Head injury — the challenge: principles and practice of service organization

Abstract

Those working with head-injured patients know the nature of the problem which confronts them in their particular sphere. Thus, the casualty surgeon will be aware of the range of problems seen in his department daily, from the infant who has fallen down a few steps and appears unscathed, to the tiler who has fallen off a roof at a time when he was earning a little extra money and was not insured by employers, through to the victim of a horrendous road traffic accident with multiple injuries, and, finally, to the unsteady, elderly person whose fall presages the end of independent existence. It is easy for this doctor to appreciate that factors such as alcohol, poor home design and lighting, perhaps contributed to such accidents. The neurosurgeon’s view of head injury may be that of dramatic intervention, often with equally dramatic recovery but sometimes with persistent coma or persistent vegetative state. He will also be aware of Jennett’s [1] observation that hypoxia and hypotension, and consequent increased disability, may result from delay in reaching the neurosurgical unit.