Concussion and Head Injuries

Being struck in the head is unfortunately common in the wildland environment. Snags, equipment, loose scree, and UTV use all abound in our environment.  Hard hats and helmets are a must and provide a degree of protection. But what if your co-worker sustains a hard hit to the head and stumbles to the ground?

Consider the scenario:

Your crew is walking along a trail when a large tree branch falls and hits the head of a crewmember. They are knocked to the ground and appear conscious. No other injuries are identified and after a few minutes, they seem to be OK. With relief, you hike onwards. A few minutes later they ask, “where are we?” and you answer. Again, after a couple of minutes they ask the same question – you give the same answer. This happens several more times and it becomes clear they are not able to process or retain the information. What’s going on? What should you do? 

A blow to the head – with or without loss of consciousness – which results in some impaired cognition is considered a concussion. Concussed individuals sometimes repeatedly ask the same question and can’t seem to process the answers. They may complain of headaches, dizziness, and nausea. More severe concussions can result in being off balance, vomiting, and some degree of panic as they cannot understand what has happened.

Fortunately, thanks to the field of Sports Medicine, there are now standard approaches to patients with concussions and clear guidelines.

Follow the 6 R’s:

• Recognize: Learn the signs and symptoms of a concussion
• Remove: If an individual has a concussion or even a suspected concussion, they must be removed from duty immediately
• Refer: Seek medical attention
• Rest: A minimum of 24 hours for mild symptoms, 72 is better
• Recover: Gradually progress to low levels of physical and mental activities over 7 – 14 days
• Return: If all symptoms have resolved and cleared to do so by a medical provider

Resources:

• NWCG Emergency Medical Committee
• American Association of Neurological Surgeons, Concussion – Symptoms, Diagnosis, and Safety Guidelines
• NWCG Incident Response Pocekt Guide (IRPG) - Emergency Medical Care (red pages), PMS 461