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Head injury - Management
What advice should telephone advice services give a person with a head injury?

  • Refer the person to the hospital emergency department using the emergency ambulance service (that is, 999) if they:
    • Are unconscious or are not fully conscious.
    • Have had a seizure since the injury.
    • Have any focal neurological deficit, such as:
      • Problems with sight, speech, understanding speech, reading, or writing.
      • Problems with balance or walking.
      • Loss of muscle power.
      • Paraesthesia of the extremities.
    • Have any suspicion of a skull fracture or penetrating head injury, such as:
      • Clear fluid (possible cerebrospinal fluid) running from the ear or nose.
      • A black eye with no damage around the eye.
      • Bleeding from one or both ears; blood behind the ear drum; new deafness in one or both ears; or bruising behind one or both ears.
      • Signs of a penetrating injury.
      • Visible trauma to the scalp or skull that is of concern.
    • Have had a high-energy head injury such as: a pedestrian being struck by a motor vehicle; a high-speed motor collision; an axial-loading injury such as diving; a 'rollover' motor accident; or a fall from a height of greater than 1 metre, or more than five stairs.
  • Refer the person to the hospital emergency department (using the emergency ambulance service if it is not otherwise possible to transport the injured person safely) if there is (or has been):
    • Amnesia for events before or after the injury.
    • Persistent headache since the injury.
    • Vomiting since the head injury.
      • More than one episode in an adult.
      • Three or more episodes in a child.
    • A previous history of brain surgery.
    • A bleeding or clotting disorder, or current anticoagulant treatment (such as warfarin).
    • Suspicion the person has taken drugs or is intoxicated with alcohol.
    • A person 65 years of age or older.
    • Suspicion of a non-accidental injury.
    • Irritability or altered behaviour, particularly in infants and children.
    • Continuing concern about the diagnosis by the healthcare professional.
  • If the criteria for referral to an emergency department are not met, advise the person to seek medical advice from community settings (such as general practice) if there is:
    • Adverse social factors that may affect safety at home.
    • Continuing concern about the diagnosis by the injured person or their carer.

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