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When a person sustains a severe head injury, begin by ensuring your own safety and calming the scene. Check responsiveness, assess breathing, and shout for help if alone. If there is no pulse, begin CPR following current guidelines. If the person is conscious, avoid moving them unnecessarily, as movement can worsen brain injury. Do not give food or drink, and monitor for vomiting. Control external bleeding with clean dressings, but avoid applying direct pressure to deep or severely depressed wounds that could affect skull integrity. Reassure quietly, keep the patient warm, and prepare for rapid transport.

The first responder should perform a quick neurological check, measuring pupil size and reactivity and noting limb strength if possible. Any deterioration in consciousness, confusion, unequal pupils, or inability to follow commands signals potential intracranial pressure or brain herniation risk. Maintain the airway using a gentle jaw-thrust maneuver if spinal injury is not suspected, and monitor breathing. Lay the patient supine with head midline and elevated barely if there is no evidence of cervical injury. Provide supplemental oxygen if available to maintain tissue oxygenation. Treat seizures promptly with antiepileptic measures if trained, but avoid inserting anything into the mouth during a seizure.

Immobilization is essential when head injury with suspected intracranial pressure is suspected. Do not attempt to reposition the patient without stabilizing the neck and spine first. Place a rigid cervical collar if you have training and the device is accessible, and immobilize the head with padded supports to prevent movement. Avoid excessive movement of the head, neck, or torso while turning or transferring. If the patient vomits, roll them gently to the side to clear secretions while maintaining spinal alignment. Keep the airway clear, and suction as necessary without dislodging immobilization devices. Continuous monitoring of breathing, airway patency, and circulation helps reduce secondary brain injury risk.

In addition to immobilization, monitor vital signs and mental status regularly. Use simple assessments such as the Glasgow Coma Scale when feasible; record eye opening, verbal response, and motor activity. Document time of injury, the mechanism, and any observed changes. If unconsciousness occurs, assume a spinal injury and maintain alignment. Administer analgesia only if trained and approved, keeping in mind that many analgesics can obscure neurological evaluation. Avoid giving sedatives or depressants that could mask symptoms of increased intracranial pressure. When possible, alert medical professionals to the possibility of a bleed or swelling.

The airway deserves careful attention in head injuries with possible intracranial pressure. Elevate the head slightly (not beyond 30 degrees) if it does not compromise breathing, to promote venous drainage. Use gentle suctioning to clear secretions and prevent aspiration, but avoid overhandling the neck or scalp. If the patient is obstructed or hypoxic, provide supplemental oxygen or bag-valve-mask ventilation, ensuring a proper seal and avoiding excessive neck extension. Continuously monitor oxygen saturation and capnography if available. Be prepared to assist ventilation for an extended period if transfer to definitive care is delayed. Do not administer nasal continuous positive airway pressure in suspected cervical injury.

Circulation management focuses on stopping any external bleeding with clean dressings while preserving skull stability. Apply firm, direct pressure to bleeding sites unless penetrating skull injury or suspicion of brain exposure makes pressure harmful. Use sterile pads and avoid removing skull fragments. Monitor for signs of shock: pale skin, cold extremities, rapid weak pulse, and confusion. Keep the patient warm with blankets and layers. Establish baseline vitals if possible and reassess frequently. Avoid giving fluids through the nose or ears, and do not give anything by mouth if unconscious. Prepare for rapid transport with clear documentation of injury details.

When transporting, maintain spinal alignment and minimize jostling. If a spine injury is suspected, use a rigid backboard or skateboard and secure the patient firmly with straps at the chest, pelvis, and legs while supporting the head to prevent rotation. Avoid twisting the body during loading or unloading. Communicate clearly with the patient to reduce stress, but do not delay transport for lengthy explanations. Confirm that all immobilization devices remain in place and padded to prevent skin breakdown. If a stretcher is unavailable, improvise by keeping the patient in a secure, immobile position with careful, coordinated assistance from responders.

During longer waits for professional care, reassess regularly for changes in consciousness, breathing, or pupil response. If a patient becomes unconscious, reposition carefully to protect the airway while maintaining spinal stabilization. Do not attempt to remove suspected foreign objects from the skull or scalp. Keep the patient warm, and avoid giving drinks that could be aspirated. Record all observed changes and the time of each assessment so medical teams can detect trends when they arrive. Provide reassurance to the patient and any bystanders to reduce panic.

The scene remains dynamic, and clinicians must adapt to evolving signs of intracranial pressure. Signs such as severe headache, vomiting, confusion, or rapid decline in consciousness require urgent escalation. When a trained clinician arrives, transfer information precisely: mechanism of injury, time to onset of symptoms, treatments administered, and the patient’s baseline status. Ensure continuous airway support, hemodynamic monitoring, and neck stabilization during handoff. If seizures recur, apply established seizure protocols and consult neurotrauma guidelines. The goal is to preserve brain function and prevent secondary injury while enabling definitive care.

Family and bystander support remains important while awaiting professional care. Communicate gently, avoiding alarmism, and provide simple explanations about what responders are doing. Keep the person still and comfortable, explain the importance of immobilization, and reassure them that help is on the way. Use clear, calm language and avoid promising outcomes. If the patient regains responsiveness, continue monitoring and reporting any new symptoms. When transport is inevitable, coordinate with emergency services to ensure a smooth, timely transfer to the appropriate facility for imaging and neurosurgical evaluation.

After admission to care, treatment strategies focus on reducing intracranial pressure while addressing systemic needs. Medical teams will likely implement imaging studies to assess bleeding and swelling, monitor intracranial pressure, and manage cerebral perfusion. Interventions may include controlled ventilation, careful fluid management, and targeted medications. Early neurosurgical consultation is often essential for decisions about intervention. Rehabilitation planning begins soon after stabilization to maximize functional recovery. Throughout, clinicians balance removing pressure with preserving blood flow, avoiding secondary brain injury from hypotension or hypoxia. Families should be informed about prognostic factors and potential outcomes with honesty and empathy.

Preventive and educational steps after head injury are crucial for long-term outcomes. Seek structured follow-up appointments to monitor recovery and adjust rehabilitation activities. Learn warning signs that require urgent medical attention, such as persistent severe headaches, vomiting, confusion, or new weakness. Wear protective gear during activities with head injury risk, and educate caregivers about safe transport, dosage decisions, and the importance of reporting any delayed symptoms. Head injuries with suspected intracranial pressure require careful management and timely, professional evaluation to minimize lasting impairment and maximize the chance for full recovery.