Suzuka background information: head injury definitions

Head injury is often divided into mild, moderate and severe. These definitions depend on a classification system that I’ve mentioned some time ago (under equally stressful circumstances) called the GLASGOW COMA SCORE (GCS). This is a standardised score used worldwide that gauges the depth of coma, and allows tracking of a patient’s condition.

The immediate approach to a patient with evidence of (or suspected of having) a head injury (and once the airway is opened and secured, oxygen provided, and circulatory status verified) involves assessment of the pupils. Normally, pupils are mid-open, and react to light.

Under some circumstances, that changes. When we remember that the diameter of the pupils is controlled in the brainstem, where most other vital functions are handled, we realise that the pupils can be a marker of significant things happening neurologically.

Dilated pupils that do not constrict with light worry us. A lot. I mean seriously a lot.

One dilated pupil means the brainstem is getting squished to one side by asymmetric pressure above. Not good at all. VERY rapid action is indicated.

There are other pupillary signs – details for us here. Let’s move on.

The next thing that’s assessed is the GCS. Scores run from a minimum of 3 to a maximum of 8. Scoring allows classification into MILD (GCS 13-15), MODERATE (GCS 9-12) and SEVERE (≤8) head injury. This determines initial management.

When the rescuer looks at the pupils, she’s also looking at the eyes. There are four possibilities, and these are given points:

  • eyes open spontaneously: 4 points
  • eyes open when you talk to the victim: 3 points
  • eyes open when the victim receives a painful stimulus: 2 points
  • no eye opening: 1 point

The patient’s vocalisation is next assessed. The verbal score is done like this:

  • oriented: 5 points
  • confused: 4 points
  • inappropriate, but stil words: 3 points
  • sounds only: 2 points
  • no verbalisation at all: 1 point

Then the patient’s movements are considered (the best side if there’s a difference):

  • obeys simple commands: 6 points
  • pushes away an “annoying” hand: 5 points
  • vague mass reaction to noxious stimulation: 4 points
  • highly abnormal generalised flexion response: 3 points
  • highly abnormal generalised extension response: 2 points
  • no movement at all: 1 point

Mild head injury (13-15) is usually what we call concussion. They lose a point because when you leave them alone they shut their eyes, and another because they’re confused.

Severe head injury patients lose points with their eyes – usually at best a 2, more often a 1. They lose points on verbal. When we get to these folks fast, they might be speaking. That rapidly becomes mumbles, moans, etc. One point gone each step. And lastly, severe head injury patients often initially show those frightening abnormal responses, which often indicate pressure on the brain from a hematoma.

Enough for now.


22 thoughts on “Suzuka background information: head injury definitions

  1. Saddened at yet another terrifying injury touching this sport, but so glad for your insight. Watching the video of Jules’ impact is just shocking. Thank you, as always, for helping us laymen make sense of all of this…as much sense as can be made.
    Fingers crossed for Jules.

  2. Hitting the recovery tractor. How could that happen? Because it was there. Simplistic? I don’t know how race cars find these objects, but they do, and often. That’s why they don’t leave disabled cars on the side of the track. Because some guy will hit them, for certain. Not on purpose, but they seem to have a magnetic field around them. And Bianchi’s circumstance was a yellow flag area.

    • The BBC say Bianchi’s aquaplaning was while the yellow flags were being deployed – it seems the tractor was into the run off area before the yellow flags had been deployed and Bianchi went off before the yellow flags had gone out.

      • That said, from seeing Sutil going off to actually DEPLOYING the flag(s) takes a finite amount of time. This is a vulnerable period anywhere, but in good conditions – long straight, good light, no spray – the driver SEES something is going on. Here, going up the essex, the next corner is blind. Remember, you’re racing, and so you’ve placed (literally) your life in the hands of the flag marshals. If, as has been suggested, Jules went off at the precise moment between the accident and the yellow coming out (entirely plausible in the circumstances), this shows how vital yellows are.

        An initial, waved, yellow would be displayed without race control needing to tell the post to do so. As soon as recovery operations start, a second waved flag is added. That’s how that works. The second flag will usually be announced by race control to the post, but can be deployed autonomously. Classically, when there are double yellows at one post, the upstream post displays a single yellow, to warn of an upcoming problem.

      • If you watch the clip of him hitting the recovery vehicle you can see a green flag waving. This is very confusing and needs investigating

      • G Wad, that green flag waving was referring to the next sector. In the sector where Bianchi aquaplaned it was double yellow, for sure.
        The question is if it should be yellow, double or single, where you see green.

  3. Doc, thanks for giving us insight.
    I really appreciated it.
    Sad that this happened to Jules.
    Let us wait for the next news.
    I agree with Nick Heidfeld when said: At the moment no news are good news. Next hours will be important.

  4. Hey Gary. From a slightly different perspective. In the event where a patient has lost capacity – are next of kind informed of what has occurred? Do the medical staff operate on the patient on grounds of best interests? Or do they have to await for decisions from next of kin or whoever holds power of attorney?

  5. Perhaps the use of these type of heavy tractors needs to be reconsidered. Would a better solution be to have cranes based on the other side of the barriers that can reach over and lift cars out of the way, a good example would be those used in Monaco. Another approach which is probably too simplistic would be fitting something like a techpro barrier around the base of the tractors.

    • I really appreciated all that information but what I would really like to know is how does one go about hitting a large tractor?

      • Mimi,
        The race began at 11pm PDT so I watched the safety car, the flooded track, the cars skidding around, and, disgusted that the thing wasn’t red-flagged until the storm blew over (I mean like IQs over 40 would recognize highly dangerous conditions and all that) I hit the off switch. This morning I read Jules Bianchi has a severe head injury because he ran into the recovery vehicle removing Sutil’s damaged car. We have to ask ourselves: On a scale of 1 to 10, how necessary was it to run a race that was certain to end up badly for someone? Just to keep on schedule to get to Russia in time to set up for next week? Who’s running this show? Oh. That’s right. Him.

      • Sue: I may be wrong but I think Mimi was asking what was a heavy tractor doing in the way of aquaplaning cars. Put it mildly it seems to be risking the lives of the drivers. Maybe these risk are deemed necessary but surely one can query it?

        Latest is that Bianchi is out of surgery and is breathing unaided.

      • Sorry. On second read I can now see that I may have misconstrued Mimis comment. I suppose that the recovery vehicle was following procedure, but that that procedure was not reviewed during the atrocious conditions in which the race was run.

        I really hope all goes well for Jules

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