How to Act on SAH: First Steps

SAH, or Subarachnoid Hemorrhage, is a medical emergency requiring immediate action. It’s a critical condition where bleeding occurs in the space between the brain and the surrounding membrane (the subarachnoid space). Acting quickly and correctly can significantly impact the outcome, potentially saving lives and minimizing long-term neurological damage. This guide will walk you through the essential first steps if you suspect SAH, whether you’re a bystander, a family member, or even experiencing symptoms yourself.

Recognizing the Signs: What to Look For 🚨

The hallmark symptom of SAH is a sudden, severe headache, often described as the “worst headache of your life” or a “thunderclap headache” because it strikes instantaneously and reaches peak intensity within seconds to minutes. This isn’t your typical migraine or tension headache; it’s an excruciating, unprecedented pain.

Beyond this characteristic headache, other symptoms can emerge rapidly:

Stiff neck: This is often a sign of meningeal irritation due to blood in the subarachnoid space.
Nausea and vomiting: These are common accompanying symptoms.
Sensitivity to light (photophobia): Bright lights can worsen the headache and cause discomfort.
Blurred or double vision: Pressure on cranial nerves can lead to visual disturbances.
Sudden weakness or numbness on one side of the body: This indicates potential neurological involvement.
Difficulty speaking or understanding speech (aphasia): Another sign of neurological impairment.
Loss of consciousness or altered mental state: This can range from confusion and disorientation to coma.
Seizures: In some cases, SAH can trigger seizures.
Dilated pupils: One or both pupils might appear larger than normal.
Drooping eyelid (ptosis): This can also be a sign of nerve damage.

It’s crucial to understand that not all these symptoms will be present in every case, but the sudden, severe headache is the most consistent and alarming indicator. If you or someone else experiences this, assume it’s an emergency.

The Immediate Response: Call for Help! 📞

This is the most critical first step: immediately call emergency services (e.g., 115 in Vietnam, 911 in the US, 999 in the UK, 000 in Australia). Do not hesitate, do not try to drive yourself, and do not wait to see if symptoms improve. Time is brain when it comes to SAH.

When you call, be prepared to provide:

Your exact location: Be precise with the address, including apartment numbers or landmarks if applicable.
The nature of the emergency: Clearly state that you suspect a subarachnoid hemorrhage. Use phrases like, “Someone is experiencing a sudden, severe headache, possibly a brain bleed.”
The patient’s current condition: Describe their symptoms, level of consciousness, and any recent changes.
Your contact number: So they can call you back if needed.

Stay on the line with the dispatcher. They can provide valuable instructions and guidance while help is en route. They might advise you on how to position the person or what to observe.

While Waiting for Emergency Services: Essential Actions ⏱️

Once you’ve called for help, every second counts. Your actions during this waiting period can be vital for the patient’s well-being.

Positioning and Comfort: Aim for Stability 🛌

Lay the person down flat: If they are conscious, gently help them lie down on their back. Elevate their head slightly with a pillow if it seems to alleviate discomfort, but prioritize keeping their spine straight.
Turn them on their side if unconscious or vomiting: If the person becomes unconscious or starts to vomit, gently roll them onto their side (the recovery position). This prevents aspiration (inhaling vomit into the lungs) and helps maintain an open airway. Support their head and neck during this maneuver.
Loosen tight clothing: Undo collars, ties, or anything that could restrict breathing around the neck.
Keep them calm and still: Agitation can worsen intracranial pressure. Reassure the person and try to keep them as still as possible. Minimize noise and bright lights.

Monitoring Vital Signs: Observe and Report 👀

While you shouldn’t attempt to diagnose or treat, observing and being able to report vital signs and changes in condition to paramedics is incredibly helpful.

Level of consciousness: Regularly check if the person is awake, alert, responsive to voice, or only responsive to pain. Note any changes. For example, “Initially, they were confused, but now they’re not responding at all.”
Breathing: Observe their breathing rate and pattern. Is it fast, slow, shallow, or labored? Are they making any unusual sounds?
Color of skin: Note if their skin appears pale, bluish (cyanotic), or flushed.
Any new symptoms: Be alert for the onset of seizures, new weakness, or changes in pupil size.

Do NOT Give Medications: Avoid Complications 💊🚫

Do not give any pain relievers: Even common over-the-counter pain medications like ibuprofen or aspirin can thin the blood, potentially worsening a hemorrhage.
Do not give any food or drink: If the person’s level of consciousness is altered, there’s a risk of choking or aspiration.
Do not attempt to self-treat: This is a medical emergency that requires professional intervention. Any attempt to “fix” the problem yourself could be dangerous.

Gather Information (if safe and possible) 📋

If there’s someone else present or if the situation allows without delaying emergency care, quickly gather relevant information for the paramedics:

Medical history: Does the person have any pre-existing conditions (e.g., high blood pressure, diabetes, heart disease)?
Medications: What medications are they currently taking?
Allergies: Do they have any known allergies to medications?
Recent injuries or falls: Even a minor head bump could be relevant, though SAH is often spontaneous.
When symptoms started: Knowing the exact onset time of the headache is crucial for diagnosis and treatment planning.

Place these details, along with any relevant medical documents (like a medication list or a “vial of life”), in an easily accessible place for paramedics.

Preparing for Paramedics’ Arrival: Clear the Way! 🚑➡️🚪

Once emergency services are en route, help them get to the patient quickly and efficiently.

