Quick recognition
Confusion, memory gap, 'what just happened' affect
Asking the same question repeatedly, forgetting the moment of impact, slow-to-answer responses. Often the most telling early sign because the patient minimizes everything else.
Headache, pressure in the head, neck pain
Most universal symptom. New-onset headache after head impact is presumed concussion until proven otherwise. Worsening headache is a red flag for ER.
Balance trouble, dizziness, nausea or vomiting
Vestibular involvement is common. Standing with eyes closed and feet together (modified Romberg) — swaying or stepping out is abnormal. Repeated vomiting is an ER trigger.
Vision symptoms — blurry, double, light sensitivity
Pupillary response should be equal and brisk; unequal pupils are an ER trigger. Photophobia (light sensitivity) is common and usually benign in the first 48 hours.
'Just not right' feeling reported by patient or noticed by partner
Subjective changes in cognition, mood, or processing speed reported by someone who knows the patient well. The CDC HEADS UP messaging emphasizes that 'doesn't seem like themselves' is a real diagnostic signal.
Loss of consciousness, even brief
Any LOC after head impact is a presumed concussion at minimum. LOC >30 seconds is an ER trigger. Note that 80%+ of concussions occur WITHOUT loss of consciousness.
Response protocol
- 1
Step 1 — Stop activity immediately
Sit the patient down. Remove from any further risk of impact. The biggest mistake is the 'let me walk it off' five minutes after the hit — second-impact syndrome (a second concussion while still symptomatic) is dramatically higher mortality.
- 2
Step 2 — Sideline screen — check the red flags
Loss of consciousness >30 seconds · vomiting >once · unequal pupils · slurred speech · weakness or numbness on one side · severe or worsening headache · seizure · clear fluid from nose or ears · neck pain after impact. ANY of these triggers a 911 call (or immediate ER if 911 cannot reach you).
- 3
Step 3 — Quiet rest for the first 24-48 hours
No screens, no caffeine, no alcohol, no vigorous activity. Sleep is fine; the old myth about not letting them sleep was based on decades-old neurology and has been retracted by CDC. Wake them every 2-3 hours in the first 24 hours to confirm orientation.
- 4
Step 4 — Urgent care or telehealth within 24 hours
Every suspected concussion deserves a clinical evaluation. Telehealth (UrgentMed, AmericanWell, Teladoc, etc.) works for the initial screen and return-to-activity planning. Bring imaging records if any.
- 5
Step 5 — Symptom-limited rest then graduated return
Days 1-2 are full cognitive and physical rest. Days 3+ are symptom-limited light activity — if symptoms worsen, back off. Graduated return-to-activity progresses through six stages per CDC HEADS UP: rest → light aerobic → sport-specific → non-contact → contact practice → full activity.
- 6
Step 6 — Do NOT drive the rig until cleared
Reaction time, processing speed, and divided attention are measurably impaired for days to weeks after a concussion. Pulling a 30 ft fifth wheel with measurable cognitive impairment is a fatality risk. Stay parked or have someone else drive.
Prevention
Treat low clearances as the #1 RV head-injury risk
Slide-out edges, awning legs, basement compartment doors at head height, low overhead cabinets, and entry-door frames cause the majority of in-rig head injuries. Pad sharp corners, lower lighting at known strike points, and slow down in the rig.
Wear a helmet for any bike / scooter / e-bike / climbing activity
Cycling and e-bike injuries are the leading recreational cause of concussion in U.S. adults. CPSC or DOT helmet, properly fitted (two-finger fit at the brow), worn EVERY ride — including the campground loop.
Use a step-stool with a handhold for any climbing in the rig
Falling off a step-stool while reaching for an overhead cabinet is a common older-RVer head injury. A two-handle step-stool with the second hand on the rig wall prevents the recoil fall.
Stabilize the rig fully before any roof, ladder, or slide work
Slide-out or ladder work on an un-leveled rig is a fall risk. Leveling jacks down, ladder feet on solid ground, second person spotting. Most ladder falls happen during routine inspection, not new repairs.
Brief everyone on the CDC HEADS UP red flags
If only one person in the party knows the symptoms, that person will not be the one who notices when they themselves are concussed. Brief the partner / kids on what to watch for so they can advocate for you.
Plan a 'no high-risk activity if recently concussed' policy
Second-impact syndrome — a second concussion while still symptomatic from the first — has dramatically higher mortality, especially in young adults. If anyone in the party had a concussion in the last 30 days, no contact sports, no high-speed cycling, no off-road ATV.
Real case studies
Annual · CDC HEADS UP campaign data
CDC's HEADS UP initiative reports approximately 3.8 million sports- and recreation-related concussions per year in the U.S., with cycling, skiing, and falls as the leading mechanisms in adults. RV-specific head injuries are not tracked separately but appear in NEISS data under bicycle, fall, and 'other recreation' codes.
Lesson: Concussion is common, often unrecognized, and the 24-48 hour rest window is critical. CDC HEADS UP toolkits are free online and the standard reference for sideline assessment.
Source: CDC HEADS UP — Concussion
Recurring · Wilderness Medical Society field guidance
WMS clinical practice guidelines for backcountry head injury emphasize that any loss of consciousness, persistent vomiting, unequal pupils, focal neurologic deficit, or worsening headache mandates evacuation. The challenge in RV / backcountry travel is reduced access to imaging, so the threshold for evacuation is lower than in town.
