Five Things Writer’s Need to Know about Being Knocked Out


Poor Forrest. Keith Jardine applies fist to face in their UFC fight.

Image copyright UFC.


Writer’s love knocking people unconscious. Mostly I mean fictional people, but not always. I’m pretty sure Matt Wallace wouldn’t hesitate to knock someone all the way into intensive care if the situation arose.


As Matt, or anyone who has ever been around combat sports or real fighting for any length of time, is that getting knocked out sucks. It’s not just a slightly inconvenient nap the way many writers portray it, and it’s not a nice gentle way for your hero to take someone out of the fight.


If you’re going to write in your protagonist knocking someone cold or getting knocked out themselves here are five things you need to know:

1. It Can Be Fatal


A blow to the head hard enough to knock a person unconscious is also hard enough to kill someone outright. A lot of the potential fatality of a strike to the head is dependant on where it lands. You will need an incredible amount of force to knock someone out through the front of their skull but the same blow delivered to the side of the head can cause massive cerebral haemorrhaging*.


The same goes for the back of the skull. The skull itself is thicker there than at the side of the head, but it’s also (obviously) where the neck vertebrae connect to your brain. That same knock out blow to the front of the head can separate vertebrae, crack the skull and cause severe brain injuries up to and including sending the recipient of said blow to the morgue.


2. Even If It Isn’t Fatal, the Damage Can Be Permanent


There’s a very good reason that MMA fighters, Kickboxers and Boxers are forced to take time away from the ring or the cage if they get knocked out. A concussion can be a very serious injury and while mortality rates from the initial concussion are almost zero there are potentially fatal complications that can develop.


Even if fatal complications don’t appear, damage from concussions can be cumulative, and anyone who’s seen a punch drunk boxer whose mind and reflexes are going because he’s taken too many blows to the head know that this is a very real thing.


Writers tend to ignore these cumulative effects; James Bond got knocked out, gassed out and generally disabled so many times he should have been ended up in a vegetative state instead of spreading syphilis to the attractive female spies of the world.

3. Recovery Is Not Instant


This goes for being choked, drugged or pummelled into unconsciousness. No matter how you go out, properly unconscious, it’s going to take you at least a minute to get your bearings properly.


Sadly I’ve had ample experience of all three and I can tell you right now that your first thought upon waking up is usually “why the hell am I on the floor?” Then most people, me included, feel sick and dizzy. Depending on how bad the blow, prolonged the choke, or powerful the drugs the feelings of disorientation and nausea can last for hours, if not days. This will hamper your hero’s efforts to do unto the bad guys. The evil doers might be disgusted if your protagonist pukes on them, but they probably won’t be rendered harmless.


4. Symptoms Can Appear A Long Time After The Initial Injury


Some of the nastier side effects of a hard strike to the head can appear a long time after the person thinks they’ve recovered. This is relatively rare but it’s still a risk, and it can make an excellent plot point.

The main one I’m talking about is something called Second Impact Syndrome. This is where a person gets a second blow to the head before the concussive effects of the first have passed. This can kill someone outright or induce serious bleeding in the brain which results life altering brain injuries.

Pugilistic Dementia can show up years after a fighter has stopped getting into the ring. And in extreme cases a powerful blow can result in a stroke occurring days or weeks after the knockout occurred.          


5. Torsion and Impact


A knockout can occur in two circumstances, at least in regards to a physical blow. The first is just outright trauma. I annoy a man who has a brick. The man belts me in the head with the brick and I take a free trip to the land of the unconscious**.


Alternatively, I see him coming, slip the brick backed blow and hit him on the point of the jaw with a left hook***; the force applied to his jaw twists his entire head around and this sudden movement starts slamming his brain back and forth inside his skull. He falls down and I take his brick away.


The actual mechanism of this sort of KO isn’t that well understood, and there are competing theories as to why the knock out is so instant. Other theories involve trauma to the brain stem, sudden loss of blood through and the separation of the neck vertebrae.


Regardless of why this kind of strike switches out someone’s lights, generally it’s a more survivable injury than pure impact trauma. Not that a punch to the head can’t kill someone (just ask your local Police, they deal with accidental punching deaths all the time), especially if someone with good technique is throwing it.


* Haemorrhaging: uncontrolled bleeding. Very bad thing to have happen to your brain.

** ‘Tis a silly place.

*** This scenario brought to you by my rich fantasy life.

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