Following trauma to the head and neck a patient may need to be evaluated at an Emergency Department. The National Institute of Clinical Excellence (NICE) of the English National Health Service has developed criteria for when a patient should be transported by an ambulance or other means to the Emergency Department (ED).


Criteria for calling an ambulance:

(1) unconsciousness or lack of full consciousness (any impairment of consciousness)

(2) problems with understanding, speaking, reading or writing

(3) loss of feeling in part of the body

(4) problems with balance or walking

(5) general weakness

(6) any change in vision

(7) any clear fluid running from the nose or ears

(8) a black eye with no associated damage around the eye

(9) bleeding from 1 or both ears

(10) new onset of deafness

(11) bruising behind 1 or both ears

(12) any evidence of damage to the scalp or skull, especially penetrating injuries

(13) any convulsion

(14) a high speed or high energy injury


NOTE: Some of these symptoms are indications for immobilization of the cervical spine (see above).


Criteria for going to the Emergency Department right away:

(1) age >= 65 years of age

(2) any loss of consciousness (any history of impaired consciousness)

(3) any problems with memory (amnesia)

(4) a headache that does not go away

(5) an episode of vomiting

(6) previous history of brain surgery

(7) coagulopathy or current anticoagulation therapy

(8) irritability

(9) change in behavior (not themselves, easy distractability, indifference, etc.)

(10) intoxication by drugs and/or alcohol

(11) suspicion that trauma was not accidental (intentional by patient or another)

(12) concern by a health care provider about the diagnosis


If the person meets one or more criteria for coming to the ED right away but cannot be brought to the Emergency Department safely, then transport by ambulance is appropriate.


Criteria for followup with personal physician:

(1) adverse social factors (no one to be with the patient, others)

(2) a continued concern about the injury


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