The primary reason of emergency surgery in group 1 in the present study was to minimise rebleed while awaiting definitive treatment. In the present series 10 patients (1 in grade II and 9 in grade III) suddenly deteriorated and died before any treatment could be undertaken. The cause of death was rebleeding and not vasospasm as the deterioration was sudden and not a gradual drift in the level of consciousness. The rebleed was also confirmed in all by a CT scan. Seven patients had been admitted in the hospital for 3 days before suffering another rebleed. One patient in grade III rebled more than 2 weeks after admission, as surgery had to be postponed because of severe chest infection. Delay in diagnosis, and referral by the primary treating hospital and infrastructural inadequacies at the tertiary referral centre contribute to postponement of treatment. In developing countries delay in transportation of patient to a specialised neurosurgical centre, further defers the treatment. Though it was not possible to expedite the treatment to the maximum possible extent, but still the average admission to surgery interval was reduced to 22 hours in group 1, compared to 95 hours in group 2. In a large neurosurgical referral centre, like the AIIMS, more than one patient with clinical SAH may be admitted on any day. There is an enormous load on the cerebral angiography laboratory, where both diagnostic as well as therapeutic angiograms are performed. Therefore occasionally deserving patients with clinical SAH may have to wait for diagnostic angiogram. This leads to an unavoidable delay, over which neither the neurosurgeon nor the neuroradiologist can exercise any control.