The following good practice and paediatric practice points relating to service delivery, training, and organisation of care from the earlier sections of the guideline are grouped together here to provide a basis for local discussion of implementation of the guideline.

Each neurosurgical department should take a lead in establishing local implementation of the guidelines, ensuring that they are widely known and regularly reviewed with staff in referring hospitals.

Staff caring for head injuries should be given training to ensure ability to carry out reliable assessments, and their proficiency documented.

The increased use of investigations may reduce hospital admissions, but there is no evidence yet of a substantial change of practice. This area is an important target for research and audit (see section 11).

All A&E Departments which receive head injured patients should have rapid access, round the clock, to facilities for skull films and CT scanning. Staff trained to interpret the results of these investigations should be available.

Patients admitted to a general hospital for observation should be cared for in wards where observation and care of head injury patients is a regular part of the workload, and where staff have sufficient training and time to provide appropriate care during admission and to arrange for appropriate aftercare following discharge.

Children requiring admission should be admitted under the care of a paediatric surgeon or paediatrician with experience in the care of children with a head injury and those children should be observed in a children's ward.

Decision-making about patients who need transfer to a second hospital with a neurosurgical unit can be difficult, particularly in the context of multiple injuries or where prognosis appears poor.

General hospitals in Scotland should have facilities for electronic transmission of images and consultation with the regional neurosurgical unit.

Children <3 years old who have sustained a head injury are particularly difficult to evaluate and clinicians should have a low threshold of suspicion for early consultation with a Specialist Paediatric Surgical Unit.

The need for severely head injured patients to be transported between hospitals should be minimised and, when required, carried out to standards recommended by the Association of Anaesthetists / British Society of Neuro-Anaesthesia.

Transfer of a child to a specialist neurosurgical unit should be undertaken by staff experienced in the transfer of critically ill children - i.e. a (Regional) Paediatric Transfer Team.