Road accident can leave you in a worse place than death
It was a freak accident, caused by loose gravel on the road. 18-year-old Varun was sitting in the passenger seat of his friend’s car when the vehicle skidded, slammed into a tree and fell down an embankment in the city of Brisbane, Australia. Despite a seat belt, his head hit the dashboard. Emergency services got to the accident site 90 minutes after the accident, too late to avert brain damage. “Varun arrived in hospital with a GCS (Glasgow Coma Scale, used to measure the damage/recovery from brain injury) of three, which is close to death,” says his mother Vanita Lal, a genetic counseller and teacher.
But Varun survived miraculously. Six years of intensive neuro-rehabilitation has enabled him to regain some mobility and speech, and recently this 24-year-old braveheart was in the city to share his experience at the World Day of Remembrance for Road Crash Victims, organised by the Institute of Road Traffic Education (IRTE), in partnership with the ministry of road transport and highways and the All India Institute of Medical Sciences. “Where there is a will, there is a way,” said Varun, to his cheering audience of survivors and their families, paramedics and doctors, police, policy makers and others.
Road accidents kill and maim thousands of people every year, and are the second leading case of death for young people globally. In New Delhi, one in five people die from injuries sustained during road accidents, says a report by the Centre for Science and Environment (CSE). “One point five lakh people die every year from head injuries and five times that number survive with serious injuries and need neuro-rehabilitation,” says Dr Rajendra Prasad, senior consultant neurosurgeon, Indraprastha Apollo Hospitals, New Delhi and also the honorary medical director of the Indian Head Injuries Foundation (IHIF). Maharaja Gaj Singh II of Jodhpur established IHIF seven years ago, after his son Shivraj Singh sustained head injuries in a polo accident. The absence of neuro-rehabilitation facilities within India compelled his highness to take Shivraj to the Mount Sinai Medical Center in New York for his rehabilitation, and spurred him to set up IHIF. Today, this organisation is at the fore of national efforts to improve awareness, prevention and treatment of head injuries, and promote timely neuro-rehabilitation. “Prompt response and trauma treatment can avert one-third of the deaths caused by head injuries,” says Dr Prasad. IHIF has worked successfully at three levels: improved road safety legislation; intensified training of first respondentspolice, paramedics and ambulance services; and improved trauma care.
“The idea is to get victims treated within the golden hour, and avert secondary brain injury,” explains Dr Prasad. But one of the biggest lacunae for people with head injuries is the absence of organised neuro rehabilitation. “Unlike Western countries, there is no automatic transition from trauma care into rehabilitation,” says Prasad.
“Trauma centres discharge people almost immediately after they are out of a critical situation, with no regard for their functional disabilities.”
Neuro-rehabilitation is a resource intensive process, involving several specialists: neurologists, plastic surgeons, orthopedic specialists, psychiatrists, physiotherapists, speech and occupational therapists. Physiotherapeutic protocol following a brain injury and stroke is very specific. “Families must enlist physiotherapists, speech and occupational therapists with an expertise in neuro rehabilitation,” says Vanita. “ Therapists must also train families and care staff to enable a recovering person to continue practicing daily tasks to improve outcomes.”
Currently, the government has no rehabilitation centre and many private hospitals lack standard protocol for rehabilitation. Even places that have the infrastructure and therapists don’t follow neurologist guided rehabilitation protocols.