A rare condition—second impact syndrome (SIS)—may lead rapidly to increased intracranial pressure and death if a recently concussed patient receives a second, even minor, blow to the head before their symptoms fully resolve. SIS should not be confused with repetitive head injury syndrome where a person suffers from repetitive head injuries over a long period of time and experience a progressive loss of cognitive abilities.
Evacuation in a Wilderness Environment
Patients suffering a significant MOI without a loss of consciousness, amnesia, or seizures should be closely monitored for 1-2 hours for S/Sx and may remain in the field if none develop. If S/Sx develop, begin a non-urgent evacuation for physician evaluation along with those who present with a temporary loss of consciousness, amnesia, or seizures. An urgent evacuation is indicated for those whose initial S/Sx increase/worsen. If the decision to evacuate is made, patients should minimize exertion during the evacuation. If during a self-evacuation their S/Sx increase with even minimal exercise, they should be carried and the urgency of the evacuation increased. It is vital that concussed patients avoid a second traumatic blow during the evacuation and should not self-evacuate via ski, board, bike, or any method involving speed or jolting.
- Any concussed patient should be evaluated and treated for a potential spine injury.
- All patients who remain voice responsive, pain responsive, and unresponsive after a blow to the head require an urgent evacuation and may not survive the event.
All WMTC medical courses address traumatic brain injuries using lecture, case study review, and simulations. Guides and expedition leaders should consider taking our Wilderness First Responder course.