The head contains the brain, organ of awareness and response. Brain is very sensitive to the trauma and needs resuscitation in a time called golden period that may be 15 minutes to 45 minutes from the time of injury to the time of resuscitation.
In the developed countries this is known as, brain is time, since health care is much advanced to deliver the necessary treatment on spot of injury only and the resuscitation starts while evacuation of the injured in highly facilitated ambulances to the hospitals for major neurosurgical procedures. This still is a dream for the 3rd world countries.
Why do younger people die more than the elderly? The Head Injury means physical insult or trauma to the skin of the head, its underlying tissue, bone, coverings of the brain, the vessels of the brain or itself to the brain tissue of a person. The injury may be mild if the bone and the brain components are not involved but it is severe if these elements are injured.
However Brain Injury always means severe head injury where bones are fractured to poke inside the brain, vessels are torn, internal or external brain hemorrhages occur, brain is bruised and swollen due to edema and the pressure inside the brain tissue increases multifold against the normal.
All this happens to the brain when it is caged and closed inside a rigid and bony locked-box, the Head (Skull), which has hardly any window or the door.
Again it is noteworthy for the awareness of the people that a young man (up to the age of 30 years) has no extra-space inside the head because of harboring a full sized, weighty and fully functional brain than an elderly person, so the reaction of the brain to the injury is also the severe in terms of swelling and pressure.
Thus the chances of recovery and survival are always lesser in youth after severe brain injury even after a long neurosurgical operation.
Although less survival in the youth is multifactorial and one among these is the impact of the brain injury being severe and other is the pre-injury use of drugs which doubly increase the chances of deep-coma and reduces the chances of survival.
More than 20% of the young head and brain injuries are drug addicts consuming commonly used cold remedies like decongestants, alcohol, banned substances like heroin etc.
But, given that, the potential to struggle, battle, thrive and survive is also found higher in the younger people than the elderly, that is why the priority, preference and timely treatment, in golden period, particularly for these patients is the requisite and the necessity to achieve desired results of survival in the long run. The elderly people may sometimes survive the severe head and brain injury due the availability of free space in their head or cranial box owing to the normal age related degeneration of the brain.
The 20th March of every year is remembered as the ‘World Head Injury Awareness Day’ and the 11th to 17th May remembered as the ‘Brain Injury Awareness Week’ in support of head injury survivors and for brain injury prevention.
The Reception Counter of Surgical Emergency Services at Sher –i- Kashmir Institute of Medical Sciences (SKIMS) receives about 30 to 50 head injuries of mild to severe intensities in 24 hours. At least 3- 6 patients of these need minor surgical interventions and 2- 4 need major neurosurgical operations.
Almost two serious brain injuries are in complete coma (sleep-like state or unconsciousness) and need long duration artificial mechanical ventilatory support to survive but may die after weeks of struggling for life.
The family suffers huge losses in economic and moral aspects. The causes of the brain injuries are most commonly road traffic accidents especially accidental motor bike stunts and high speeds; un-belted seated passengers of a motor car crash; then the falls from the heights like trees, walls and roof tops; assaults in disputes using the metallic rods, axes, flying bricks and stones and the fire-arms.
The commonest age is the student and the working age group of 16 to 35 years and mostly the male gender is involved. The involvement of this particular age group and gender due to head and brain injury in the society leads to the loss of daily social work product, loss of family and community development, progress and education.
A young patient with severe brain injury is fully dependent on the support of attendants and family like blood donation, medical and operative expenditure during a major brain operation.
While after the surgery, since the patient is in coma and on a mechanical ventilator for the life support, he/she is dependant again on the attendants for the limb and body movements, cleaning of body, urinary and excreta disposal, dressing and bedding, feeding and nursing and for the psychological and rehabilitator support.
After a long struggle for life the young man may need to breathe through an additional hole in the throat (tracheostomy) if he survives the artificial ventilatory period.
Even if the patient survives, the frail and fragile body may not be able to support itself or stand without support, the head wound might be healed but the large part of the head bone (Skull) may not be covering the brain since its removal and the speech of the patient may not be restored sooner due to hole in the throat (tracheostomy).
The living youth may not be able to remember or recognize (amnesia) anything which is injury induced and he may be visually blind. The fact that such patients need multiple operations in the future also if they escape death, for the revival of their head shape.
Additionally, the family is drained and dried up economically during the hospital stay buying antibiotics and other costly medicines. Despite all the treatments and best attempts to salvage a young life, the end might be the fatality.
The hospital stay days are counted as the loss of working days for the patient as well as for the attendants. It seems the head and brain injury of youths is a big punishment for the family and the community if only we understand.
The young head and brain injury survivor needs long active and passive physical therapies in physical medicine and rehabilitation services. The patient needs consultations to come out of cognitive dysfunction and manic depressive psychological illness.
Then finally the survivor needs rehabilitation for survival and individual independence from the family and community. The drug de-addiction is a wholesome challenge in these patients.
The Govt. needs to play a major role in such circumstances by the enforcement of the laws to prevent head injuries and also by providing the legal and rehabilitative help to the victims. The calculated annual cost of treatment for head and brain injuries in road traffic accidents for the whole World is 230 billion dollars.
No doubt the world has come of age in developing swift and advanced technologies and sophisticated health machinery but nothing can be a deterrent to the road traffic accidents causing head and brain injuries except prevention by the strict rules and laws.
Mass public awareness and education is the only means to prevent the head and brain injury especially in the youth. The community needs to control the younger generation at the family, religious and social levels.
The drug addiction in the youth needs discouragement and prevention as an educational programme in the homes, mosques, schools and colleges. The motor bike riders and passengers of 4-wheelers must be encouraged to use helmets and use seat-belts respectively.
The traffic and transport officials can apply the traffic rules strictly to avoid high speeding, stunts by the youth and discourage helmet-less riders and unbelted occupants of 4-wheelers. They may also instruct petrol/diesel pump owners not to furnish fuel to the helmet-less bikes and unbelted drivers and passengers.
The author is Head of Surgical Emergency Services, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.