We’ve all seen it — a slip on wet rock, a poorly ducked branch, a flying elbow in a group shelter. Head injuries happen fast and without warning, and in remote places, it’s up to you to manage the situation until help arrives — or until you walk them out.
👤 “I’m fine.” – The Famous Last Words
Mild head injuries often look like nothing. A bit dazed, maybe a scratch or graze. But beneath that could be a concussion — a brain injury. And in rare cases, a serious or even life-threatening problem.
In the hills, we take every head injury seriously. Especially if:
The casualty was knocked out, even for seconds
They seem dazed, slow or confused
They complain of nausea, vision changes, or a headache
Their behaviour just seems… off
Head injuries are not just from regular sports. Outdoor activities are a high risk for head injuries. Always wear a helmet. Prevention is better then cure.
🧠 What Is a Concussion?
A concussion is a mild traumatic brain injury. The brain doesn’t like being bounced around the skull — even without a fracture or bleed, it can become bruised or temporarily miswired.
Symptoms can include:
Confusion or memory loss
Headache
Dizziness or balance issues
Nausea or vomiting
Light or noise sensitivity
Feeling foggy, emotional or irritable
These may show up immediately or take hours. And crucially — you don’t have to be knocked out to have a concussion.
🚨 Red Flags: When to Call for Help
Even in the wilderness, a head injury may need emergency evacuation. Get help if the casualty has:
Loss of consciousness
Repeated vomiting
Seizures
Slurred speech or confusion
One pupil larger than the other
Weakness or numbness
Increasingly severe headache
Blood or clear fluid from nose/ears
Can’t stay awake
In short: if it’s more than just a bump — don’t take chances.
🏕️ Managing a Head Injury in the Field
Here’s what I do as an EMT when I can’t just hand them off to an ambulance:
Stabilise & assess
Sit or lie them down safely
Do a full body check — head injuries often happen with other trauma
Check for spinal tenderness if it was a fall
Monitor their level of response
Use AVPU: Alert / Voice / Pain / Unresponsive
Ask questions: name, location, what happened
Repeat checks every 15 minutes
Protect the airway if unconscious
Recovery position if breathing normally
Airway adjunct if trained
Prepare to manage vomit
Keep them warm & calm
Shock can sneak up on you in the hills
Use insulation, group shelter, or emergency blanket
Don’t give painkillers immediately
You want to monitor signs of deterioration first
If mild and stable later, paracetamol is a safe choice (GSL) see blog on meds
🥾 Should They Walk Out?
If they’ve got a mild bump, no red flags, and they're fully alert with no worsening signs, they may be able to walk with supervision. But:
Never alone
Monitor constantly
Keep communication open
Don’t hesitate to call for backup if they worsen
Rule of thumb: When in doubt, sit them out.
⛑️ Concussion Recovery Advice
Once home or with medical support, they’ll need rest — not just physical, but mental. No screens, no intense thinking, no rushing back to sport. Gradual return over days to weeks.
Always recommend a medical check-up, even if they seem okay. Concussion recovery is not one-size-fits-all.
🧭 Final Thoughts from the Hill
Head injuries are deceptive. You’ll often hear, “I’m okay,” when they’re anything but. Trust your training, trust your gut, and treat every bang on the head with respect — because the brain doesn’t bounce.
Want to learn more about managing outdoor emergencies like this?
Check out our next Outdoor First Aid course
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