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Traumatic brain injuries (or TBIs) usually occur from a sudden blow to the head. It’s one of the most common causes of disability and death in adults. TBI’s a broad term that encompasses many types of damage that can impact the brain. If it effects one area of the brain, it is termed a “focal” injury. If it spans over several areas, it is called a “diffuse” injury. Severity can range from a mild concussion to a life-threatening situation involving fracture of the skull.

Fortunately, most head injuries aren’t lethal and cause only superficial damage, such as a laceration of the scalp, a black eye, a broken nose, or a painful bump. These wounds, however, can hide damage inside the cranium (the part of the skull that contains the brain). It’s important for the off-grid medic to recognize when trauma to the skull causes damage that can lead to a bad outcome.


Concussions are the most common type of TBI. It’s associated with a variety of symptoms that are often immediately apparent, although the effects vary from one individual to the next.

Classically, you might expect a loss of consciousness; in the majority of cases, however, the victim remains completely alert. Headache is actually the most commonly seen symptom and may occur on-and-off for days afterwards.

Other symptoms include:

• Dizziness
• Confusion
• Nausea
• Loss of motor coordination
• Blurred or double vision
• Slurred speech
• Ringing in the ear (also called “tinnitus”)
• and Difficulty focusing on tasks at hand

It should be noted that a physical strike to the head is not necessary to suffer a concussion. A particularly jarring football tackle or the violent shaking of an infant can cause a concussion or worse. This is because the brain “bounces” against the hard walls of the cranium. When injury occurs at the site of a blow to the head, it’s called a “coup” injury. Just as often, it can occur on the opposite site of the head as the brain rebounds, known as a “contrecoup” injury.

Let’s say a person has been knocked unconscious by a blow to the head. In most cases, they will regain consciousness in less than 2 minutes. You can expect them to be “foggy,” move clumsily, be slow to answer questions, and behave inappropriately (put me in, coach!). They may not even remember the events immediately prior that led to the injury. In sports, an injured player may not remember their position, the score, or who their opponent is.


Loss of consciousness is a serious concern. Even if the victim is “out” less than two minutes, they’ll merit close observation for the next 48 hours. You should examine for evidence of other injuries and determine that the patient has regained normal motor function. Make sure they can move all their extremities with normal range of motion, coordination, and strength.

A period of “relative rest” is prescribed for the next 48 hours. The patient should avoid strenuous activity or perform duties that require serious mental effort (including video games). The patient does not have to be kept awake nor has to remain in a dark room, as suggested by some. There are many who no longer believe it’s necessary to wake the patient if they’re asleep as long as they’re breathing normally, but some still recommend awakening them every two or three hours the first night, to make certain they’re easily aroused.

The victim can gradually increase daily activities if they don’t trigger symptoms. Light exercise and physical activity (as tolerated) starting a couple of days after the injury have been shown to speed recovery, but avoid any activities that could cause another head impact.  Headaches, which are common in the aftermath, may be treated with acetaminophen, but avoid ibuprofen or aspirin due to an increased risk of bleeding. In good times or bad, there is always the risk of head injury.

The survival medic must always be aware of the signs and symptoms of concussion and other traumatic brain injuries. We’ll discuss more severe head trauma in the near future.

Joe Alton MD



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