ATP 4-02.11 Reference

HEAD INJURY & TRAUMATIC BRAIN INJURY ASSESSMENT

Source: ATP 4-02.11, Chapter 11 — Head Injury, 23 March 2026

Key Points

  • Assess consciousness with AVPU: Alert, Verbal, Pain, Unresponsive
  • Do NOT remove a protruding object from the head
  • Do NOT apply pressure to visible brain matter — cover loosely
  • Do NOT give a head-injured casualty anything to eat or drink
  • Use jaw thrust (not head-tilt) if spinal injury suspected
  • Monitor pupils: unequal pupils or no response to light = serious
  • Maintain patent airway — head injury patients may vomit
  • Monitor continuously for seizures, convulsions, deteriorating consciousness

Common Mistakes

  • Applying pressure directly to protruding brain matter
  • Using head-tilt when spinal injury may be present
  • Failing to monitor AVPU status continuously
  • Not checking both pupils for equality and light response
  • Giving food or drink to head-injured casualty

AVPU Assessment

  • A — Alert: fully conscious, responsive
  • V — Verbal: responds to voice/commands
  • P — Pain: responds only to painful stimulus
  • U — Unresponsive: no response to any stimulus

Document AVPU on DD Form 1380. Deterioration from A to V/P/U = serious sign.

Critical Warning

The first aid provider should NOT attempt to remove a protruding object from the head. Do NOT give the casualty anything to eat or drink. Do NOT apply pressure to visible brain matter — cover loosely only. Casualties with severe open head injuries may not survive regardless of evacuation speed. (ATP 4-02.11, para 11-31)

Types of Head Injuries

Closed Head Injury

No external wound — impact on the brain with the skull intact. Ranges from mild concussion to severe cerebral contusion. Signs and symptoms: (ATP 4-02.11, para 11-6)

  • Headache or pressure in the head
  • Nausea and vomiting
  • Dizziness and balance problems
  • Confusion and disorientation
  • Memory loss or difficulty concentrating
  • Mood and behavior changes
  • Sensory changes — blurred vision, ringing in ears
  • Sensitivity to light and sound
  • Loss of consciousness (severe cases)

Concussion

A type of TBI caused by a sudden, forceful movement of the brain within the skull. Concussions can occur without a direct hit to the head (e.g., blast overpressure, body impact). Most concussions do NOT involve loss of consciousness. (ATP 4-02.11, para 11-10)

Concussion symptoms overlap with closed head injury signs; every concussion is unique. Initial management: physical and cognitive rest. A gradual return to activity is required under medical guidance.

Cerebral Contusion (Coup-Contrecoup)

Bruising of the brain tissue. Contusions can occur at the site of impact (coup) AND on the opposite side as the brain rebounds (contrecoup). Severe contusions can lead to increased intracranial pressure and life-threatening complications. (ATP 4-02.11, para 11-15)

Additional symptoms may include: seizures, difficulty speaking, changes in vision, weakness on one side of body.

First Aid for Head Injuries

Provide direct manual stabilization of the head — hands on each side, head in line with body. Assess AVPU immediately. (ATP 4-02.11, para 11-30)

  1. 1

    Maintain a patent airway — use jaw-thrust maneuver (spares the cervical spine). Clear the airway. Head-injured patients may vomit; be prepared to roll them while maintaining spinal precautions.

  2. 2

    Assess AVPU — Alert, Verbal, Pain, Unresponsive. Document the initial score and recheck continuously.

  3. 3

    Control external bleeding — Apply dressings. Do NOT apply pressure over protruding brain matter or skull deformities. For non-penetrating scalp wounds, apply gentle pressure.

  4. 4

    Protect the wound — For open skull wounds: cover with a moist sterile dressing. Do NOT probe, clean, or attempt to remove any protruding object or brain matter.

  5. 5

    Treat for shock — Control all external bleeding, prevent hypothermia. Exception: Do NOT elevate legs for suspected head injury patients.

  6. 6

    Monitor continuously — Check AVPU, pupils (equal and reactive to light?), motor functions. Look for seizures or convulsions. Any deterioration is an urgent evacuation indicator.

  7. 7

    Request evacuation — All significant head injuries require medical evaluation and evacuation to an MTF. Document all findings and interventions on DD Form 1380.

Monitoring the Head-Injured Casualty

Monitor unstable casualties continuously for: (ATP 4-02.11, para 11-34)

  • Level of consciousness using AVPU indicators
  • Pupils — respond to light and are equal in size (unequal pupils = increased intracranial pressure)
  • Motor functions — strength, mobility, coordination, and sensation
  • Seizures or convulsions
  • Vomiting — risk of aspiration

Neck Injuries

Neck injuries may result in heavy bleeding. Apply pressure above and below the injury. Do not interfere with the breathing process. Apply a dressing. When blunt trauma occurs, always evaluate for a possible neck fracture or spinal cord injury — if suspected, seek medical treatment immediately. (ATP 4-02.11, para 11-35)

ATP 4-02.11 Source

Chapter 11: Head Injury — Army Techniques Publication 4-02.11, Casualty Response, Tactical Combat Casualty Care, and First Aid. Headquarters, Department of the Army, 23 March 2026.

See It in Practice — ESB Tasks

These ESB Medical Lane tasks apply this doctrine directly:

M8: Open Head Wound (CBRN)
Eye Trauma Burn Injury Management