Factors Influencing Prehospital Management of Head-Injured Patients in Emergency Medical Service in Saudi Arabia


Traumatic head injury (TBI) is a critical health challenge across the world. Andriessen et al. (2011) estimate that more than 10 million individuals are affected by the condition, which can result in hospitalization or death (p. 341). Studies have indicated that one of the major causes of brain damage at the pre-hospital level is road accidents (Maas et al., 2008). Although advanced prevention and treatment models for related brain complications have been realized by healthcare providers, death rates remain high (Hyder, Wunderlich, Puvanachandra, Gururaj, & Kobusingye, 2007). Statistical analysis of the condition reveals that road accidents cause 60% of TBIs while about 20-30% are occasioned by falls (Hyder et al., 2007, p. 341). Further, 10%  are sports-related injuries and activities in the workplace, whereas another 10% are linked to violence (Hyder et al., 2007, p. 341). Although major TBIs occur in environments that are unavoidable, it is significant to seek clinical examinations and interventions to manage increasing mortality rates.  

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Literature Review

In the Kingdom of Saudi Arabia, the leading causes of TBI are attributed to motor vehicle collisions and pedestrian injuries from road accidents (Al-Habib et al., 2013, p. 353). The study by Al-Habib et al. (2013) reveals that traumatic head injuries (THI) are higher in men compared to women. The authors acknowledge that the variance may be based on the fact that women do not drive cars in Saudi Arabia (p. 353). In addition, the authors clarify that 40% of mortality rates occurred in the pedestrian group while 29.2% were as a result of motor vehicle collisions (p. 353). The data presented in the retrospective study by Al-Habib et al. (2013) indicate the need for an integrated approach to the health problem and the utilization of both administrative and clinical preventive approaches. Accordingly, Al-Habib et al. (2013) aver that restraining devices such as seat belts or helmets are never reported to have been used during injuries. Therefore, the significant severity levels can be managed through inclusive models, involving all stakeholders.

The older populations have a higher susceptibility to TBI. Accordingly, epidemiological patterns in TBI are related to stagnating mortality levels (Andriessen et al., 2011). According to Andriessen et al. (2011), elderly people are linked to poorer health outcomes, which jeopardize the impact of patient management. Badjatia et al. (2008) further explain that limited intervention can manage a primary injury of a patient. However, the authors illustrate that intervention can be applied to minimize secondary brain damage. Hence, pre-hospital management has the potential to detect and manage further impacts at the scene of the accident.

Emergency medical services (EMS) have important principles that can be exploited to manage TBI. EMS is a significant part of Saudi Arabia’s healthcare system. Alshammari et al. (2017) explain that EMS is the preliminary contact for pre-hospital patients. Further, the authors illustrate that pre-hospital care models in Saudi Arabia are emerging with community approaches, such as attitudes, awareness, and knowledge limitation prominent in healthcare providers. Another significant limitation within the Saudi Arabian EMS model includes the statistical inconsistencies related to the rate of transfer and response time (Alshammari et al., 2017). EMS services have greater significance in managing secondary TBI and should be applied in professional practice.  

Scope of the Study

Broad Objective

The primary objective of this study is to scrutinize the management of head injuries for patients in pre-hospital settings in Saudi Arabia.

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Specific Objectives of the Study

The specific objectives of this study are:

  1. To evaluate the level of pre-hospital management of head injuries for patients in pre-hospital settings in Saudi Arabia.
  2. To recognize the factors that influence the pre-hospital management of head injuries for patients in pre-hospital settings in Saudi Arabia.

Research Questions

  1. How is the pre-hospital management of head-injured patients implemented in prehospital settings in KSA?
  2. What are the factors affecting the prehospital management of head-injured patients in KSA?


This study adopts a retrospective approach to launch its empirical investigation. The study utilizes primary and secondary research methods to conduct its investigations.

Primary Research

The study will utilize primary research models for its data collection. The investigation will be carried out at an EMS facility in Saudi Arabia. The study will partner with the Saudi Red Crescent Authority  (SRCA), which provides EMS in five administrative regions of the Kingdom of Saudi Arabia. Additionally, the data will be collected from three or four hospitals for the first category. The primary research will be conducted through questionnaires, which will be developed with open-ended questions to examine factors that affect the pre-hospital management of patients with head injuries. The primary research will provide data based on real-life situations and relevant experiences from direct stakeholders. 

Secondary Research

The research will also conduct secondary investigations, which will rely on data, publications, and other healthcare reports from the SRCA. The study will gather data from patient records, other publications, and peer-reviewed journals to answer the research questions. The data will be collected to ascertain the level of severity of injuries in pre-hospital care as given by providers.


Accordingly, the study will focus on patients with head injuries that occurred between 2017-2018. The duration is identified to enable the researcher to access the immediate published clinical reports that can provide accurate facts.

Ethical Issues in Research

The study seeks to apply ethical practices during its investigations. Medical records are highly secured data and are bound to generate ethical questions. Therefore, the research will seek permission from the facility to access the patient record and informed consent from the EMS personnel who will participate in answering the questionnaire. The study will also acknowledge all the sources consulted in the course of the study either as comparative text or as significant factual evidence.


Traumatic head injury (THI) has severe consequences for people. Moving vehicle accidents and other personal accidents, such as falls and sporting casualties have a high rate of THIs. Clinical steps should be initiated to manage the secondary impacts of TBI. Additionally, conceited effort and partnership should be developed between EMS and the government departments to ensure protective measures are undertaken, especially on the roads to minimize further accidents.

I will need permission from the facility to access the patient record and inform consent from the EMS personnel who will participate in answering the questionnaire



Al-Habib, A., A-shail, A., Alaqeel, A., Zamakhshary, M., Al-Bedah, K., AlQunai, M., & Al-Enazi, S. (2013). Causes and patterns of adult traumatic head injuries in Saudi Arabia: implications for injury prevention. Annals of Saudi Medicine, 33(4), 351-355.

AlShammari, T., Jennings, P., & Williams, B. (2017). Evolution of emergency medical services in Saudi Arabia. Journal of Emergency Medicine, Trauma and Acute Care, 2017(1), 4. doi:10.5339/jemtac.2017.4

Andriessen, T. M., Horn, J., Franschman, G., van der Naalt, J., Haitsma, I., Jacobs, B., … Vos, P. E. (2011). Epidemiology, severity classification, and outcome of moderate and severe traumatic brain injury: a prospective multicenter study. Journal of Neurotrauma, 28(10), 2019-2031.

Badjatia, N., Carney, N., Crocco, T. J., Fallat, M. E., Hennes, H. M., Jagoda, A. S., … Pons, P. T. (2008). Guidelines for prehospital management of traumatic brain injury 2nd edition. Prehospital Emergency Care, 12(SUPPL. 1).

Hyder, A. A., Wunderlich, C. A., Puvanachandra, P., Gururaj, G., & Kobusingye, O. C. (2007). The impact of traumatic brain injuries: A global perspective. NeuroRehabilitation, 22(5), 341-353.

Maas, A. I., Stocchetti, N., & Bullock. R. (2008). Moderate and severe traumatic brain injury in adults. Lancet Neurology 7(8), 728-741.

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