Head Injuries: The emergency we underestimate until it’s too late

In a city like Hyderabad, where rapid urban growth meets high-speed mobility, head injuries have become an everyday reality. From the busy stretches of Outer Ring Road to the narrow lanes of residential colonies, the risk is constant, yet the awareness is not.

In this conversation, Dr. Nickhil addresses the critical questions surrounding head injuries, with a lens on Hyderabad’s evolving risk landscape.

Dr. Nickhil Vangapally
Lead, Department of Emergency Medicine,
STAR Hospitals, Nanakramguda

Q: How serious is the problem of head injuries in a city like Hyderabad?
Hyderabad is witnessing a steady rise in head injury cases, largely driven by increasing vehicular density and urban expansion. Road traffic accidents remain a leading cause, particularly involving two-wheelers. A significant proportion of these cases are linked to either non-usage or improper use of helmets.
What is equally concerning is the number of fall-related injuries seen in homes - especially among the elderly. With nuclear families and aging populations, many seniors live alone or with minimal supervision, increasing both the risk and the delay in response. In many cases, patients are brought to the hospital only after symptoms like vomiting or disorientation begin, which is often several hours after the injury.
 
Q: What are the most common scenarios you encounter in emergency care?
In Hyderabad, the patterns are quite telling. Young professionals involved in late-night or high-speed commuting, delivery personnel navigating traffic under pressure, and students on two-wheelers form a significant chunk of road-related injuries. Many of these cases involve individuals who either skipped helmets or wore them incorrectly.
At the same time, there is a growing incidence of indoor injuries - elderly individuals slipping in bathrooms, missing a step on staircases, or experiencing imbalance-related falls. Children, too, frequently present with head injuries from play-related incidents within apartment complexes. These are not extreme scenarios - they are everyday occurrences, which is precisely why they are underestimated.
 
Q: Are people able to identify warning signs early enough?
Traumatic brain injury (TBI) can cause physical, sensory, and psychological effects that may appear immediately or days later. Mild TBI symptoms include headache, nausea, fatigue, dizziness, speech difficulty, blurred vision, and sensitivity to light or sound. Individuals may feel confused, disoriented, or experience memory issues, mood changes, anxiety, or sleep disturbances.
Moderate to severe TBI includes more serious signs such as prolonged loss of consciousness, worsening headache, repeated vomiting, seizures, unequal pupils, fluid from the nose or ears, limb weakness, and loss of coordination. Patients may also show severe confusion, agitation, slurred speech, or even coma, requiring immediate medical attention.
 
Q: What should be done immediately after a head injury in such scenarios?
The first response can significantly influence outcomes. In a city environment, where help is usually within reach, the priority should be to avoid delay. The individual should be kept still, observed closely for any change in consciousness or behaviour, and transported to the nearest emergency facility without waiting for symptoms to worsen.
One common mistake is assuming that if the person is talking or walking, they are fine. This is not always true. Internal injuries can progress silently, which is why early evaluation is critical, even in seemingly minor incidents.
 
Q: Can Hyderabad reduce its burden of head injuries?
Absolutely - but it requires a shift from awareness to behavior. Helmet usage needs to move from being a rule to a reflex. Despite enforcement, compliance remains inconsistent, particularly for short-distance travel within city limits.
Homes need to be made safer, especially for the elderly, with simple modifications like anti-slip flooring and better lighting. Workplaces must continue to enforce safety standards, and individuals must take responsibility for avoiding risk behaviours such as drunk driving.
In a city that prides itself on infrastructure and growth, safety must become part of the culture.
 
 
Q: How critical is timely medical care in these cases?
Timely intervention is often the difference between recovery and long-term damage. Hyderabad has access to advanced emergency care and diagnostic facilities, but the challenge lies in reaching them in time.
The concept of the “golden hour” is crucial - early imaging and clinical evaluation can identify complications before they become life-threatening. When patients arrive early, outcomes are significantly better, both in terms of survival and quality of recovery.
 
Q: What are the long-term consequences you see in delayed cases?
Delayed treatment often leads to outcomes that could have been avoided. Patients may experience cognitive decline, speech impairment, or motor deficits that affect their independence. In severe cases, it can alter personality and behaviour, placing emotional and financial strain on families.
In a city where many individuals are primary earners, such outcomes have a ripple effect beyond the individual - impacting entire households.
 
Q: What is your message to Hyderabad’s citizens?
Hyderabad is moving fast—but safety cannot be left behind. Head injuries are not rare, and they are not always obvious. The difference between a close call and a critical condition often lies in how quickly we respond.
Wear a helmet, even for short rides.
Do not ignore a fall, however minor it may seem.
And most importantly, do not wait for symptoms to worsen before seeking care.
Because when it comes to head injuries, in a city like ours, awareness is not enough—action is what saves lives.