Early diagnosis of patients with stroke is paramount in order to achieve benefits from thrombolytic therapy. Public education, improved access to pre-hospital care and healthcare personnel along with prompt neuroimaging are some means by which care can be improved.

The majority of transferred head-injured patients sustained mild injuries with a third requiring surgical procedures and 19% requiring Intensive Care Unit care. Appropriate educational, training and transfer programmes and transfer policies must be implemented to minimize inappropriate transfers.

Reduction in unnecessary admissions, cost savings and increased efficiency may result from standardization of admission criteria for head-injured patients and consistent implementation of guidelines for admission without increased risk to patients.

Head injury in admitted patients is mainly due to road traffic accidents, falls and interpersonal violence. More effective prevention strategies including education and law enforcement are urgently warranted.

An observational cross-sectional study of seatbelt utilization conducted in Kingston, Jamaica, showed 81.2% utilization by private motor vehicle drivers and 74.0%, by front seat passengers. This was significantly improved compared to 21.1% and 13.6% respectively in 1996, before the introduction of legislation in 1999 (p < 0.001). Females were significantly more likely than males to wear seat belts, both when driving (92.5% vs 77.3%; p < 0.001) and as front seat passengers (79.9% vs 66.3%; p < 0 001).

The transfer of head-injured patients, many with multiple injuries, is not being performed in a manner consistent with modern medical practice. There is urgent need for implementation of a standardized protocol for the transfer of such patients in Jamaica.

Elderly surgical patients at the University Hospital of the West Indies, Kingston, Jamaica, had less emergency admissions, underwent more surgery, had a longer mean hospital stay, a higher mortality rate and a greater mortality amongst emergency admissions. Cancer was the commonest admission diagnosis and that amongst mortalities.