ALL head-injury patients must be constantly monitored during transport. Be prepared to suction and turn patient onto his/her side if they vomit.

Some EMS agencies use the Glascow Coma Scale, in addition to AVPU, for neurological assessment. The scale goes according to the information below:

Eye Response
give them 4 points if eye response is spontaneous
3 if eye response is to voice
2 if eye response is to pain
1 if there is no eye response

Spontaneous eye opening means that the patient opens his/her eyes without you having to do anything.
To Voice- means that when you say, "open your eyes" they should obey, however if their eyes remain closed apply a painful stimulus, such as placing a pen between two fingers and squeezing.

Verbal response
5 points if oriented
4 points if confused
3 poinrs if inappropaite words
2 points if incomprehensible sounds
1 point if no response

oriented- The patient, once aroused, can tell you who they are, where they are, and the day of the week.
confused- The patient cannot answer the above questions, but can speak in phrases and sentences.
Inappropriate words- The patients shouts or says a word or several words at a time. Usually this requires physical stimulation. Often, the patient curses.
Incomprehensible sounds- The patient responds with moans, groans, or mumbling.

Motor Response
6 points if they obey commands
5 points if they can localize pain
4 points if they withdraw from pain
3 points if they flex because of pain
2 points for extention
1 point for no response

Obeys command- the patient must be able to understand your instruction and carry out the request.
Localizes pain- should the patient fail to respond to your commands, apply pressure to one of their nail beds for five second and note if they try to remove your hand.
Flexion/Extension- note if the legs and arms extend, if there is apparent stiffiness with these moves.

Once you are done add up each number you received and that will be your total Glasgow Coma Scale number.

*NOTE Do not spend time at the scene calculating the GCS score. There is always time in the ambulance.