Phillip Hughes and the Management of Head and Neck Injuries

Phillip Hughes, 30 November 1988 – 27 November 2014

The tragic death of a promising batsman in Sydney on the 27th of November highlights the relative difficulty in the management of head and neck injuries even in developed countries like Australia.

The batsman, who was compared to an early Don Bradman, was struck in the neck by a bouncer delivery. The strike was a freak occurrence and had struck the man at a point where his neck was unprotected. He was wearing full, regulation safety gear, and experts in the field say that he was well protected. The chances of the ball bouncing the way it did and striking him where it did were astronomically low.

Hopefully this will lead to a full review of safety precautions for all the players in the field.

The nature of the injury was a surprise to all who dealt with the situation. The ball bounced in such a way that it hit his neck damaging the very sensitive vertebral artery. This is one of the major arteries supplying blood to the brain. That, coupled with the force of the injury (causing swelling and preventing the neurons of the brain from getting the vital nutrients we need) lead to a situation which was almost impossible for even the most advanced trauma units in the world to deal with.

Immediately after the injury, Hughes was taken to a trauma centre and surgery was done to decompress the skull. The skull is a bony closed compartment. When the brain swells, the skull doesn’t really give way which leads to the development of very high pressure inside the skull. That high intracranial pressure directly injures the neurons of the brain and at the same time prevents the heart from pumping blood to the brain to keep the rest of the brain alive.

Hughes was put into a medically induced coma to slow the metabolic processes in the brain. This is, sort of, a last-ditch effort in most head injuries to try and slow the development of the swelling and allow the medical care team more time to let the drugs that control swelling work.

It works sometimes. In this case, it didn’t. Phillip Hughes passed away on November 27th. His death is a tragedy but hopefully a tragedy we all can learn from. Phillip Hughes will be remembered as a good man and an excellent sportsman. Hopefully the public health systems of both the developed and developing worlds will take notice of the precariousness of such injuries, and work on a war footing to increase the response times of EMS systems. Training and investment in infrastructure, to deal with such injuries, is actually a savings as injuries like this cost the society a great deal more in terms of lost lives and economic hardship for the families and communities involved.

This incident shed light on a disturbing truth that freak accidents can happen to anyone. It is the duty and responsibility of the citizenry to demand and work towards better EMS management in our communities.