First Aid Training - Skull fracture


If a casualty has a head wound, be alert for a possible skull fracture. An affected casualty may have impaired consciousness.

A skull fracture is serious because there is a risk that the brain may be damaged either directly by fractured bone from the skull or by bleeding inside the skull. Clear fluid (cerebrospinal fluid) or watery blood leaking from the ear or nose are signs of serious injury.

Suspect a skull fracture in any casualty who has received a head injury resulting in impaired consciousness. Bear in mind that a casualty with a possible skull fracture may also have a neck (spinal) injury and should be treated accordingly.


  • Wound or bruise on the head.
  • Soft area or depression on the scalp.
  • Bruising or swelling behind one ear.
  • Bruising around one or both eyes.
  • Clear fluid or watery blood coming from the nose or an ear.
  • Blood in the white of the eye.
  • Distortion or lack of symmetry of the head or face.
  • Progressive deterioration in the level of response.

Your aims

  • To maintain an open airway.
  • To arrange urgent removal of the casualty to hospital.


If the casualty is conscious:

  • Help them to lie down.
  • Do not turn the head in case there is a neck injury.
  • Control any bleeding from the scalp by applying pressure around the wound.
  • Look for and treat any other injuries.
  • Dial 999 for an ambulance.
  • If there is discharge from an ear, cover the ear with a sterile dressing or clean pad, lightly secured with a bandage. Do not plug the ear.
  • Monitor and record vital signs - level of response, pulse, and breathing - until medical help arrives.

If the casualty is unconscious:

Open the airway using the jaw thrust method and check for breathing (primary survey).
Be prepared to give chest compressions and rescue breaths if needed.
Dial 999 for an ambulance.
If the position in which the casualty was found prevents maintenance of an open airway or you fail to open it using the jaw thrust, place her in the recovery position. If you have helpers, use the "log-roll" technique.

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