Unlock the door: If you’re in a house or apartment, unlock the main entrance door so paramedics can enter without delay.
Clear a path: Move any furniture, rugs, or obstacles that might hinder their access to the patient or block equipment.
Turn on lights: Ensure the area is well-lit, especially if it’s nighttime.
Silence pets: If you have pets, secure them in another room to prevent them from interfering with the paramedics or causing distractions.
Have someone meet them: If possible, have someone wait outside to direct the paramedics to your exact location, especially in large buildings or complexes.

When Paramedics Arrive: Follow Instructions 🗣️

When emergency medical personnel arrive, they are highly trained to handle situations like SAH.

Step back and allow them to work: Give them space to assess the patient and begin their immediate care.
Provide the information you’ve gathered: Clearly and concisely report everything you’ve observed, including the onset of symptoms, changes in condition, and any medical history or medications.
Answer their questions truthfully: They will ask specific questions to help them understand the situation.
Follow their instructions: They might ask you to move to another room, hold something, or provide further details. Cooperate fully.
Do not interfere with their care: Trust their expertise. They are performing critical actions to stabilize the patient.

Beyond the Immediate Emergency: Hospital Care and Beyond 🏥

Once paramedics transport the patient to the hospital, the journey for SAH treatment begins. This is not within your direct control, but understanding what happens next can help you cope with the situation.

At the hospital, the patient will undergo rapid evaluation, which typically includes:

CT Scan (Computed Tomography): This is usually the first diagnostic test and can quickly identify bleeding in the brain.
Lumbar Puncture (LP): If the CT scan is inconclusive but SAH is still suspected, a lumbar puncture may be performed to check for blood in the cerebrospinal fluid.
Cerebral Angiogram: Once SAH is confirmed, an angiogram is often performed to pinpoint the source of the bleeding, such as an aneurysm.

Treatment for SAH depends on the cause, but often involves:

Clipping or Coiling: If an aneurysm is identified, a neurosurgeon may perform either surgical clipping (placing a tiny metal clip at the base of the aneurysm) or endovascular coiling (inserting tiny platinum coils into the aneurysm to block blood flow) to prevent re-bleeding.
Medications: To manage blood pressure, pain, seizures, and prevent complications like vasospasm (narrowing of blood vessels in the brain).
Supportive care: Including monitoring in an intensive care unit (ICU), managing fluid balance, and preventing secondary injuries.

Understanding SAH: Causes and Risks 💡

While immediate action is paramount, a brief understanding of SAH’s background can provide context. The most common cause of spontaneous SAH is a ruptured brain aneurysm. Aneurysms are weak, bulging spots in the wall of an artery that can balloon out and eventually rupture, spilling blood into the subarachnoid space.

Less common causes include:

Arteriovenous malformations (AVMs): Tangled masses of abnormal blood vessels.
Trauma: Head injuries can also cause bleeding in this space, though the presentation might differ.
Blood clotting disorders: Conditions that affect the blood’s ability to clot.
Drug abuse: Particularly stimulants like cocaine.

Risk factors for developing or rupturing an aneurysm and thus SAH include:

High blood pressure (hypertension): A major modifiable risk factor.
Smoking: Significantly increases the risk.
Family history: A genetic predisposition can exist.
Certain genetic disorders: Like Ehlers-Danlos syndrome or polycystic kidney disease.
Excessive alcohol consumption.
Cocaine or amphetamine use.

Prevention and Awareness: Empowering Yourself 💪

While not all SAH can be prevented, especially those from spontaneous aneurysm ruptures, managing certain risk factors can reduce your overall risk of cerebrovascular events.

Control blood pressure: Regular check-ups and adherence to prescribed medications are vital.
Quit smoking: This is one of the most impactful changes you can make.
Manage cholesterol and diabetes: If you have these conditions, work with your doctor to control them.
Maintain a healthy lifestyle: Regular exercise, a balanced diet, and maintaining a healthy weight contribute to overall cardiovascular health.
Limit alcohol intake: Moderate consumption is key.
Avoid illicit drug use: Especially stimulants.
Be aware of family history: If SAH or aneurysms run in your family, discuss screening options with your doctor. While routine screening for aneurysms in the general population isn’t typically recommended due to risks associated with imaging and false positives, it might be considered in high-risk families.

The Emotional Toll: Support and Coping 🫂

Witnessing or experiencing an SAH is a traumatic event. It’s crucial to acknowledge the emotional impact on both the patient and their loved ones.

For the patient, recovery can be long and challenging, involving physical therapy, occupational therapy, and speech therapy. They may also experience cognitive and emotional changes.

For family and friends, the stress, fear, and uncertainty can be overwhelming.

Seek support: Don’t hesitate to reach out to family, friends, support groups, or mental health professionals.
Educate yourself: Understanding the condition and recovery process can help alleviate some anxiety.
Practice self-care: Remember to take care of your own physical and mental well-being during this challenging time.
Be patient: Recovery from SAH is a marathon, not a sprint. Celebrate small victories and be prepared for setbacks.

Subarachnoid hemorrhage is a severe medical emergency. The key to a better outcome lies in rapid recognition of symptoms and immediate activation of emergency medical services. By understanding the signs, knowing what to do in those crucial first moments, and preparing for the arrival of paramedics, you can play a critical role in potentially saving a life and minimizing the devastating effects of SAH. Awareness and quick action are truly lifesaving.