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Clinical Evaluation of Head Injuries-On-the-Field Evaluation

The initial on-the-field evaluation is directed toward assessing the levels of consciousness and of associated injuries, particularly cervical spine trauma. The medical personnel must first assess the patient’s airway, breathing, and circulation (i.e., ABCs).

If the patient is unconscious, the initial respondent must assume that an associated cervical spine injury has occurred, and the neck should be stabilized immediately. A rapid assessment must be made concerning the need for possible emergent transport to a hospital setting.

The standard method for assessing the level of consciousness is the Glasgow Coma Scale. In addition to observing the patient’s motor, eye opening, and verbal responses, medical personnel should assess for orientation to person, place, and time and for the presence of retrograde amnesia.Symptoms such as dizziness, visual changes, and head or neck pain must be ascertained before removing the athletefrom the field.

If the athlete is able to understand and follow commands, he or she may be assisted to a seated position. If the initial respondent is confident that the athlete has sufficient strength and coordination, the patient can be helped to his or her feet and assisted off the field. Medical personnel should consider the use of a motorized cart or stretcher if the athlete cannot maintain balance in the seated or standing position.

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