(1) Head injuries range from minor abrasions or cuts on the scalp to severe brain injuries that may result in unconsciousness and sometimes death. Head injuries are classified as open or closed wounds. An open wound is one that is visible, has a break in the skin, and usually has evidence of bleeding. A closed wound may be visible (such as a depression in the skull) or the first aid provider may not be able to see any apparent injury (such as internal bleeding). Some head injuries result in unconsciousness; however, a service member may have a serious head wound and still be conscious. Casualties with head and neck injuries should be treated as though they also have a spinal injury. The casualty should not be moved until the head and neck is stabilized unless he is in immediate danger (such as close to a burning vehicle).
(2) Prompt first aid measures should be initiated for casualties with suspected head and neck injuries. The conscious casualty may be able to provide information on the extent of his injuries. However, as a result of the head injury, he may be confused and unable to provide accurate information. The signs and symptoms a first aid provider might observe are —
• Nausea and vomiting.
• Convulsions or twitches.
• Slurred speech.
• Confusion and loss of memory. (Does he know who he is? Does he know where he is? Does he know what day it is?)
• Recent unconsciousness.
• Dizziness.
• Drowsiness.
• Blurred vision, unequal pupils, or bruising (black eyes).
• Paralysis (partial or full).
• Complaint of headache.
• Bleeding or other fluid discharge from the scalp, nose, or ears.
• Deformity of the head (depression or swelling).
• Staggering while walking.
b. Neck Injuries. Neck injuries may result in heavy bleeding. Apply pressure above and below the injury, but do not interfere with the breathing process, and attempt to control the bleeding. Apply a dressing. Always evaluate the casualty for a possible neck fracture/spinal cord injury; if suspected, seek medical treatment immediately.
NOTE
Establish and maintain the airway in cases of facial or neck injuries. If a neck fracture or spinal cord injury is suspected, immobilize the injury and, if necessary, perform basic life support measures.
c. Facial Injuries. Soft tissue injuries of the face and scalp are common. Abrasions (scrapes) of the skin cause no serious problems. Contusions (injury without a break in the skin) usually cause swelling. A contusion of the scalp looks and feels like a lump. Laceration (cut) and avulsion (torn away tissue) injuries are also common. Avulsions are frequently caused when a sharp blow separates the scalp from the skull beneath it. Because the face and scalp are richly supplied with blood vessels (arteries and veins), wounds of these areas usually bleed heavily.