Amid rising head injury cases, AIIMS doctor seeks resumption of trauma services at JPN Centre

A neurosurgeon at the premier AIIMS here has sought resumption of trauma services at the Jai Prakash Narayan (JPN) Apex Trauma Centre which has been functioning as a dedicated Covid-19 facility since April last year.

On the occasion of World Head Injury Awareness Day on Saturday, the doctor said the number of head trauma cases which had witnessed a dip during the lockdown period has increased and now stands almost at the pre-pandemic level.

He also said the occupancy of beds by Covid-19 patients at the trauma centre was low with a large number of beds remaining unoccupied.

"Various other centres and hospitals in the city and the country have resumed normal trauma services in dedicated centres. The National Cancer Institute (NCI) in Jhajjhar, which was run by AIIMS and was earlier used for dedicated Covid-19 care, has resumed routine cancer care too in the past two months," Professor in the Department of Neurosurgery at AIIMS Deepak Gupta said.

"It's high time some policy decision is taken to shift trauma services back to the JPN Apex Trauma Centre," Dr Gupta said.

Surge in Covid-19 cases resulted in the conversion of the 265-bed JPN Apex Trauma Centre attached to the AIIMS to a dedicated Covid-19 facility in March-end last year and all trauma cases are being admitted and treated in the main hospital facility since then.

"As against 70-80 cases of head injury care beds in trauma centre, we are now able to provide support only to 25-30 head trauma cases as other neurosurgical emergencies like brain tumours, brain hemorrhages, hydrocephalus cannot be ignored either," Dr Gupta said.

Most head injury cases demand urgent surgical interventions irrespective of Covid-19 infection status of patients.

Two to three dedicated operation theatres used to run round the clock at JPN Apex Trauma Centre in the pre-Covid-19 period.

"As against over 1,000 head and spinal injuries operations in 2019, only one third of head injuries could get admission and operated in 2020 at AIIMS. With unchanged incidence of head injuries, many patients are thus probably getting treated in peripheral centres where infrastructure and facilities to treat such cases may not be apt," he said.

Many head injury patients have associated spinal injuries and many of these have to wait for long periods due to a limited number of operation theatres and long waiting list for other brain tumour/brain hemorrhage and other life-threatening neurosurgical emergencies, he stated.

The pandemic has also impacted organ donation and transplantation significantly and increased the number of patients waiting for organ transplants as many of the donors used be severely head injured brain dead patients, Gupta highlighted.

Speaking in the context of the ongoing pandemic, Gupta said like following Covid-19-appropriate behaviours such as wearing a mask, maintaining hand hygiene and social distancing along with vaccination 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 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-wheelers, using dedicated cycling /walking paths by pedestrians, following speed limits can bring down the instances," he said.

Worldwide, more than 50 million people have traumatic brain injury each year, and it is estimated that about half the world's population will have one or more brain injuries over their lifetime. Nearly a million people are disabled owing to traumatic brain injury in India each year, and between 60 per cent and 70 per cent of such cases result from road accidents, Gupta said.

On an average, one person dies of head injury every three minutes in India. Fall from height amongst children remains a unique pattern of head injury in our population, majority of these are preventable.

Over one third of head injuries are severe cases and many of these require surgery, ventilatory support and long hospital stays subsequently.

Only one third of severely injured come back to normalcy, while the remaining ones either die or remain in vegetative state or with severe neurological deficits for many years requiring prolonged rehabilitation care.

Over half of head injured population in the country are sole bread-earning members of their families.