James Pierson
When someone mentions concussions, most people think of car accidents or full contact sports like football, rugby, or hockey. But with such an increased chance of an impact to our heads - whether it be from a falling rock from above, or us falling and hitting our heads - climbers have a serious chance of sustaining a concussion.
Symptoms and Effects
According to the Centers for Disease Control and Prevention (CDC), “a concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.” This jostling can cause your brain to bounce around in your skull, possibly stretching and damaging the cells and tissues.
There are a variety of both short-term and long-term effects from concussions and TBIs. Most of the effects of mild TBIs have to do with one or more of the following areas: thinking, sensation, language, and/or emotion. Severe TBIs can result in permanent disability and even death, and are a contributing factor in 30% of injury-related deaths in the U.S.
How do you know if you have a concussion?
How do we know if someone has a concussion? It can be difficult to diagnose in the wilderness since many of the signs and symptoms are shared and confused with other conditions. The first question to ask is, “is there a mechanism of injury that would cause a TBI?” In other words, did you see a rock hit someone on the head, or did you see them trip and fall? If you did not actually see the incident, are there other clues that might suggest this (like a dented helmet or a cut on the head)?
If there is nothing that indicates a mechanism of injury that would produce a TBI, there are still plenty of signs and symptoms that can help you figure out what is going on. The CDC divides these up into four main categories, with multiple signs and symptoms for a mild TBI under each:
Thinking/ remembering
- Loss of consciousness (even briefly)
- Difficulty thinking clearly
- Feeling slowed down
- Difficulty concentrating
- Difficulty remembering new information
Physical
- Headache
- Fuzzy/ blurred vision
- Nausea or vomiting
- Dizziness
- Sensitivity to noise or light
- Balance problems
- Feeling tired, having no energy
Emotional/ mood
- Irritability
- Sadness
- More emotional than normal
- Nervousness or anxiety
Sleep
- Sleeping more than usual
- Sleeping less than usual
- Trouble falling asleep
Some or even none of these signs or symptoms may appear right away. Others may come on once the person starts physically exerting his or herself more, while still others may not present until much later.
Scenario & Lesson's Learned
A good example of all this is an alpine scramble with the Seattle branch a few years ago. The group was on their way down after a successful summit of Silver Peak. A few hundred feet down from the summit, one of the members lost her footing on a loose rock in the talus field and hit her head. She had a cut on her forehead, but no other immediate issues.
According to Paul Nicolazzo, Director of the Wilderness Medical Training Center in Mazama, patients that do not have a loss of consciousness, amnesia or seizures should be monitored for 1 - 2 hours for the signs and symptoms mentioned earlier. If none of these develop, then an evacuation is not immediately necessary. In the case of the injured climber on Silver Peak, since they were already on their way out and there were no immediate signs or symptoms, they stopped the bleeding, closed up the cut and bandaged up the fallen scrambler. To aid in the descent and minimize the effort on the injured person, her gear was distributed among the rest of the group and the descent continued.
Mr. Nicolazzo further recommends that if signs and symptoms develop, the group should begin an urgent evacuation (this is the same for a patient who has experienced a loss of consciousness, amnesia or seizures). In this case, the injured scrambler did not start to show any signs or have any symptoms until after they started moving again. On the way down, she mentioned an increase in her headache, became more groggy and vomited. However, she was still able to move comfortably and with only minor assistance through some “rough sections” of the trail. Once they reached the trailhead, the injured scrambler was driven to the emergency room.
Mr. Nicolazzo also recommends that if a patient’s signs and symptoms increase during the minimal exertion needed to self-evacuate, then they should be carried or transported and the urgency of the evacuation should be increased. He also stresses that, “concussed patients avoid a second traumatic blow during the evacuation and should not self-evacuate via ski, board, bike, or any method involving speed or jolting.”
It should be noted that there are situations when an immediate, rapid evacuation is necessary. There are some critical danger signs to watch out for that could alert you to the need for a rapid evacuation:
- Headache that gets worse and does not go away
- Weakness, numbness or decreased coordination
- Repeated vomiting or nausea
- Slurred speech
- The patient looks very drowsy or cannot be woken up
- One pupil is a different size than the other
- Convulsions or seizures
- Unable to recognize people or places
- Getting more and more confused/ restless/ agitated
- Loss of consciousness some time after the initial injury
Mr. Nicolazzo emphasizes two final points: 1. that any concussed patient should be evaluated and treated for a potential spine injury, and 2. that a patient who is unresponsive, or only pain or voice responsive after a blow to the head requires an urgent, rapid evacuation and is in dire need of medical attention.
Hopefully you will never have, or need to treat someone with, a concussion or TBI. The team on the trip that I mentioned in this article handled the situation well and got the scrambler down to the trailhead without further incident. As with many of the skills that we practice, like crevasse rescue or leader tie-off, I hope this better prepares you for identifying and handling the situation.
