Three Key Stages
Three stages need complete attention
Immediately after a possible traumatic spinal cord injury, three broad areas need to be the focus:
01 Prevent worsening of the primary pathology (the immediate first damage)
02 Management of the injury and prevention of additional complications, as a result of the injury.
03 Medical treatment & rehabilitation
In certain cases, all of these may start on the first day itself.
Prevent worsening of the primary pathology (or the immediate first damage)
This should ideally start at the accident site & is also relevant while the injured person is being moved to a hospital.
Assume spinal cord injury: At the accident site, the dictum must be that until proven otherwise, you should always assume it as a spinal cord injury if the above mentioned red-flag symptoms are present.
What you must not do:
- Do not make the injured person sit
- Do not make the person stand.
- Do not give soda, juice, coffee, tea, any other liquid or solid food to an unconscious person; this is the worst thing you can do. It may even cause death. If the injured person has had any liquid or solid food, it may delay surgery. It may cause complications in anesthesia and surgery. There are many instances of persons suffering brain injury due to having been fed fluids or food.
- Injured person may ask for water but it is not essential. What is essential is quickly and safely taking him to a hospital that has the capability for diagnosis and treatment of spinal injuries.
- Do not go to a local clinic or primary health centre asking for bandage for treating small wounds. Do not take the person home for rest. It could delay the process of diagnosis and treatment. Delayed transportation of spinal injury patients to a definitive treatment center is associated with less favorable outcomes, longer hospitalizations, and increased costs.
Positioning & carrying a person: How will you position the injured person? How will you lift the injured person? How will you carry the patient?
There should not be any additional damage to the spinal cord or any other part due to improper handling immediately after the accident.
While extracting from the site of trauma, the person should not be lifted manually. The persons should continue to be strapped to a rigid, flat surface until reaching the hospital. During such transfers to a rigid stretcher or a board, care should be taken to treat the whole person as you would a newborn baby, ensuring that the injured person’s head, neck, upper & lower back and legs are well supported, and like a log of wood that cannot be flexed.
If a stretcher is not available, please get the next best thing to a stretcher. Create a stretcher-like rigid, flat holder, if nothing else is available. Look for a board, piece of wood or bed sheets, and use them for this purpose. Use a stretcher and insert the stretcher under the person’s body gently by lifting the injured person slightly with the help of three persons – one each to hold the head & neck, upper & lower back, and legs.
The person must be moved to the first point of medical care in the same lying down position only. In the vehicle, if the injury appears to be in the neck region, in which case the person may have no or limited movement of his arms, a combination of any type of carefully applied rigid cervical collar, with supportive blocks, on a rigid backboard with straps and tape to immobilize the entire body is effective at achieving safe, effective spinal immobilization for transport. Sandbags with the patient strapped to a rigid backboard are not sufficient and are not recommended as the first line of neck immobilization. Do not ask the person to try and move his neck. The objective is to completely avoid any sort of movement of the neck.(2)
If the injured person has normal hand movements, it is likely the injury will be in the trunk region. Positioning him supine (on his back with head facing the ceiling) should be enough.
The injured person must be taken to the nearest tertiary care hospital that has ortho- or neuro-surgeons. If possible, go to a hospital that offers spine injury treatment, though such hospitals are few and far between.
How you retrieve a person from the site of the accident, how you carry him to the vehicle and how the vehicle goes – these will be absolutely vital steps. Doing these basic steps improperly will cause additional damage.
Please note that immobilization is not needed for trauma patients who do not have the red-flag symptoms mentioned above, and who fulfill all the following criteria:
- are awake, alert, and are not intoxicated
- are without neck or back pain/tenderness
- do not have an reduced muscle power or sensations in their arms/legs
- do not have any significant associated injury that might detract from their general evaluation.