Head Injuries: When a Bump Becomes Something More Serious

A 3-minute read on recognising and managing head trauma in the workplace.

The scaffolder fell just two metres, but he landed awkwardly and hit his head on the concrete. At first, he seemed fine – a bit dazed, but talking and walking around. Twenty minutes later, he was vomiting and complaining of a severe headache. What started as a "minor bump" was turning into something much more serious.

This scenario reminded me of an incident during my Army service when we were conducting field exercises and one of our team took a knock to the head during equipment training. Like the scaffolder, he insisted he was fine and wanted to continue with the exercise. But military training had taught us never to take head injuries lightly – the brain is too precious, and the consequences of getting it wrong are too severe.

That lesson, reinforced through countless incidents during my 14 years in the police, is why I'm so passionate about teaching people to recognise the hidden dangers of head injuries. Now, as founder of Typhon Training Solutions, I make sure every student understands that head injuries are among the most deceptive and dangerous injuries you can encounter.

The Hidden Danger

After teaching first aid with Typhon Training Solutions for over over five years, I've learned that head injuries are among the most unpredictable emergencies you'll encounter. Someone can seem absolutely fine initially, then deteriorate rapidly. Conversely, dramatic-looking head wounds might be relatively minor.

The brain is remarkably well-protected by the skull, but it's also vulnerable to injury from the forces involved in impacts. Understanding when to worry and when to act can make the difference between a full recovery and permanent disability.

The Mechanism Matters

Not all head injuries are the same. A direct blow to the head is obvious, but the brain can also be injured by rapid acceleration and deceleration – like in whiplash injuries or falls where the head doesn't directly hit anything.

The brain essentially floats in fluid inside the skull. When the head moves suddenly, the brain can bounce around, causing bruising, bleeding, or swelling. This is why someone can have a serious brain injury without any external signs of trauma.

The Concussion Confusion

Concussion is probably the most misunderstood head injury. People think you need to lose consciousness to have a concussion, but that's not true. In fact, most concussions don't involve loss of consciousness at all.

In our HSE-approved First Aid at Work courses, I teach people to look for the subtle signs: confusion, memory problems, nausea, dizziness, or changes in behaviour. The person might repeat questions, seem "not quite right," or have trouble concentrating.

The Danger Signs

While many head injuries are minor, some require immediate medical attention. I teach the "red flag" symptoms that mean you need to call 999 right away:

Loss of consciousness, even briefly. Repeated vomiting. Severe or worsening headache. Confusion or disorientation that doesn't improve. Seizures. Clear fluid leaking from the nose or ears. Unequal pupil sizes. Weakness or numbness in arms or legs.

The Lucid Interval

Here's something that catches people off guard: someone with a serious brain injury can have what's called a "lucid interval" – a period where they seem completely normal before deteriorating rapidly. This is why anyone with a significant head injury needs medical assessment, even if they seem fine.

I remember training a warehouse supervisor who later dealt with a worker who'd been hit by a falling box. The worker seemed fine for an hour, then suddenly became confused and drowsy. Quick thinking and immediate medical attention probably saved his life.

The Assessment Challenge

Assessing head injuries requires careful observation. Check their level of consciousness using simple questions: What's your name? Where are you? What day is it? What happened?

If they can't answer these correctly, or if their answers change over time, that's concerning.

Monitor their pupils – they should be equal in size and react to light. Check their balance and coordination. Most importantly, keep reassessing. Head injuries can change rapidly.

Spinal Injury Concerns

Any significant head injury raises the possibility of spinal injury too. If someone has fallen from height, been in a vehicle accident, or suffered a high-impact head injury, treat them as if they might have spinal damage until proven otherwise.

This means keeping their head and neck still, not allowing them to get up and walk around, and being very careful about how you position them if they become unconscious.

The Recovery Position Dilemma

If someone with a head injury becomes unconscious but is breathing normally, you face a dilemma. The recovery position helps keep their airway clear, but moving them might worsen spinal injuries.

The general rule is that airway takes priority – if they're not breathing properly, you need to act to clear their airway, even if it means moving them. But do it as carefully as possible, ideally with help to keep their head and neck aligned.

When to Worry About Bleeding

Scalp wounds bleed dramatically because the scalp has an excellent blood supply.

A relatively minor cut can produce alarming amounts of blood. Don't be fooled by the amount of bleeding – it doesn't necessarily indicate the severity of the underlying injury.

Control bleeding with direct pressure, but be gentle if you suspect a skull fracture. Never try to remove objects embedded in the head – secure them in place and get immediate medical help.

The Return-to-Work Decision

Deciding when someone can return to work after a head injury is complex. Even "minor" concussions can affect concentration, reaction times, and decision-making for days or weeks. This is particularly important in safety-critical roles.

Anyone who's had a head injury should be medically cleared before returning to work, especially if their job involves driving, operating machinery, or working at height.

The Cumulative Effect

Multiple head injuries, even minor ones, can have cumulative effects. This is why proper reporting and medical follow-up is so important. Someone who's had several "minor" head knocks might be at higher risk of serious complications from the next one.

Documentation and Reporting

Head injuries require careful documentation. Record exactly what happened, the person's condition immediately after the injury, and any changes you observe. This information is crucial for medical professionals and for accident investigation.

Creating a Head Injury Protocol

Every workplace should have a clear protocol for dealing with head injuries. This includes when to call 999, who makes the decision about medical referral, and how to monitor someone with a minor head injury.

The Long-Term View

Most people recover completely from minor head injuries, but some experience ongoing problems with headaches, concentration, or memory. Understanding this helps create realistic expectations and appropriate support.

Want to ensure your workplace can handle head injuries properly? Contact Typhon Training Solutions. Call me on 07939557029 or email mark.phillips@typhontrainingsolutions.co.uk to discuss head injury training that builds real competence.

Because when it comes to head injuries, what you don't see can be more dangerous than what you do.

Mark Phillips delivers practical first aid training through Typhon Training Solutions, helping workplaces across the UK respond appropriately to head trauma and other medical emergencies.