PRE-HOSPITAL MANAGEMENT OF SPINAL INJURIES IN A NATURAL DISASTER
Abstract
Background: Spinal injuries are one of the most devastating and crippling conditions known tomankind. Natural calamities follow no rules, and all have the potential of devastating medical andpublic health resources, earthquakes being the deadliest. The incidence of spinal injuries increases byleaps and bounds in such calamities. Improper pre-hospital management and inadvertent manipulationof the spine during rescue and transfer can aggravate the damage. This study was conducted in order toaccess the level of pre-hospital care that had been provided to the patients with spinal injuries reachingAyub Teaching Hospital, Abbottabad after the October 2005 earthquake. Methods: This study wasconducted in the department of Neurosurgery, Ayub Medical College after the earthquake of October2005. All patients sustaining spinal injuries were included in the study. Demographic data like age,gender and time of arrival at hospital were recorded. The important aspects of pre-hospital care likespinal immobilisation, intravenous access, fluid resuscitation, catheterisation, pain killers andintravenous steroids administration were also recorded. Results: Out of the 83 patients with spinalinjuries, 55 (66.26%) were females and 28 (33.7%) were males. Age ranged from 12‒68 years (mean26.6±13.2 years). At the time of presentation 70 (84.3%) patients had complete spinal injury whereas13 (15.6%) had incomplete spinal injury. Sixty-one (73.5%) patients were paraplegic and 22 (26.5%)cases were quadriplegic. Only 8 (9.6%) patients were brought to the hospital after proper spinalimmobilisation on the spinal boards. Intravenous line was maintained in 24 (28.9%) patients and only18 (21.7%) received some sort of fluid resuscitation. Thirty-eight (45.7%) were catheterised, 18(21.6%) received some sort of parenteral analgesics and 4 (4.8%) received steroids at the time ofpatients. Only 10 (12%) were brought in properly equipped ambulances. Conclusion: Poor pre-hospitalmanagement of spinal injured patients depicts the lack of emergency preparedness as well as the lack ofbasic knowledge rescue teams and health care providers about the common trauma managementmeasures. There is a dire need of educating rescue workers and volunteers about spinal injury in orderto save lives minimise the secondary damage to already affected spine.Keywords: Spinal injury, pre-hospital management, earthquake 2005, spine immobilisationReferences
Blumer CE, Quine S. Prevalence of spinal cord injury: an
international comparison. Neuroepidemiology 1995;14(5):258–
Dryden DM, Saunders LD, Rowe BH, May LA, Yiannakoulias
N, Svenson LW, et al. The epidemiology of traumatic spinal cord
injury in Alberta, Canada. Can J Neurol Sci 2003;30(2):113–21.
National Spinal Cord Injury Statistical Center. Spinal cord injury.
Facts and figures at a glance. J Spinal Cord Med
;28(4):379–80.
Crosby ET. Airway management in adults after cervical spine
trauma. Anesthesiology 2006;104:1293–318.
Lenehan B, Boran S, Street J, Higgins T, McCormack D,
Poynton AR. Demographics of acute admissions to a National
Spinal Injuries Unit. Eur Spine J 2009;18:938–42.
Woersching JC, Snyder AE. Earthquakes in El Salvador: a
descriptive study of health concerns in a rural community and the
clinical implications, Part I. Disaster Manag Response
;1(4):105–9.
Raissi GR. Earthquakes and rehabilitation needs: experiences
from Bam, Iran. J Spinal Cord Med 2007;30:369–72.
Tauqir SF, Mirza S, Gul S, Ghaffar H, Zafar A. Complications in
patients with spinal cord injuries sustained in an earthquake in
Northern Pakistan. J Spinal Cord Med 2007;30:373–7.
Fehlings MG, Louw D. Initial stabilization and medical
management of acute spinal cord injury. Am Fam Physician
;54(1):155–62.
Eismont FJ, Currier BL, McGuire RA Jr. Cervical spine and
spinal cord injuries: recognition and treatment. Instr Course Lect
;53:341–58.
Priebe MM. Spinal cord injuries as a result of earthquakes: lessons
from Iran and Pakistan. J Spinal Cord Med 2007;30(4):367–8.
Rathore FA, Farooq F, Muzammil S, New PW, Ahmad N, Haig
AJ. Spinal cord injury management and rehabilitation: highlights
and shortcomings from the 2005 earthquake in Pakistan. Arch
Phys Med Rehabil 2008;89:579–85.
Rathore MF, Rashid P, Butt AW, Malik AA, Gill ZA, Haig AJ.
Epidemiology of spinal cord injuries in the 2005 Pakistan
earthquake. Spinal Cord 2007;45:658–63.
Perry SD, McLellan B, McIlroy WE, Maki BE, Schwartz M,
Fernie GR. The efficacy of head immobilization techniques
during simulated vehicle motion. Spine (Phila Pa 1976)
;24:1839–44.
Chandler DR, Nemejc C, Adkins RH, Waters RL. Emergency
cervical-spine immobilization. Ann Emerg Med 1992;21:1185–8.
Ahn H, Singh J, Nathens A, MacDonald RD, Travers A, Tallon
J, et al. Pre-hospital care management of a potential spinal cord
injured patient: a systematic review of the literature and
evidence-based guidelines. J Neurotrauma 2011;28:1341–61.
Martchenke J, Lynch T, Pointer J, Rooker N. Aeromedical
helicopter use following the 1989 Loma Prieta earthquake. Aviat
Space Environ Med 1995;66:359–63.
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