Brain Trauma
Brain trauma is basically related to all the accidents, falls, and the violence wherein the brain gets injured, either physically, even sometimes emotionally. Now, most of the times it is the physical injury that causes it. And today, unfortunately, we have the credibility that India has the highest number of road traffic accidents and the highest number of deaths related to the road traffic accidents in the world.
So, day in and day out, these accidents are happening. It is like becoming more or less like an endemic in India. And most people who suffer from these accidents or injuries to the brain are the most productive age group, the young age between 20 to 45 years. That is a sad part. The brain, you know, is the most important organ in the body. And the brain is the one which controls the functionality of every single part of the body.
And a part of the brain not functioning or getting damaged either temporarily or permanently can lead to a significant amount of disability. We have the misfortune of having the highest number of deaths as well as the highest number of disabilities purely due to brain injury. Now, it is estimated that every four minutes, there is an accident in this country.
For every death that happens, five people are permanently disabled for the rest of their life. So, you can imagine the number of people dying due to accidents. Each one is talented and contributing, and can contribute to the growth of the society and the nation. But we are losing them simply on the roads. That is the physical brain drain, as I call it. The second part of it is the disability associated. It is a huge disease burden.
Golden Hours
Golden hours are the first few hours after, you know, primarily a brain injury or a spinal cord injury or even a stroke or a medical emergency, including a cardiac emergency. You know, it essentially means that is the crucial time wherein a lot of events take place following the primary event, complicating the primary event.
For example, if there is a head injury, you know, the person loses consciousness immediately and they will not be able to protect themselves. There can be bleeding, there can be difficulty in breathing and there can be, you know, convulsions, brain swelling and all these things, lack of oxygen to the brain. So a patient can have a shock.
All these things can complicate the primary brain injury. Now, we call this the preventable secondary complications. Now, unfortunately, the accident has already happened that causes the primary brain injury that is not avoidable in a way, but all head injuries by and large are preventable.
The secondary complications are something which can be completely prevented, you know, soon after the primary injury, you know, people become unconscious and do not breathe well, bleeding occurs and blood pressure drops, all these things, convulsions can make the person drown in his own secretions and not having oxygen, not having blood supply to the brain, not having glucose, even for a few minutes can make brain damage permanent. So that obviously will result in permanent disability for that individual. The complications which follow the primary injury always happen in the first few hours, predominantly the first one hour.
So that is why it is called the golden hours. And during these golden hours, if we can act, we can certainly prevent all the secondary complications. Thereby, we reap five benefits.
We can reduce the death rate. We can reduce the disability. We can reduce the complications. We can reduce the hospital stay. We can reduce the medical expenses, and the quality of life after the treatment, after recovery can be pretty good.
So in the golden hour, what is important is that we should have a very good rescue system, you know, soon after the accident and people should be rescued to a safe place so that, you know, their secondary damages in the same place can be avoided.
Checking A, B, C
And then what is important, the most essential thing is checking A, B and C. A stands for airway, B for the breathing, C for circulation. These A, B and C are fundamental. Now, if the airway, breathing and circulation is compromised, that means we are dealing with a life-threatening situation.
And these are the people who need to be protected right there from the scene itself to ensure these three are sustained until they reach the hospital. And if they do not do that and simply blindly carry them to the hospital during the transportation itself, the brain is going to damage permanently. The most important thing in the golden hours is that the ambulance should reach in time.
So for that, we have a lot of logistic issues. The ambulance goes with the siren. They need to go with the siren to reach the place in time and they need to rescue as quickly as possible and then bring him back safely, protecting all these things until they reach the hospital.
And once they reach the hospital, then the medical team will take over. Of course, afterwards, maintaining becomes easy because it is a well-set system in the hospital, whereas on-the-road care is something that makes a huge difference in determining the degree of death as well as the disability in the population today.
Today we have a wide variety of possibilities. Road traffic accidents, especially two-wheelers in this country are becoming a big thing, not wearing helmets, not wearing seatbelts, not following traffic rules, zigzag way of driving. All these are possible causes and drunken driving is one of the major reasons for these accidents. The secondary things are bad vehicles and bad roads and bad weather conditions.
I see sometimes in the north, huge fog is a problem and still people keep driving in the fog without any reflector, proper safety systems. So these are all the potential threats for accidents. In addition, we have a lot of falls. Violence is also becoming a big cause and emotional trauma is entirely a different thing where people, you know, abuse each other and then emotionally hurt themselves. But that is treatable. I know it can heal after a while.
Enhancing Longevity
Once the brain damage happens, we do not have any replacement today for the brain. You know, it has to recover on its own. Neurosurgery has not advanced to the extent that we can repair the damaged brain. So this is the biggest unfortunate thing, but also the reality at the same time. So as a result, we must focus on the prevention of the primary injury as well as the secondary complications.
Doing the right kind of treatments at the right time can probably prevent further damage to the brain as well as promote recovery. A significant amount of neurorehabilitation is essential along with the medications.
Certain areas of brain functions can recover by the brain taking over the extra functions by the surrounding areas which are not damaged. So this phenomenon is called neuroplasticity and the brain has that ability over a period of time to regain certain abilities, but it can never be the original. So therefore, we must emphasise primary prevention as well as management in the golden hours so that you can avoid secondary brain damage so that the brain damage can be minimised, and recovery can be promoted.
