Brain injuries are increasing in severity because of the State's economic success, and because medical advances help more people to survive, according to neurosurgeon Mr Jack Phillips at Beaumont Hospital.
Among the worst affected are young men who can afford to buy new cars and drive them at high speeds, which increases the risk of serious brain damage in a crash.
Thousands of people now have significant problems arising from brain injuries and are in need of rehabilitation, he said.
Mr Phillips estimates that as many as 13,000 people suffer head injuries each year from a variety of causes including road traffic accidents, falls and assaults.
Road traffic accidents are by far the biggest contributors to head injury. Half the 2,000 patients referred to the National Neurological Centre in Beaumont each year get their injuries on the road.
About 250 come to the hospital in a coma, he said. Of these, about 60 die and about 60 make a "moderate to totally clear" recovery. But as many as 125 are left with serious conditions which could range from a total personality change to a semi-vegetative state.
What happens to the 13,000 people who, by his estimate, suffer head injuries ranging from minor to severe each year is unknown, he said. There was an urgent need for a research programme to follow them up.
A small-scale research project at Beaumont found that of injuries in road traffic accidents, 75 per cent occur between 5 p.m. on Friday and 1 a.m. on Monday.
"Tragedy starts in Ireland at 5 p.m. on a Friday," he said.
As many as two-thirds of those who suffer brain injury in traffic accidents are young men between the ages of 18 and 25.
He is concerned that "it takes 12 hours on average for a patient to get to us after being identified with a head injury in the west of Ireland." A solution would be to base helicopters in Donegal and Mayo; he hopes that this will happen shortly.
The effects of brain injury vary from person to person, but if serious can include inability to control anger, loss of a sense of humour, intolerance of noise, being unable to make or carry out a simple plan and little or no capacity to remember what happened minutes or days ago.
It happens too often that "people are sent home with no information, no nothing," said Ms Bernie Murphy, director of the support and campaigning group Headway Ireland.
The person who comes home may be "a different person." The whole family life can suffer. Marriages can break down or undergo tremendous strain.
Some young, brain-damaged people end up in geriatric wards or psychiatric hospitals, she said.
For many people a serious head injury means the end of their social life, said Ms Magdalen Rogers, family support officer with Headway Ireland. Social contacts shrink to the immediate household, which puts a heavy psychological burden on the members of the household.
Headway Ireland has called for a national strategy on head injuries with suitable facilities to meet rehabilitation and other needs in each health board area.
Rehab is setting up a project in Galway to help people with head injuries to get back to work, whether sheltered or in the open market. Through its National Training and Development Institute, Rehab aims to provide two similar projects at its Roslyn Park College in Dublin.
"We started trying to get approval over 10 years ago," said Ms Dorothy Gunne, chief executive of NTDI, of Rehab's desire to provide this service. The organisation has found a ready welcome in Britain for the idea where it has 11 such facilities either in operation or on the way.
A survey at the National Rehabilitation Hospital last October found that 78 per cent of persons with brain injuries failed to receive the continuous treatment recommended for them when they returned home.
When the matter was raised in the Dail by the Fine Gael health spokesman, Mr Alan Shatter, the Minister said regional committees had been established to improve the planning and co-ordination of services for people with physical and sensory disabilities, including head injuries.
It emerged in the reply that since 1997 only 18 extra physiotherapy posts have been created for that whole category of people of which those with head injuries form only part. Sixty-five posts in other disciplines have also been created along with 95 extra respite care places.
In the meantime, said Ms Gunne, "people are waiting, waiting and waiting for services and not getting them." pomorain@irish-times.ie