Lesson: When you are 4 hours from a CT scanner, the red-flag threshold drops. Evacuate sooner rather than later for any concerning finding.
Source: Wilderness Medical Society
What authorities don't always tell you
Editorial secrets
The 'don't let them sleep' rule was retracted years ago
The old advice came from a fear of intracranial hemorrhage progressing during sleep. CDC and current neurology guidance is that normal sleep is fine and likely beneficial. Wake every 2-3 hours in the first 24 to confirm orientation; do not deprive them of sleep.
Loss of consciousness is NOT required for concussion
Approximately 80% of diagnosed concussions occur without loss of consciousness. The CDC HEADS UP messaging specifically calls this out because the public still believes 'they didn't pass out, so they're fine.' That belief sends concussed people back into activity.
The most useful single screening question is 'do you feel like yourself?'
Athletic trainers use it on sidelines because it captures the subjective 'something is off' that beats every objective test for early concussion detection. If the answer is no, treat it as concussion until proven otherwise.
Second-impact syndrome is the reason graduated return matters
A second concussion while still symptomatic from the first carries dramatically higher mortality, especially in adolescents and young adults. The graduated return protocol exists specifically to avoid this catastrophe. Do not shortcut it.
RV head-strike injuries are wildly under-reported because owners minimize them
Slide-out edges, awning legs, low cabinets. The 'I just bonked my head' minimization is exactly the cognitive distortion concussion produces. If you saw stars or lost a few seconds, sit down and run the screen.
Equipment recommendations
Generic categories — no brand endorsements. Verify current specifications against the manufacturer's documentation.
Foam edge padding for slide-out and cabinet corners
Spec: Open-cell foam strips with adhesive backing; minimum 0.5 in thick; applied to all head-height sharp edges in the rig.
Storage: Inventory in the RV-supplies bin; replace annually when sun-degraded.
CPSC / DOT helmet per person
Spec: Properly fitted (two-finger fit at brow, snug strap, no fore-aft slip); worn for cycling, e-bikes, scooters, ATVs.
Storage: Outdoor gear bin; one helmet per family member, sized for current head circumference.
Concussion screen card (CDC HEADS UP printable)
Spec: Pocket reference card with red-flag list and orientation questions; laminated.
Storage: First-aid kit.
Cold packs (instant chemical or refreezable gel)
Spec: At least 4 instant ice packs (single-use chemical activation); supplement with reusable gel packs in the freezer.
Storage: First-aid kit + freezer.
Step stool with handhold for in-rig climbing
Spec: Two-tread step stool with a 30 in vertical handhold; non-slip feet.
Storage: Outdoor gear bay; pulled into the rig for any overhead cabinet work.
When to call 911 vs ER vs self-care
Call 911 now
- Loss of consciousness >30 seconds
- Repeated vomiting after head impact
- Unequal pupils, slurred speech, seizure, weakness on one side
- Clear fluid from nose or ears
- Severe or worsening headache
- Cannot wake the patient or confusion that does not resolve
Drive to ER
- Single brief LOC <30 seconds with normal current mental status (still warrants imaging)
- Persistent headache, dizziness, nausea >24 hours despite rest
- Any concussion in a child <2 years old
Urgent care
- Suspected concussion without red flags — initial clinical assessment and return-to-activity planning
- Telehealth acceptable for the initial screen
Self-care at home
- Mild head bump with no symptoms after 30 minutes of rest, no other risk factors — monitor for 24 hours
Frequently asked questions
Does a concussion require loss of consciousness?
No. Approximately 80% of concussions occur without LOC. Confusion, memory gap, headache, dizziness, vision changes, and 'just not right' feeling are the dominant early signs. The 'they didn't pass out' belief is the single biggest reason concussions get missed.
Can I let them sleep after a concussion?
Yes. The old 'don't let them sleep' advice was retracted years ago. Normal sleep is fine and likely beneficial. Wake them every 2-3 hours in the first 24 hours to confirm orientation (name, location, date); if they cannot be roused or are confused, call 911.
How long does a concussion take to recover?
Most adults recover within 7-14 days with rest and graduated return. Some take longer — persistent post-concussive syndrome can last weeks to months. Following the graduated return-to-activity protocol reduces persistent symptoms and prevents second-impact syndrome.
Can I drive the RV after a concussion?
Not until cleared. Reaction time, processing speed, and divided attention are measurably impaired for days to weeks. Driving a 30 ft rig with measurable cognitive impairment is a serious risk. Stay parked or have someone else drive.
What is second-impact syndrome?
A second concussion sustained while still symptomatic from a prior one. Mortality is dramatically higher, especially in young adults and adolescents. The reason the graduated return-to-activity protocol exists is to prevent this catastrophic outcome.
Should I get a CT scan after a head injury?
Not every concussion needs imaging. Most do not. CT is indicated for any red flag (LOC >30 sec, repeated vomiting, focal neuro deficit, etc.). Urgent care or ER will apply a clinical decision rule (Canadian CT Head Rule, New Orleans Criteria) to decide.
Is this page a substitute for a doctor?
No. PickRV reference only. CDC HEADS UP toolkits are the public standard; an in-person clinical assessment is recommended for every suspected concussion.
Sources
Related safety pages