in a cloth can be applied to the outside of the head to reduce swelling from a bump. Apply for 20 minutes at a time. This helps with pain and reduces the visible “goose egg” that often forms after a head impact.

Step 6: Seek Medical Evaluation

Any suspected concussion should be evaluated by a healthcare provider. While most concussions resolve on their own with rest, a medical assessment can rule out more serious injuries like bleeding inside the skull (intracranial hemorrhage) and provide guidance on safe return to activity.

Concussion Management and Recovery

Recovery from a concussion requires physical and cognitive rest. In the first 24 to 48 hours, the person should avoid screens, reading, bright lights, loud environments, and strenuous physical activity. After the initial rest period, a gradual return to normal activities is recommended, guided by symptom tolerance.

Return-to-play protocols for athletes follow a stepwise progression: complete rest, light aerobic exercise, sport-specific exercise, non-contact training drills, full-contact practice (after medical clearance), and finally return to competition. Each step should take at least 24 hours, and any return of symptoms means going back to the previous step.

Most concussions resolve within 7 to 14 days in adults and two to four weeks in children. However, some people experience post-concussion syndrome, where symptoms persist for weeks or months. Persistent symptoms should be managed by a healthcare provider experienced in concussion care.

Concussions in Children

Children and adolescents are particularly vulnerable to concussions and typically take longer to recover than adults. Young athletes should be held to stricter return-to-play standards, and parents and coaches should err on the side of caution.

In young children who cannot describe their symptoms, look for behavioral changes such as increased crying, loss of interest in favorite activities, unsteady walking, changes in eating or sleeping patterns, and irritability. Any child suspected of having a concussion should be seen by a healthcare provider.

Teaching children about concussion safety and ensuring that coaches and parents are trained in emergency first aid can help protect young athletes. Leagues and schools that require concussion awareness training for coaches and officials create safer environments for all participants.

Get Trained in Head Injury First Aid

Recognizing head injuries and concussions is a core component of Standard First Aid training. At Coast2Coast in Brampton, Mississauga, Calgary, Saskatoon, and 30+ other locations, our certified instructors guide you through real scenarios so you can respond with confidence when it counts.