Road traffic accidents continue to be a menace despite the improved roads, quality of vehicles and safety devices. Among them, Head Injuries continue to be a serious cause of concern for morbidity as well as mortality. Most productive age group of 18-45 are the most affected, that can tilt the balance of the country and society in terms of productivity, talent and skill pool ultimately impacting the overall growth and economy. Lots of efforts have gone on in many developed countries in implementing the safety and driving regulations stringently which has immensely benefitted in declining the number as well as the severity of the accidents over the years. Unfortunately, this process has not percolated among the developing countries still. Hence, head injury still is a major public health problem contributing to the disease burden of non-communicable diseases.

Recent Covid related lockdowns has reduced the travel, commuting and the number of road users at any given time. Surprisingly even in those hard times the number of deaths related to head injury never declined. India has the dubious distinction of having the highest number of head injuries recording more than one million head injuries in a year (according to the Indian Head Injury Foundation). Majority of the victims are in the most productive age group between 18-35 years. This must provoke some introspection about our attitudes compulsorily.

Head injury is preventable, provided there are good roads, good vehicles, proper driving licensing system and strict enforcement of driving laws and compliance of the people. It is sad to note that all these factors are lacking in developing countries resulting in huge numbers of accidents and enormous loss of human lives. India also has the disrepute of having the highest mortality from the road traffic accidents in the world. In every 100 accidents, 33 percent has direct head injuries, 37 per cent has indirect head injury due to the severe face injuries. 3 per cent will have spinal injuries, 30 per cent will have significant fractures and 10 per cent are abdominal injuries.

Majority of the head injuries are due to road traffic accidents followed by fall from the height, pedestrian injuries and civilian riots. Among the road traffic accidents, two wheelers contribute to the maximum, followed by senior citizens as pedestrian victims. The reasons for this anomaly are many and vary at different geographic locations. Not having proper roads, bad design and poor maintenance of the roads, invisible black spots, poor road signages, non-awareness of signage’s, and poor compliance from driving regulations are some notable examples across the country. In addition potholes, improperly designed humps, invisible medians, acute curves and unanticipated surprises such as barricades, driving on the wrong side, improper medical evaluation of drivers, (epilepsy) fatigue are equally common and contributory.

Improperly maintained vehicles, driving beyond speed limits, not implementing safety gear, not following the traffic rules, disobeying the traffic signals and regulations and bad driving practices are some personal factors related to attitude. Overcrowding of roads with vehicles automatically reduces the stipulated distance between vehicles, traffic jams are responsible for road rage as well as violation of traffic regulations often times. In fact, such lack of compliance puts tremendous stress on the police, the pedestrians and other co drivers on the road. During night, poor visibility, over speeding, drunken driving and use of mobile and other gadgets have become a social norm leading to tremendous distraction.

After an unfortunate accident lack of established pre-hospital care systems, is resulting in an enormous delay in reaching the accident victims to the hospitals. This is due to the lack of coordinated communication system, coordinated medical transportation system and co-ordinated social support including Good Samaritan attitude. As a result, the golden hour is missed resulting in increased number of secondary complications that will result in death as well as disability. Inadequacy of designated facilities to treat such individuals within the “golden hour” is a major medical deficiency in the country even today.

Implementation of state of the art trauma systems across the country will certainly reduce this calamity. However, this requires establishment of good trauma care facilities across the country, proper infrastructure, effective training systems and resources to get the right things done at the right time. The fact to be remembered is an accident is preventable and every one must put all possible efforts to do so. Once the brain is damaged it can neither be replaced nor repaired. Apart from the loss of life, the damage to the society and the nation at large is enormous. We are losing the most productive and talented resources of the country and many may not be replaceable. There are innumerable social and economic losses at the individual, family and national level. A strong social system must evolve to combat this problem comprehensively then only we will be able address the problems and can evolve on par with the best of the world.