Bermuda does not need a brain surgeon despite the high number of road accidents which send scores of people to the emergency room with head injuries.

Emergency department chief Dr. Edward Schultz insisted King Edward VII Memorial Hospital's management of moderate and severe head injuries was very good.

"In Bermuda most of the major road traffic accidents involve head injuries,'' Dr. Schultz explained. "We have a high incidence of head injuries but our management of our head injuries is very good.

"We have an aggressive policy with head injuries.'' Dr. Schultz said the Anaesthesiology department played an important role in the treatment of head injuries.

"The anaesthesiologist comes down to the emergency room and a comprehensive head management process starts,'' he explained. "If a patient is combative and confused, they will put the person under anaesthesia and then take them for a CAT Scan.

"Then a decision is made, based on that CAT Scan, if surgery is needed.'' Dr. Schultz said that if surgery was required, in most cases, one of Bermuda's four general surgeons would handle the delicate operation, like decompressive procedures or alleviating skull fractures.

"If a more complex procedure is required they are sent overseas,'' he added.

"But most moderate cases do not require more than a removal of a blood clot.'' Dr. Schultz disclosed that most of the severe cases of head injuries could not be treated with surgery.

"The most severe head injury is a global defused head injury, which is when a shearing force causes damage,'' he said. "These injuries usually have very bad outcomes regardless of what hospital you are treated at.

"You can't do anything surgically for it. You can monitor the intercranial pressure in the head or give medication. Most people who die of head injuries have this type of injury.'' He added: "There is nothing you can do. We don't have a lot of options and it can't be surgically corrected.'' Dr. Schultz said that the four local general surgeons were more than capable of handling the emergency head injury cases in Bermuda, so "Bermuda in most cases does not need'' a neurosurgeon.

"The four general surgeons do an outstanding job,'' he reassured. "They provide excellent coverage for the head injuries in the emergency department.'' And he pointed out that the Island could not support a neurosurgeon. "It would be impossible for a neurosurgeon to earn a living on a population of 60,000,'' Dr. Schultz said. "You tend to find neurosurgeons in major city centres.'' In addition to trauma cases, neurosurgeons deal with swollen veins in the brain -- known as aneurysms -- haemorrhaging in the brain as a result of high blood pressure and spinal chord injuries.

"Many communities do not have the services of a neurosurgeon,'' he added."The hospital does an outstanding job for a community hospital.

"We are not a university teaching hospital with 2,000 beds. But we do have very sophisticated equipment for a community hospital.'' Dr. Schultz suggested the best way to reduce head injuries was to prevent them from ever occurring.

"Many of the injuries involve the use of high speeds on the roads and dangerous driving,'' he explained. "And often the outcome is tragic.

"Driving at a high speed increases the injuries.'' HIGH LEVEL OF CARE -- Dr. Ed Schultz says treatment for victims of head injuries is good at King Edward VII Memorial Hospital