That moment when you realize that you’re not invincible as you get smacked in the head, really hard, and the lights go out.

What do you do when you’ve hit your head? I almost decided not to write an article on head injuries because of how serious they are. It was the experience of a friend who knocked himself out and wasn’t sure how seriously to take it that made me realize that this article would be useful. He had brain contusions which are not cool. Hopefully this article will help people decide to go to hospital sooner.

Eye injuries, smashed noses, broken ear drums and other facial trauma will be discussed in other articles.

Porthleven UK on an early November swell. The only time I’ve hit my head hard in the sea.

We all think about it when see the water boiling in front of us, or set up to navigate a dry section, but serious head injuries in the surf are quite uncommon. You’re actually far more likely to have a head injury on the way back from the beach in the car (like my mate), or your way home from the pub, than you are in the water.

Everyone has a ‘sketchy-car-journey-abroad’ story. This article is aimed at advice on what you, or your mates, should look for if the lights go out and you see stars.


This isn’t a very lighthearted article. I’ve seen people who have died or been severely disabled from relatively unremarkable low impact head injuries. It really is very difficult to diagnose early without imaging machines. Head injury followed by a loss of consciousness is one of the injuries that I don’t advocate getting back in the sea straight after. Wait until you’re well. When you feel well do some exercises and see if you still feel well. A second impact is much more likely to be fatal. Get advice from a doctor.

Your brain is a box. If it bleeds the pressure in the box after a while can increase. The rising pressure gradually squeezes your brain and eventually pushes it out of the only opening in the box at the base of your skull. This kills you in the process. Before the pressure increases there may be a period of time when you may feel fine after an injury as your brain makes room for the extra blood in its box. You may then deteriorate rapidly.

Your brain may not bleed, but it may have little stress fractures (contusions) as well as swelling. This swelling creates mild pressure and basically causes the symptoms of concussion.


You Don’t.

head injury
sport hurts


Head injuries are really serious. Take them seriously. They’re an opportunity for your mates to prove their metal.

Bottom line is, if you’re in any way concerned about the behavior of a mate who’s hit their head you need to make plans to get them to a medical organization as soon as possible. This is why you have insurance. Throw all your money at it if you need to.

Remember head injuries can also mean spine injuries. Its thought that 10% of head injuries also have a spine injury. Be careful handling injured people. If help can come to them, don’t move them. Let professionals do their job. Read our article on spinal injuries.

If you’re concerned or just interested then the following link is a document that has the current UK guideline on Head Injuries. Skip to chapter 4.

Another useful resource:

The following then is a guide only, not the rule on when it may be okay for an adult not to go to a hospital after a head injury.


When all of the following are met:

(remember that if you have anyamount of concern you should go to hospital)

  • Normal level of alertness and ability to process information.
  • Low force injury
  • No loss of consciousness
  • No memory loss of what happened before injury
  • Maximum of one episode of vomit
  • No seizures.
  • No areas of numbness/tingling anywhere
  • No neck stiffness or discomfort from bright lights
  • No generalized irritability (this is important!)
  • No difficulties with vision
  • No bowel or bladder accidents
  • No severe or worsening headache
  • You weren’t hammer drunk or off your head before the injury!
Apart from the serious issue of the head injury, you may also have to navigate the problems associated with coral cuts, sea urchin stings/spines and general wound management.
Make sure you’re clued up on what to do.

Author: Dr Dave Baglow

Download this article here


There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.

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