The immediate management ob’ head injuries a clinical exierience at Muhimbili Medical Centre

Hand injuries constitute a special and particularly tragic problem both in developing and developed countries: A number of lives are lost due to head injuries in all age groups commonest being below 4-0 years. The incidence being higher in the developed countries. A survey was made to know what immediate treatment was given to patients with head injuries in Dar es Salaam in the whole chain from the accident site, cm the way to Emergency Department at Muhimbili Medical Centre to the Wards, X-ray Department, ICU and Theatre. There were 220 patients of head injuries admitted from 1st May 1982 to 30th May 1983. There were 45 deaths, of these 20 patients died or declared dead at the Emergency Department and 25 patients died after staying in the hospital for an average of 72 hoursi. The commonest cause according to postmortem findings was due to intracranial haemorrhage which constituted 14- deaths, followed by subdural haemorrhage 11 patients. The motor vehicle was the prime cause of head injury which constituted about 44.5/°» the next commonest cause of fatal head injury being assault which recorded 16.3. A number of shortfalls were noted, these include absence of resuscitation to the injured at the site and on the way to the hospital. Inadequate resuscitation at the emergency department. Poor ambulance services, with uncoordinated communications between the accident site and the hospital. Less aggressive management of head injuries due to lack or frequent shortage of essential drugs and important monitoring equipments, for example equipment for intracranial pressure monitoring. Among the suggested methods *of improving the services include emphasy on resuscitation at the site of accident and on the way, decentralisation of ambulance services with adequate equipment for resuscitation, introduction of Radio call to the hospital and finally imparting the knowledge on the art of cardiopulmonary cerebral resuscitation to ambulance services personnel and the hospital.