Health: When life or death is down to chance

A car crash nearly killed Tracey Caplan. Luckily she ended up at one of the few hospitals that could save her.

THE NOISE of the impact is all that Tracey Caplan remembers about the moment when she almost died. "I was listening to music. There was a bang. And then, that was it," she recalls. A few moments earlier, she had been driving along an open road in Turkey with her boyfriend, Suleiman. They had fallen in love the previous year and Tracey was five months pregnant, about to meet his parents for the first time.

Then, the black-out. The car suddenly swerved out of control, and Suleiman felt the vehicle slewing into the path of an oncoming lorry. When he regained consciousness in the crushed vehicle, he saw Tracey's limp body being carried away.

Tracey's injuries were so bad that her father failed to recognise her at the hospital. She was flown back to Britain in a coma, and doctors could not guarantee that her condition would improve. There were deep contusions in her brain. An unstable fracture beneath her skull threatened to cut her spinal cord, and one artery to her brain was blocked. She was paralysed down one side, and at risk of becoming paralysed in her arms and legs. "A few days after the accident I thought she was gone," says Suleiman.

The accident happened on 17 June 1997. The fact that Tracey did survive is a medical miracle. The arrival of the couple's healthy baby, in October 1997, was even more remarkable. Today, 20-month-old Jordan wanders happily about the the family flat in Waltham Cross, Hertfordshire, oblivious to the dramas that surrounded his birth. Meanwhile Tracey, now 36, continues to make good progress. "I'm not in a wheelchair. I can move. My left side isn't 100 per cent, but I can walk, I can talk," she says.

Admittedly, she is unlikely to regain the kind of life she had before. She suffers from loss of short-term memory. "Before, I was like a computer, I was so organised," she says. Now, she cannot turn her head without experiencing problems, and she has difficulty carrying out basic tasks. Her mother looks after her for most of the day: "Mum had so many plans; now she's stuck with me."

Tracey owes her survival to medical skill, as well as luck. She ended up at one of the few hospitals in Britain with the facilities and experience to deal with severe brain and spinal injuries.

Every year, a million people are admitted to hospital with a head injury. One in six head injuries is caused by a road accident. However, a survey this week by the Royal College of Surgeons found that one in five accident and emergency departments lacks a brain scanner, an essential tool for diagnosing the severity of head injuries and determining whether surgery is required. Delays can mean disability or death.

Only 5 per cent of British hospitals have neurosurgeons, a lower percentage than in any other industrialised country. Britain has two neurosurgeons per million people, half the number in Germany, a quarter of those in Sweden, an eighth of those in Japan. The Royal College of Surgeons surveyed 243 accident and emergency departments and found that seven in 10 had no access to a brain surgeon and more than one in 10 was more than 50 miles from the nearest neurosurgical unit.

Peter Hamlyn, a consultant neurosurgeon at St Bartholomew's Hospital in London, argues that funding has failed to keep pace with advancements in neurosurgery and greater public expectations. Twenty years ago, he says, higher fatality rates were expected after severe accidents. "Neurological disorders were quite rightly off the agenda; there was nothing you could do."

However, there are now better ways to see inside the body. Computer tomography - the CT scan - has transformed doctors' work. Techniques are improving all the time. Survival prospects have altered dramatically, too. Ten years ago, half of those who suffered a serious head injury died; now, the figure is less than a third.

Mr Hamlyn and his colleagues at the Brain and Spine Foundation are convinced that the mortality could drop much further. But the reality is that if you live close to a hospital with a neurological unit when you suffer a brain haemorrhage, you have a good chance of surviving; if you don't, you won't.

Partly, the problem is people's failure to recognise potential warning signs, including tingling on one side, temporary jumbling of speech and violent "thunderclap" headaches, all of which can prefigure a brain haemorrhage. However, the Foundation, which Mr Hamlyn helped launch, is determined to raise money to combat the belief that nothing can be done after injury.

Tracey Caplan says: "Suleiman told me, `You're remarkable'. But I'm not remarkable. I'm lucky."

For more information contact the British Brain & Spine Foundation, 7 Winchester House, Kennington Place, Cranmer Road, London SW9 6EJ (0808 808 1000), or Headway, the National Head Injuries Association, 4 King Edward Court, King Edward Street, Nottingham, NG1 1EW. (0115 924 0800), e-mail www.headway.org.uk