Preventation of head injury and the role of trauma systems

Biswadev Mitra, russeli I Gruen

Preventation of head injury involves a wide range ofinterelated programs, actions and
activities. Injury preventation engages governments, doctors, nurses, aliled health professionals
andother community organitations.
Preventation activites are regardedbas primary
secondary or tertiary, primary
preventation measures are designed to prevent the actual injury, thereby reducing both the
insidance and prevalence of the disease, secondary prevalention aimsto lissen the severity of the
damage after the injury has occurred, principally throngh hight quality system of care. Tertiary
preventation aims to prevent complications, minimise disability and, through
rehabilitation,restore functionand independence.
Haddons matrix is a conceptual framework for understanding the origins of injury
problrs and for identifying ways to addres these problems. William Haddon JR first developed
his model for applying basic principls of public health to road safety in the 1970s, 1 Since then the
matrixhas been used as a tool to aid the development of ideas to address many types of injuries.
The matrix consists of three tows and three colums the combine the consept of primary,
secondary and tertiary preventation with the public health concepts of host-agent-environment as
targets of change. The columns define the interacting factors that cause an injury to occur the
host (the injured); the agent or vector that inflicts the injuri or, in the case of post injury response,
provides the treatment the physical environment ( characteristics of the setting in which the
injury takes place), and the social environtment ( social and legal norms and practices ). The
rows define the phases at which change could have its effect pre-event, during the event and post
event.
Primary preventation; various measures
The loading cause of TRI, both in Australia and wordwide, in transport accidwnts
followed by falla, collision with objects and water-related accidents.2
Minimising exposure
To a greed exient road traffict injuries are preventable, because the risk of incurring injury in a
crash is prediectable, and many effective coantermasures exist. The provision of save, affordable
and sustable mearis of travel should be a key objective in road transport planning and design.
Minimizing, exposure to high risk scenarios through effective infrastructure planning prevents
injury.
Vehicles, and have clear reparation of raffic and segregated junction. Giving priority in the road
network to higher-ocupancy vehicles through specialized lanes eads to reduction in vehicle use
and reeducated exposure of individuals to the risk of craseshes.

Restrains
One the most effective strategies in the prevention of head injury wordwide has been mendatory
three point seatbelt legislation the first state to introduce suchlegislation was Victoria, Australia,
in 1970. One year after its introduction, eat occupant deaths had fallen by 18% seatbelts,have
been particullary protective of the upper body, reducing traumatic brain injuries and spine
injuries
Seatbelt use is influecud by the existance and enforcement of legislation mendating their use, and
by motivation for use advrse effect of seatbelt ase do exist including potentially increased neck
cheast ( sternumand rib fractures), abdominal, spine and fetal injuries.
Airbags
Air bag is designed to deploy rapidly and automatically duringa frontal collision, with the effect
of creating an absorbtive barrier between the occupant and paneling. This allows safer transfer of
energy during rapid deceleration. Airbags are standard in almost all newer mdel passenger cars.it
has been estimated that driver and front passanger airbags would have prevented 25% of
traumatic brain injuries in the 1980s and 1990s. More recently developed side impact and curtain
airbags also mitigare the effect of side and rear impact collisions and rollovers.
Falls
Falls have consistenly been identified as the second most commoncause of traumatic brain an
spinal injury and occur mose commonly in young children and the elderly,preventiveeffort have
included legislation,protective barriers and education in 1972, the New York City apartments.
This was estimated to resultin a 96% decrease in falls in the suburban areas. Preventative
measures inplaygrounds included iristallation of protective surfaces, the use of soft materials
such as woodchip around sliders and swings, and compulsory adult supervision.
Governance and oversight
Trauma system are complex structures involving many agencles and dapartments which require
governance, monitoring and improvement for:
1. Polley development to ensure optimal outcomes for trauma patients
2. The development of key performance indicator and benchmark with which to monitor
performance, and the best ways of reporting this information
3. Methods that ensure that ensure that clinical care delivered to trauma patients is of ahigh
quality, including the development and evaluation of clinical management policies and
protocol
4. Injury prevention initiatives
5. Lingking education program to service provision.
Most jurisdiction have developed broadly representative trauma committers that preside
overtheseactivities and that have responsibility for oversight and improvement of the system.
This stewardship function is most important and is carried out by government and their
ministries of healt. There may also be limited contribution from the private sector and from other

sources, in addition to allocating sesource for healthcare delivery, govermant are usually
responsible for establishing and overselling health sector policles.
Monitoring and improvement
The primary data source for monitoring and improvement activities is the trauma registry.
Trauma committees and trauma centres monitor performance by systematically evaluating
aotcomes of care, including performance by systematically evaluating outcomes of care, in
cluding performance indicator and edverse outcomes. For monitoring system performance and its
effect on the outcomes of head-injured petients, however, the traditional and-point of in- hospital
mortality is insufficient. Future performance indicator for head-injured patients will included the
very important functional and quality of life outcome that are important. To patient, their carers,
service providers and payers.
Tertiary prevention: rehabilitation
For every two patients who die of traumatic brain injuries, there are ten survivoce with severe
permanent disabilities, rehabilitation aims to achieve tertiary prevention- the promotion of
recovery and independence thpught the reduction of disability and tehe restoration of fungsion
and independence. The overall goal of rehabilitation after a traumatic brain injury is to improve
the patients ability to function at home and in society in the face of the residual effect of injury.
An additional goal of the rehabilliation program is to prevent, wherever possible, but other wise
to diagnose and treat in an effective manner any complication (e.g, post traumatic hydrocephalus,
neuro- endocrine, defencies,adjustment reactions, deep venous thromboembolism) that may
cause additional morbidity and mortality. Walle TBI can cause long term physical disability
complex neurobehavioral sequalec produce significant distruption the quality of life.