On the eve of World Head Injury Awareness Day, doctors have pitched for spreading awareness among police and common people about the importance of 'golden hour' the first 60 minutes following a traumatic head injury which they said can be the difference between saving or losing a life.

They said that in most cases, the 'golden hour' is lost due to delay in shifting the victim to a healthcare facility, which in turn results in serious complications, and even death. Dr Deepak Gupta, a professor in the Department of Neurosurgery at AIIMS Delhi, said many head injury patients require immediate surgical intervention and any delay in shifting leads to permanent brain damage and poor surgical outcomes even at best trauma centres.

If patients come after the 'golden hour', he said, they can have low blood pressure (Hypotension), a lack of oxygen supply to the brain (Hypoxia) and any associated cervical spine injury can complicate head injury further. "We still get patients who were previously admitted in other peripheral levels 3/level 4 centres for more than 12 hours and then shifted as a neurosurgeon was not available there.

Police, PCR vans, while shifting road trauma victims must know the list of hospitals dealing with head trauma and must not waste time in paper-works as time is the brain in head trauma," Dr Gupta stressed, emphasising the importance of timely treatment in such cases.

For first aid support to a victim of head injury especially during a road traffic accident, the police force, traffic policemen and the first responders need to be trained, said Dr Rajendra Prasad, Senior Consultant, Brain and Spine Surgery, Indraprastha Apollo Hospitals. This is especially to provide the information with how a victim with various severe injuries needs to be given the first aid till the time the ambulance arrives, he said.

One head-injured person dies every three minutes in India, Dr Gupta stated. "More than 1 million people have head trauma (traumatic brain injury) each year in India. Half of those who die of head injury, usually die within the first couple of hours of injury. Only 5-10 per cent of patients are able to reach and receive optimal care within the golden hour period to hospitals", Dr Gupta said.

Dr K B Shankar, Professor and Head of Department of Neurosurgery at Safdarjung Hospital, said, "We at this hospital frequently see patients with severe head injuries requiring urgent surgical management, being treated conservatively for a day or two at some of the renowned hospitals and by the time patient comes to us it's already too late. In spite of all the efforts, we lose the patient and a young, earning member of the family (maybe the only one) is gone forever. Similarly, patients sustaining head injuries in remote areas with a lack of adequate infrastructure and facilities are being deprived of their opportunity to 'golden hour' -- the opportunity of life -- and "succumb by the time they reach us".

Speaking in the context of the ongoing pandemic, Gupta said like following COVID-appropriate behaviour can help prevent the disease, wearing a helmet, following traffic rules, using the seat-belt and avoiding mobile phones while driving can bring down instances of head injury. "Wearing a face mask is more common these days than wearing a helmet or putting on a car seat-belt. For sure, it is good to take the vaccination, wear face masks and follow appropriate behaviour for COVID-19 prevention. However, it is equally and probably more important to follow appropriate behaviour for head injury prevention. Wearing helmets, safety seat belts while driving four-wheeler vehicles, using dedicated cycling /walking paths by pedestrians, following speed limits can bring down the instances", he said.

Road traffic accidents account for a majority of head injuries reported every year in India, Dr Prasad stated. "With awareness around the importance of wearing helmets (for both the riders) and seat-belts (for all passengers in a car), we will be able to reduce the deaths and disabilities that arise from a severe head injury during road traffic accidents" he stated. Over one-third of head injuries are severe and many of these require surgery, ventilator support and long hospital stays subsequently, Dr Gupta said.

Only one-third of severely injured come back to normal, while the remaining ones either die or remain in a vegetative state or with severe neurological deficits for many years requiring prolonged rehabilitation care. Over half of the head-injured population in Indian is sole bread earning members of the family, he elaborated.