Prehospital management of head injuries: international perspectives

The extent of disability and, therefore, the management of head injured patients before their arrival to the hospital should be influenced by a number of factors including: the age of the victim (children with comparable severity of head injury have less disability and lower mortality than persons over the age of 40); the type of injury (motor-vehicle accidents are the most frequent cause of head trauma in the U.S. and Canada); the decision to transfer the patient to either the nearest hospital or to a designated neurotrauma center (at several communities in the U.S. and Canada, recent analysis has demonstrated that the extent of disability and the mortality among head injured victims can be significantly decreased by their admission to specialized trauma units); elapsed time as another important factor (at least in one type of traumatic injury--acute subdural hemorrhage--it has been shown than an interval of less than 2 hours between the time of injury and the time of the craniotomy can significantly decrease both the mortality and the extent of neurological impairment among the survivors). A number of acute injury effects on endothelial, neuronal or glial cells could potentially be influenced by compounds that may be administered before the victim arrives to the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)