Assessment
Glasgow Coma Scale in Head Injury Assessment
Scoring eye, verbal, and motor responses to quantify neurologic status and guide trauma transport decisions.
Components and scoring
The Glasgow Coma Scale sums eye opening (1–4), verbal response (1–5), and motor response (1–6) for a total between 3 and 15. The CDC identifies traumatic brain injury as a major cause of death and disability; GCS gives EMS a reproducible snapshot at scene and during reassessment.1 Score each component separately—do not default to “GCS 15” without testing all three domains.
Eye opening ranges from none to spontaneous. Verbal scores account for intubation (“E” notation) and language barriers where applicable. Motor response distinguishes purposeful movement, withdrawal from pain, abnormal flexion or extension, and none. Bilateral assessment matters: unequal pupils or lateralizing motor deficits suggest focal brain injury beyond the total score.
GCS in transport and triage decisions
MedlinePlus notes that head injury severity correlates with altered consciousness, vomiting, and amnesia—GCS helps quantify the first of those findings.2 Field triage guidelines use GCS thresholds (often ≤13) as trauma center criteria alongside physiology and mechanism. A dropping GCS during transport is more alarming than a stable low score at first contact.
Document GCS with time stamps after interventions—sedation, pain control, and hypoxia all depress scores. Repeat scoring every five minutes in unstable head injury or when coexisting shock or hypoglycemia could mimic neurologic decline.
Practice this skill
Apply what you read with a hands-on GCS Scoring drill — instant feedback on every scenario.
