First Responder Field Guide: Properly Assessing Traumatic Brain Injuries/Concussions 
First responders play a key role in helping to identify, diagnose and manage traumatic brain injuries (TBIs).  More importantly, they can also help improve patient outcomes by properly managing the patient’s condition before transferring the patient for continued medical treatment.

Concussions: Most Common TBI
Concussions are one of the most common TBIs. According to the Centers for Disease Control, approximately 75 percent of TBIs that occur each year are concussions or other forms of mild TBI.

Long-Term Effects
Previously, concussions were often overlooked as a minor injury. However, recent research has shown that concussions may lead to long-term problems, affecting memory, sensation, communication, and emotions. TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age.

Symptoms of a concussion may appear mild, but can lead to significant, life-long impairment affecting an individual's ability to function physically, cognitively, and psychologically. The following symptoms are red flags for TBIs/concussion and require emergency medical treatment:

  • Headaches that worsen
  • Looks very drowsy/ can’t be awakened
  • Can’t recognize people or places
  • Neck pain
  • Seizures
  • Continuous vomiting
  • Increasing confusion or irritability
  • Unusual behavioral change
  • Focal neurologic signs
  • Slurred speech
  • Weakness or numbness in arms/legs
  • Change in state of consciousness

Managing a TBI/Concussion
First, check to see if the patient is alert by asking:

  • Can you open your eyes?
  • Can you explain to me what happened?

If the patient is alert, ask the following questions:

  • Do you have a headache?
  • Do you feel like you may vomit?
  • Do you feel drowsy?

If the patient’s breathing and heart rate are both normal but he/she is unconscious:

  • Treat as if there is a spinal injury.
  • Stabilize the head and neck.
  • Keep it in line with the spine and prevent movement.

If there is an open head wound and you suspect a skull fracture:

  • Do not apply direct pressure to the bleeding site.
  • Do not remove any debris from the wound.
  • Cover the wound with gauze.

Source: Centers for Disease Control and Prevention