Falls from heights are a leading cause of death and serious injury in Australia. In 2020 there were over 10,000 falls from heights in Australia that resulted in hospital admissions. Of these over 1000 resulted in death.

If you’re a caring for a patient who has fallen from a height, such as a horse fall, it is important to be aware of the specific risks and signs of head injury in this context.

It is entirely possible that the old saying ‘Get back on the horse’ might not be the best course of action if you suspect a head knock. At least not yet.

In the assessment of the patient, along with Signs and Symptoms, remember to consider the History of the event ie. What happened.

With potential head injury you want to be suspicious and then proven wrong over time rather than comfortable now and figure out later that it might be worse than first thought. Head injuries tend to have a pattern of deterioration over time that we can’t see and can’t do anything about.

So be edgy based on the ‘What happened’. Get a good history. If the patient can’t tell you, find someone that can. Failing that it’s detective work.

So, stop the activity and sit the patient down, not lie down. Head elevated is important.

Take vital signs particularly concentrating on the GCS (Glasgow Coma Scale). Think eyes, verbal, motor function.

“What’s your name? Do you know where you are? Do remember everything that just happened? What year is it? What month is it? Reach up and grab my fingers. Squeeze them. Pull towards you. Push away. Look at the tip of my finger” (this is so you can have a good look at the pupils).

Recognising the Signs of a Head Injury

The effects of a head injury can range from mild concussion to life-threatening trauma. Here’s what to watch for:

• Obvious signs: Loss of consciousness, bleeding from the head or ears, severe headache, vomiting, or difficulty speaking.
• Behavioural changes: Confusion, disorientation, drowsiness, unusual behaviour, or slurred speech.
• Physical symptoms: Nausea, dizziness, blurred vision, difficulty concentrating, or changes in balance or coordination.

Then sit a little bit away from them to go through some more general questions. Write down the details so you can compare them with later sets.

Are we worried about this patient? You should be until proven otherwise. So, check the same details listed above every 5 minutes. Exactly the same.

You want 4 sets at 5 minute intervals that are good before I’d be comfortable to stretch them out to 15 mins. Maybe they just have a big headache and might need reduced stimulus for a 24 hours. That means no screens by the way.

Any move of any of the answers to questions or requests for action that are negative – hospital. Don’t wait until they are sick. Because we can’t see the deterioration. Get them to a scanner asap. And that means hospital.

It’s a hospital call for any period of loss of memory, any vomit following a head knock, any confusion, pupil changes, or stroke-like symptoms. Or even if you just think it was a good hit!

Wouldn’t it be good if that hospital called back and said the scans were all clear and you can have them back. But don’t play this one the other way around. Be very cautious. I can’t say enough, get the vital signs particularly GCS and go from there.

By Scott Brown

If you would like more information about this topic or any others, purchase any First Aid stock or equipment, or to book a Remote Area First Aid course, please contact us on 0491 057 339 or email info@ruralandremotefirstaid.com.au

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Author bio:

For over 23 years Scott Brown has been training Remote Area First Aid across Australia. Having first joined Rural Ambulance Victoria in 2001 and working in the high-country in Victoria, he began teaching First Aid for Rural Ambulance Victoria. 23 years on, he works with some of Australia’s largest pastoral corporations and property managers that combined manage over 200,000 square kms of the Australian landscape.

Known for conveying detailed First Aid information in a relatable and relaxed way, Scott’s courses have become popular with Agricultural Property Managers, overseers and ringers alike. The highly practical course content ensures relevance to actual situations that are possible to encounter on a working property.

Scott continues to work with Ambulance Victoria alongside his First Aid training. 

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