Head injury and concussion

How to recognise and manage minor head injuries, spot red flags for serious brain injury and know when to call 999.

What is head injury?

Head injuries range from minor bumps with brief discomfort to serious trauma causing bleeding or swelling inside the skull; concussion is a transient disturbance in brain function after a blow to the head or body, which may or may not involve loss of consciousness. Symptoms can include headache, dizziness, nausea, confusion, memory problems, sensitivity to light or noise and balance difficulties.

Red flag features suggesting more serious brain injury include prolonged or worsening headache, repeated vomiting, seizures, unequal pupils, weakness, slurred speech, drowsiness that worsens, fluid or blood from the ears or nose and any deterioration in consciousness. Children, older adults, people on anticoagulants and those with previous head injuries are at higher risk of complications and often warrant lower thresholds for hospital assessment.

Head injury and concussion are common reasons for emergency and urgent care attendance, but a minority involve serious brain injury, so recognising red flag symptoms is critical.

Who needs this skill?

Any setting where people may fall, be struck or be assaulted requires staff who can distinguish minor head injury from possible serious brain injury and act accordingly.

Health & Social Care

In health and social care, head injuries are common after falls, seizures and behavioural incidents; staff must combine first aid with safeguarding, mental capacity assessment and documentation, particularly if injuries could relate to abuse or neglect. Clinical staff should follow head injury guidelines and imaging decision rules.

Licensed venues & nightlife

In nightlife and licensed venues, head injuries frequently occur through assaults, falls on stairs or intoxication-related incidents; staff must avoid simply removing injured patrons, instead monitoring for deterioration, calling 999 when red flags are present and preserving evidence where violence is involved.

Schools

Head injuries are common in playgrounds and PE; schools need staff who understand concussion, red-flag symptoms and the need for rest and graduated return to play and learning.

Workplaces

In workplaces, first aiders encounter head injuries from falls, tools, vehicles and aggression; they should conduct primary survey, manage wounds, monitor for red flags and ensure 999 is called when indicated, documenting details for investigation and possible RIDDOR reporting.

How to manage head injury

These steps outline how to manage minor head bumps safely, look for red flags and know when a casualty needs emergency care.

1

Ensure airway and breathing are safe first

If the casualty is unresponsive, open the airway with jaw thrust or head tilt-chin lift as appropriate, check breathing and start CPR if they are not breathing normally, protecting the neck as far as possible.

If they are breathing but unconscious, place them in the recovery position while trying to keep the head, neck and spine aligned, especially after high-energy mechanisms.

2

Control bleeding and avoid unnecessary movement

Treat external scalp wounds with gentle pressure around, not directly on, obvious fractures, using dressings and gloves, and support the head and neck to reduce movement.

Do not remove embedded objects from the head and do not apply bandages so tightly that they impair breathing or venous drainage.

3

Look for and act on red flag features

Monitor for worsening headache, repeated vomiting, seizures, unequal pupils, confusion, agitation, drowsiness, slurred speech, weakness or loss of consciousness, and call 999 immediately if any of these develop or are present from the outset.

Treat any significant mechanism of injury with red flags as requiring emergency assessment, particularly in anticoagulated or high-risk patients.

4

Give head injury advice and arrange follow-up for minor cases

If the injury appears minor with no red flags and the casualty is fully alert, advise rest, avoidance of alcohol and drugs that impair alertness, and observation by a responsible adult for at least 24 hours.

Provide clear written or verbal advice on when to seek urgent medical help if symptoms such as worsening headache, vomiting or confusion develop.

5

Document, safeguard and review

Record the circumstances, witnesses, observations and any safeguarding concerns carefully, especially where injuries may relate to violence, self-harm or neglect.

Ensure incidents feed into risk assessments and, where appropriate, security, environmental or clinical governance reviews.

This guide is a learning reference only. It does not replace attended, assessed first aid training.

Qualifying courses

These courses all cover head injury first aid and concussion awareness, with advanced programmes exploring neurological assessment, imaging decisions and complex trauma management. Choose the course that matches your role, sector, and the level of clinical practice required.

Qualsafe Level 3 Award in First Aid at Work (RQF)

3 days

3 years

Learn More

Qualsafe Level 3 Award in Paediatric First Aid (RQF)

EYFS recognised; paediatric head injury red flags

2 days

3 years

Qualsafe Level 2 Award in Activity First Aid (RQF)

2 days

3 years

Learn More

Qualsafe Level 3 Certificate in First Response Emergency Care (RQF)

More advanced head injury management

5 days

3 years

Learn More

Common questions

Practical answers for employers, venue managers, and healthcare teams about head injury training.

Can't find your answer? Contact us.

B

Do all head injuries need a CT scan?

No; imaging decisions depend on factors such as mechanism, symptoms, age, neurological signs and anticoagulant use, guided by clinical decision rules. First aiders should not try to decide on imaging but should recognise red flags and refer appropriately.

B

Can someone have a serious brain injury without being knocked out?

Yes; loss of consciousness may be brief or absent in some significant head injuries and concussions. Persistent or worsening symptoms, behavioural change or neurological signs can still indicate serious pathology.

B

Is it safe for someone with concussion to sleep?

After a minor head injury without red flags, sleep is not inherently dangerous, but a responsible adult should be able to wake the person to check they are rousable and should seek urgent help if they become difficult to wake or deteriorate. Follow local head injury advice sheets.

B

What about people who are drunk or on drugs?

Alcohol and drugs can mask or mimic head injury symptoms, making assessment more difficult; do not dismiss confusion, vomiting or unsteadiness as intoxication alone when there is a history of a blow to the head. Err on the side of calling 999 if in doubt.

B

How can organisations reduce head injuries?

Measures include environmental safety (lighting, flooring, handrails), violence reduction strategies, PPE where appropriate and staff training in de-escalation and safe handling, combined with learning from incidents and near-misses.