Factors Influencing Prehospital Management


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Traumatic head injury (THI) is a critical health challenge across the world. THI refers to the impact of a violent trauma or a strong blow to the head, which may cause severe long-term effects or death. Accordingly, mild effects of such impacts may occasion strain leading to negative but temporary consequences on brain cells (Mayo Clinic, 2019). Oliver, Walter, and Redmond (2017) demonstrate that accidents are the main causes of THI, which lead to pre-hospital deaths, which occur due to inadequate and timely first aid response to victims (p. 978). According to Mayo Clinic (2019), THI demonstrates various symptoms ranging from sensory symptoms, cognitive, and physical. Some of the common symptoms of THI are disorders, such as sensory problems, sensitivity to light, headaches, sleep problems, dizziness, and poor body balance, including mood swings and memory challenges. Hyder, Wunderlich, Puvanachandra, Gururaj, and Kobusingye (2007) estimate that more than 10 million individuals are affected by the condition globally, and result in hospitalization or death. Studies also confirm that that one of the major causes of brain damages at the pre-hospital level entails road accidents (Maas et al., 2008). Although advanced prevention and treatment models for related brain complication have been realized within healthcare providers, death rates remain high (Hyder et al., 2007). World Health Organization (WHO) data on the prevalence of THI reveals that road accidents cause 60% of THIs while falls occasion about 20-30% of THI (Hyder et al., 2007). Furthermore, 10% are sports-related injuries and activities in the workplace, whereas another 10% is linked to violence (Hyder et al., 2007). Although major THIs occur in unavoidable environments, such as road accidents, fights, falls, or other natural disasters, it is significant to seek clinical examinations and interventions to manage increasing mortality rates. The study focuses on the management of head injuries for patients in pre-hospital settings in Saudi Arabia and schedules its empirical investigations on clinical preventions and management of the condition. Pakkanen et al. (2016) assert that half of the individuals who die from THI do so in the first two hours of the injury. Early response is expected to manage such situations. The authors reveal that the response time of paramedics and nurses in basic emergency took between 5-7 minutes, while advanced life support response time took between 10-15 minutes. Another significant finding by Pakkanen et al. (2016) was the low rate of intubation process by EMS paramedic staff. As a result, important steps of managing patients with head injuries are skipped due to capacity limitations from the clinicians. Van Wyck, Grant, and Laskowitz (2015) explain that approximately 70-90% of victims of penetrating traumatic brain injury (PTBI) die before arriving in healthcare facilities. Furthermore, the authors demonstrate that 50% of those who reach die due to failed resuscitation trials. The possible reason for such deaths can be explained from the delayed response of professionals or EMS interventions.

Literature Review

The global prevalence of THI continues to escalate annually. Garg, Singh, and Kashyap (2018) estimate a worldwide prevalence of 10 million people per year. The authors further illustrate that the damages occur at either a time of insult or those that occur after the injury. In the Kingdom of Saudi Arabia, the leading causes of THI are attributed to motor vehicle collisions and pedestrian injuries from road accidents (Al-Habib et al., 2013). The study by Al-Habib et al. (2013) reveals that traumatic head injuries (THI) are higher in men compared to women. Although the number of women drivers are few, the authors assumed that the variance could be because women are more careful on the road compared to men. 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. 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 utilization of both administrative and clinical preventive approaches. Accordingly, Al-Habib et al. (2013) illustrate that limited use of restraining devices, such as seat belts or helmets, has been reported as a major contributor to THI. Therefore, the significant severity levels can be managed by implementing strict policies on driving and stringent street crossing rules.

The older populations have a higher susceptibility to THI, indicating that older people are more likely to experience THI compared to other population. According to Andriessen et al. (2011), the elderly are linked to poorer health outcomes, which jeopardize the impact of patient management. Badjatia et al. (2008) further explain that early intervention can manage a primary injury of a patient since EMS staff would concentrate on handling the emergency process and stages of care for patients with THI. However, the authors illustrate that intervention can be applied to minimize secondary brain damages through early intervention of clinical management, such as first aid and extended emergency clinical management to avoid further escalation. Hence, pre-hospital management has the potential to detect and manage further impacts at the scene of the accident.

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The emergency medical services (EMS) have important principles that can be exploited to manage THI. EMS is a significant part of Saudi Arabia 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. Further, another significant limitation within the Saudi Arabian EMS model is the infrastructural limitations that reduce the susceptibility to THI for the people in partnership with stakeholders (Alshammari et al., 2017). EMS services have greater significance in managing secondary THI and should be applied in professional practice.

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.

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 under 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 at an EMS facility in Saudi Arabia. The study will partner with Saudi Red Crescent Authority (SRCA), which provides EMS in five administrative regions of the Kingdom of Saudi Arabia or else, the data will be collected from three to four hospitals. 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 EMS stakeholders.

Secondary Research

The research will also conduct secondary investigations, which will rely on data, and other healthcare reports from the SRCA. The study will gather data from patient records 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 available 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 bound to generate ethical questions. Therefore, the research will seek permission from the facility to access the patients’ record and inform 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 in people. Moving vehicles 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 THI. Additionally, conceited effort and partnership should be developed between EMS and government department to ensure protective measures are undertaken, especially on the roads to minimize further accidents.


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