HEAD TRAUMA

IN DISASTER
Wawan Mulyawan
Neurosurgeon
Vice Dean, Military Medical Faculty
Indonesia Defense University

PIT IKABI XXIV

BANDAR LAMPUNG
8-11 MARET 2022
 Head injury :
Car accident is majority
 EVERY 15 SECONDS
DEATH : EVERY 12 MINUTES

HEAD TRAUMA

50 % DEATH CASES IN TRAUMA

60 % DEATH CASES : TRAFFIC ACCIDENT

HOW IN DISASTER ??
Head Trauma Challenge in Disaster
• The management is challenging :
– Disaster preparedness planners
– Emergency medical personnel response
• The kinetic energy released by rapid-onset
natural disasters (earthquakes, tsunami, etc)
can cause mild, moderate, or severe HT
Head Trauma is a major risk factor for
mortality and morbidity outcomes in disaster
 Concerns on Head Trauma
during Disaster
• Immediate emergency care
• Long term care
• Post event pediatric and disabled person
head trauma
• General surgeon involvement in head
trauma
1. Immediate emergency care

• The immediate medical responses of

disaster victims with head injuries is
essential  minimize the development of
secondary brain injuries
• Challenge :
– Time delivery of emergency medical care when
disasters happens
– limited medical infrastructure capacity that may
degraded by the disaster
 Principle in emergency care :
mass casualties perspectives
• Pre hospital life support is much important
– Scene rapid assessment : priority
– Green first, not red first
• Hospital ER : ABC first, not diagnosis
– The availability of state- of-the-art neurological
care is scarce
– Still : Green first, not red first
 MECHANISM in DISASTER

•
• BLUNT •
ANY KINETICS ENERGY
CHAOTIC EVENT
• TRAFFIC ACCIDENT
• FALL

• PENETRATING • ANY KINETICS ENERGY

• CHAOTIC EVENT

Intracranially : Closed vs Open

 HEAD TRAUMA CLASSIFICATION
(GLASGOW-modified atls)

MILD : GCS 14 – 15 (13-15)

MODERATE : GCS 9 – 13 (9-12)
BERAT : GCS 3 - 8
 VICTIM CARE :
RESPONSIVENESS
ABC MANAGEMENT :
AVOID HYPO OXYGENATION AND HYPOVOLEMIA

PREVENT
SECONDARY BRAIN DAMAGE
Monro Kellie doctrine

Vc = V blood + V lCS + V parenchim

mmHg
Fatal 60
ICP
100
50
Brain
40
Disfunction
50
30
Treat
20

Intracranial Volume Normal

10

0
 Important patient data

• Age and MoT

• Respiration and cardio status
• GCS, PUPIL, LATERALITATION
• Multiple trauma
• Diagnostic exams
 Other concerns in
immediate emergency care
• Allocating scarce neurotrauma care
• Medical ethics vs green first
• Telemetric medicine
• Scalp bl;ood loss neglection
• Prolonged disaster
 2. Long term care
• The challenge : providing long term care for
head trauma patients in the aftermath of
rapid-onset natural disasters
• Many brain injuries need long term care:
– Post trauma seizures/epilepsy
– Memory loss / cognitive problems / stress
– Be disabled person
– Dependent person
 The survivors who need long
term care aftermath of disaster
• The survivors :
– Severe : mostly need long term care
– Mild and moderate : mostly not need long term
care, but due to neglection during disaster or
with comorbidities need long term care
– More complicated care in multiply disaster
(earthquake, tornado, floods, etc)
 3. Post event pediatric and
disabled persons head trauma
• Childen and disabled persons are vulnerable
for abused or negletion trauma
• US study : Statistical analysis determined
that the incidence of both inflicted and non-
inflicted child head traumas dramatically
increased in the 6-month period
immediately after the hurricane
– Indonesia : no data
 4. General surgeon involvement
in head trauma during disaster
• US :
– Around 40000 neurosurgeons for 300 million
citizens
– Continent
• Indonesia :
– Less than 500 neurosurgeons for 260 million
– Thousand islands
 In disaster
with scarce neurosurgeons
• General surgeon is needed
• Have competency in managing head trauma
according to curriculum

Question :
• Is general surgeon well prepared for
immediate emergency care of head trauma
NOW ?
 Take home message
• Immediate emergency care for head
trauma during disaster in pre hospital
and in hospital is very important
• Long term care for head trauma
survivors aftermath of disaster need
attention
• Post event pediatric and disabled person
head trauma : no data in Indonesia
• General surgeon involvement in head
trauma during disaster : a MUST