First aid for self-harm resource: banging/hitting

This resource contains information which may be useful for performing care or advocacy work, or describes overall policy and principles.

This protocol is a draft. It has not yet been accepted as protocol and may be incorrect or poorly cited. Please do not use this in your work until it has been accepted.

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This is a resource for people who are self-harming, or people who are supporting someone who self-harms. It covers some basic first aid tips for treating injuries caused by hitting, banging, punching or kicking, which often cause bruises without breaking the skin. Also see 'Cuts' if the injured area is bleeding.

You may also want to see our 'Safer self-harm resource' for discussion of how to reduce the risk of serious injury.

This is not a substitute for first aid training and does not qualify anyone to describe themself as a ‘first aider’.

This guide sets out signs that an injury may present an urgent/potentially life-threatening risk, requiring an ambulance. It also covers situations where the injury is likely to deteriorate and risk further damage unless you go to A & E or seek other urgent medical treatment. You can still call an ambulance in these scenarios if you don’t feel well enough to travel to hospital.

We recognise that many people may be concerned about the potential consequences of going to hospital after self-harming. This resource is intended to help you assess when the risks of not getting medical help may outweigh the risks of doing so.

If you are supporting another person to treat their injuries, it’s also important to remember the risks of disease transmission, and wear gloves while handling any bodily fluids.

Hitting/banging injuries

How to treat

All hitting/banging injuries will benefit from rest, applying ice and avoiding anticoagulant painkillers.

Some injuries may also be eased by compression and elevation, particularly injuries caused by punching or kicking a hard surface. Together, these form the mnemonic RICE (Rest, Ice, Compression, Elevation)

You should also remember to remove any jewellery from injured hands or feet, in case the injury swells up and makes it impossible to take your rings off.

Painkillers

• You can take paracetamol or ibuprofen for pain, but avoid aspirin.
• Aspirin slows the blood from clotting. This may worsen the bruising, since bruises are caused by small broken blood vessels under the skin, and may put you at risk if you have any more serious internal bleeding.

Rest

• Try to avoid strenuous activities in the days following the injury.

Ice

• Reduce pain and swelling by holding a cold pack against the injured area.
• If you don’t have one, you can use a bag of ice cubes or frozen vegetables wrapped in a cloth.

Compression

• If you know how to apply a bandage, you can bandage the area - it should feel supportive, but not uncomfortably tight.
• This may have some benefit for bruises, but is most useful for supporting joint injuries (e.g. if you have jarred your wrist or elbow as a result of punching a wall.)

Elevation

• This is most relevant if you have injured a hand, wrist, foot or ankle. To reduce swelling and bruising:
  • prop your foot up on a stool or chair.
  • if you don’t have access to a sling, you can insert your hand into the neck of a zipped-up hoodie or buttoned-up jacket.
• If you think you may have broken a bone elsewhere in your arm or leg, do not attempt to elevate it - this might disturb the fracture and cause further damage.

Call an ambulance if...

• You notice any of the following symptoms
  • You feel weak, dizzy, sick or confused.
  • Your skin feels cold, but clammy and sweaty.
  • Your skin looks paler than usual (lighter skin) or has a greyish tone (darker skin).
  • This is called ‘shock’, and indicates that there is not enough blood in your circulatory system to sustain your tissues and organs. If a broken bone has punctured a blood vessel, you could be losing blood internally even if you can’t see any signs of this.

• You think you have broken a bone, and can’t get to hospital without moving the broken limb (for example, if you have hurt your leg).

Go to A & E/get urgent medical help if...

• You see any indications of a possible broken bone. Signs may include:
  • Swelling
  • Limb looks misshapen.
  • Numbness or tingling
  • Any severe pain in the injured area may also point towards a broken bone. Fractured bones do not always look visibly distorted and may be impossible to diagnose without an X-ray.

Headbanging

Like other impact injuries, head injuries will benefit from:

• Rest: Try to avoid strenuous activities after banging your head.

• Ice: Hold a cold pack against the injured area, or use a bag of ice cubes or frozen vegetables wrapped in a cloth.

• If you take a painkiller, you should avoid aspirin, as this will increase any internal bruising or bleeding.

However, there are some particular warning signs which could indicate that the injury has affected your brain.

If possible, it’s worth letting a housemate know that you have banged your head recently, so that they can seek medical help if they see any changes in your behaviour. You could also ask someone to check in with you by phone over the following days.

Call an ambulance if...

You have banged your head and have any of the following symptoms, or are feeling seriously ill in any other way. This could indicate swelling or bleeding in the brain.

These symptoms may not appear immediately - if they develop on the following day, it’s equally important to call an ambulance.

• Feeling confused and disoriented
• Problems with your senses, e.g. blurred vision or seeing double
• Problems with speech, balance or coordination
• Vomiting
• Seizures (if you don’t usually have seizures)
• Severe/increasing pain
• Clear or pale yellow fluid coming from your ears, nose or eyes. This might also be bloodstained.
• Unexplained bruises on your head in places you didn't hit, especially under your eyes or behind your ears

Go to A & E/get urgent medical help, if...

You feel unwell for longer than a brief period, with symptoms such as

• headache
• nausea
• dizziness
• forgetfulness or lack of concentration
• changes in mood, e.g. feeling irritable

It’s common to feel slightly dizzy, sick, confused or to have a headache immediately after banging your head. However, if the symptoms linger, it’s likely that you have concussion - mild temporary damage to the brain when it is shaken inside your skull. This usually gets better after a few days or weeks, but a hospital should check that you don’t have a more serious injury.