Head injuries in the outdoors can be very serious. Being able to recognise the early signs of concussion and act appropriately could save someone from permanent damage, or worse, says Cory Jones of First Aid Training Cooperative.

Trigger warning: some graphic images

---

A slip on a rocky path. A lead fall inversion. A tumble from a scramble. A chunk of ice falling from above. Head injuries can—and do—happen in the mountains. Sometimes the casualty walks away with nothing more than a headache. But at other times, a head injury can be subtle, serious, and life-threatening.

Recognising the difference between a bump and a brain injury is one of the most important things a climber, hillwalker, mountaineer or outdoor leader can do.

Why head injuries are so concerning outdoors

In remote areas, where help may be hours away, a head injury brings a set of challenges:

• Casualties may appear "fine" before deteriorating rapidly
• Symptoms can be masked by cold, fatigue, or confusion
• Reduced responsiveness or coordination can make self-rescue impossible

Even a minor blow can lead to concussion, and in rare cases, internal bleeding in the skull. That's why it's vital to assess early and monitor often.

First: What is a concussion?

A head injury might not look dramatic, but the risks are real. Trust your instincts, monitor closely, and when in doubt—get them off the hill

Concussion is a brain injury caused by a blow to the head (or even a sudden jolt without direct impact). It affects how the brain functions—usually temporarily, but with symptoms that can linger or worsen.

You do not have to be knocked out to have a concussion. In fact, most people stay conscious.

Spotting the signs of concussion

Concussion can be sneaky. It might take minutes—or hours—to fully develop. Be alert for:

• Headache or "pressure" in the head
• Dizziness or poor balance
• Nausea or vomiting
• Blurred or double vision
• Sensitivity to light or noise
• Confusion or slowed speech
• Fatigue or drowsiness
• Difficulty concentrating
• Memory problems (e.g. forgetting the accident itself)

Red flags for a more serious brain injury include:

• Loss of consciousness (even briefly)
• Seizures or convulsions
• Repeated vomiting
• Slurred speech
• Unequal pupils
• Worsening headache
• Clear fluid or blood from nose or ears

What to do in the hills

1. Stop and assess

Don't ignore a head knock. Sit the casualty down, ask how they feel and carry out a basic memory check (e.g. "What's your name?", "Where are we?", "What just happened?", "Ask a maths question like add up to 15 in threes"). Check pupils for change in size and reaction to light.

2. Monitor closely

Even if they feel OK initially, symptoms may appear later. Keep checking in every 15–20 minutes for at least an hour. Watch for changes in behaviour, speech, balance or level of alertness.

3. Evacuate if necessary

Plan to evacuate if:

• There are any red flag symptoms
• The casualty lost consciousness
• Symptoms worsen or persist
• They're unable to walk out safely
• You're unsure and erring on the side of caution

If in any doubt call 999/112 and ask for Police who call out Mountain Rescue. Provide your location using a grid reference or an app like What3Words.

4. Keep the casualty warm and still

Sit or lie the person down in a comfortable position. Use jackets, a group shelter or a bivvy bag to reduce heat loss. Avoid unnecessary movement, especially if there may be other injuries.

What About Helmets?

Helmets are nowadays generally considered essential when climbing (including, increasingly, sport climbing), scrambling, or travelling under rockfall—but they don't make you invincible.

A helmet reduces the risk of skull fracture, but concussion and internal brain injuries can still happen. If someone bangs their head while wearing a helmet, remove it only if necessary to manage an airway or if they're struggling to breathe. Otherwise, keep it on to protect against further impact unless trained in safe removal techniques.

Aftercare: What happens next?

If someone has had a suspected concussion—even a mild one—they should be monitored closely for the next 24–48 hours and rest for at least two weeks before returning to full physical activity. That means no running, climbing or high-risk movement until cleared by a medical professional.

Multiple concussions—especially if they occur close together—can increase the risk of long-term complications, including memory issues and mood changes. Recovery should always be taken seriously.

Final word: Stay vigilant, stay prepared

A head injury might not look dramatic, but the risks are real. Being able to recognise the early signs of concussion and act appropriately could save someone from permanent damage, or worse. Trust your instincts, monitor closely, and when in doubt—get them off the hill.

Get trained. Think clearly. Stay safe.

---

Want to Learn More? Take a Specialist Course

Head injuries are complex and managing them in a mountain environment adds even more challenge. If you lead groups or regularly head into remote terrain, consider taking the A Deeper Understanding of Concussion course by the First Aid Training Co-operative.

This advanced short course explores:

The physiology of brain injuries

Real-world outdoor scenarios

Decision-making when evacuation is delayed

How to support a casualty through recovery