The Founder-Chairman of Brains Super Speciality Hospital, Dr N.K. Venkatramana, states that brain trauma basically relates to all the accidents, falls, and violence wherein the brain gets injured, either physically, even sometimes emotionally. However, he notes that most of the time it is physical injury that causes it. He points out that unfortunately, India has the highest number of road traffic accidents and the highest number of deaths related to them globally.
Road Accidents in India
Dr Venkatramana says that these accidents are happening day in and day out, becoming more or less like an endemic in India. He adds that most people who suffer these injuries are in the most productive age group, between 20 and 45 years, which he considers a sad fact. He explains that the brain is the most important organ, controlling the functionality of every part of the body, and damage, whether temporary or permanent, can lead to significant disability.
He mentions the unfortunate statistic that India has the highest number of deaths and disabilities due to brain injury, estimating an accident occurs every four minutes. Dr Venkatramana explains that for every death, five people are permanently disabled, highlighting the loss of talented individuals who could contribute to society. He laments that they are being lost simply on the roads, which he terms a “physical brain drain,” but causes a huge disease and social burden.
Golden Hours
Dr Venkatramana explains that the golden hours are the first few hours after a primary brain injury, spinal cord injury, stroke, or cardiac emergency. He says this is a crucial time when many events following the initial incident can complicate it. For instance, with a head injury, a person immediately loses consciousness and cannot protect themselves, potentially leading to bleeding, breathing difficulties, convulsions, brain swelling, lack of oxygen, and shock.
Dr Venkatramana states that all these factors can complicate the primary brain injury and are known as preventable secondary complications. While the initial accident causing the primary injury might not be avoidable, he believes most head injuries are largely preventable. He elaborates that secondary complications can be completely prevented soon after the primary injury. Factors like unconsciousness, poor breathing, bleeding, low blood pressure, and convulsions can lead to a person drowning in their own secretions, and a lack of oxygen, blood supply, or glucose to the brain, even for a few minutes, can cause permanent brain damage and disability. He emphasises that these complications predominantly occur in the first hour after the primary injury, hence the term “golden hours.”
Dr Venkatramana suggests that acting during these golden hours can certainly prevent secondary complications, resulting in five benefits: reduced death rate, decreased disability, fewer complications, shorter hospital stays, lower medical expenses, and a better quality of life after treatment and recovery.
Dr Venkatramana highlights the importance of a very good rescue system to move people to a safe place soon after an accident to avoid further damage at the scene, such as chemical injuries from spills or injuries from broken glass. He stresses the essential step of checking the A, B and C: A for airway, B for breathing, and C for circulation, which he considers fundamental. If these are compromised, it indicates a life-threatening situation, and these individuals need immediate protection at the scene to maintain these functions until they reach the hospital. Failure to do so and simply transporting them without care can cause permanent brain damage during transit.
According to Dr Venkatramana, the most critical aspect of protecting the golden hours is ensuring the ambulance arrives in time, which involves addressing logistical issues. He notes that ambulances need to use sirens to reach the scene quickly, rescue efficiently, and transport the patient safely while maintaining vital functions until hospital arrival.
Dr Venkatramana explains that once the patient reaches the hospital, the medical team takes over, and maintaining their condition becomes easier due to established hospital systems. He emphasises that on-the-road care significantly impacts the degree of death and disability in the population.
Causes of Brain Trauma
Dr Venkatramana states that brain trauma today has a wide variety of causes, with road traffic accidents, particularly involving two-wheelers in India, being a major concern due to not wearing helmets or seatbelts, disobeying traffic rules, and erratic driving. He adds that drunken driving is a primary cause, with secondary factors including poor vehicle condition, bad roads, and adverse weather. He also mentions the dangers of driving in heavy fog without proper safety measures. Furthermore, Dr Venkatramana notes that falls and violence are significant causes, while emotional trauma, though different, is treatable.
Dr Venkatramana explains that once brain damage occurs, there is no replacement, and the brain must recover on its own. Despite advancements in neurosurgery, damaged brain tissue cannot be repaired. Therefore, he stresses the importance of preventing primary injuries and secondary complications.
Neuroplasticity
Dr Venkatramana points out that various techniques and timely treatments can prevent further brain damage and promote recovery, with neuro rehabilitation being essential alongside medication. He mentions that certain brain functions can recover through neuroplasticity, where undamaged surrounding areas take over lost functions. While the brain has this ability to regain some abilities over time, it will never be the original state. Consequently, Dr Venkatramana concludes by emphasising primary prevention and management during the golden hours to avoid secondary brain damage, minimise overall brain damage, and promote recovery.
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