From a medical point of view concussion is actually the state of being shaken or the result of such a jarring. The term has, however, passed into both lay and medical colloquialism, referring only to brain concussion and so is now used to describe an immediate loss of consciousness, transient in nature due to a violent shaking or agitation of the brain within the cranium (skull). Concussion may be associated with a penetrating injury but usually it is due to a blunt blow and is caused by a change in the momentum of the head. What this means is that a blow causes the skull to go in one direction but the brain, because it is floating in cerebrospinal fluid, stays stationary and gets ‘hit’ by the skull.

Most often such an injury results in a headache and nothing more, but if a loss of consciousness is associated then the term concussion is used to describe the situation.

Concussion may also be used for a partial loss of consciousness where an individual is clearly unaware of where they are or aspects of reality that relate to that current time.

Associated with concussion may be a shallowness of breathing, a massive adrenaline response leading to pale, cold and clammy skin, a tachicardia (rapid heart rate) and a drop in blood pressure noted by a weak pulse. Recovery may also be connected with nausea and vomiting, and loss of bowel and bladder control. Upon recovery, a loss of memory is not uncommon.

It is important to remember that concussion is a temporary state and if it persists then the term used is unconsciousness. Further symptoms occur in unconsciousness which are generally not associated with concussion. These include twitching of the limbs or convulsions, a flushed face rather than pallor and, as the patient recovers consciousness, weakness or paralysis may be noted in any part of the body and the awareness or alertness of the individual may be deficient.

A warning sign that the brain has been damaged and that an intracranial bleed may be occurring is an inequality in pupil size, a bilateral dilation of the pupils, or pupils that are not reactive to light .


Whether concussion or unconsciousness is the ultimate definition, emergency first aid is relevant and the ABC (airways, breathing, circulation) routine or cardio-pulmonary resuscitation (CPR) is the first step.

Once the ABC of resuscitation is performed, establish the probable cause of concussion. Cover with a blanket and, if possible, also place one underneath the casualty.

Check the patient’s wallet and pockets for any medical notification, such as a diabetic card, steroid card, anti-coagulant card or medical-alert bracelet that may be worn.

The recovery position

Any unconscious patient should be placed in the recovery position to avoid the possibility of vomiting, which may be inhaled and cause asphyxiation. The positioning of a casualty into the correct position, which used to be known as the coma position, must be preceded by clearly establishing that there is no neck or spinal injury. Moving a patient with such damage may lead to paralysis or death by putting pressure on or severing the spinal cord.

Moving a body safely

Place both arms of the casualty close to the body.

Turn the casualty on to his/her side. This is done most conveniently by grasping clothing at the hip (1).

Pull up the upper arm until it makes a right angle with the body and then bend the elbow (2).

Draw up the upper leg of the same side until the thigh makes a right angle with the body and then bend the knee (2).

Pull out the other arm, which is generally underneath the body at this stage, and extend it slightly behind the back (3).

Bend the undermost knee slightly.

This position places the body in such a way that it will be stable and prevent asphyxia (4). The heavier the body, the more difficult this procedure and it is often easier to do all of the above in a kneeling position beside the casualty.