Early immobilisation and treatment are crucial to recovery from spinal cord injury.
Spinal cord injury (SCI) is always an emergency as it can lead to permanent paralysis, cardiovascular problems or even death. ER24 paramedics are trained to deal with SCIs to minimise further complications. Grant Stewart, ER24 branch manager at the North Metropole, Western Cape explains that the most common types of SCI include contusion (bruising of the spinal cord) and compression caused by pressure on the spinal cord. Other types of injuries include lacerations (severing or tearing of nerve fibres, such as damage caused by a gunshot wound), and central cord syndrome.
‘As a bystander, you should keep the patient as found,’ Stewart says. ‘If you suspect a spinal injury, don’t move the person unless they’re in imminent danger from traffic or fire, for example, or if you need to perform CPR. If the person is in water, don’t move them to land. Rather keep them lying face up until help arrives, as the water will immobilise the spine. If the person must be moved, there should be one person controlling the neck and head to keep them in alignment, and at least two people on either side of the person to lift them without moving the spine.’ As you wait for ER24 to arrive, make every effort to keep the patient calm and focused on you, rather than looking around the accident scene.
As first responders, ‘ER24 paramedics will first perform triage to ascertain whether the patient requires immobilisation,’ Stewart explains. ‘This entails checking for both physical and neurological impairment, such as loss of motor and sensory functions.’
Paramedics are able to follow a well-researched protocol to identify patients who do not need to be immobilised. This prevents patients with uninjured spines from developing pain in their back as a result of being immobilised for prolonged periods. ‘Many years ago, as a first responder at an accident scene, the victim was able to tell us that she had heard her neck fracture on impact,’ Stewart recalls. ‘To avoid further damage, we cut out her car seat with her still strapped in – and transported her to hospital. If we’d moved her head or her neck, the sharp fragment of bones could’ve damaged her spinal cord and killed her.’ That incident was unusual, Stewart explains – especially now since vehicles now have more advanced airbags and crumple zones to protect drivers and passengers.
In addition, in the majority of medical response situations, the spine board has been replaced by the scoop stretcher, which comes in two halves and can slide under the patient with minimal movement. The length of the scoop stretcher can be adjusted according to the patient’s height, and the patient is secured by a spider harness or webbing. ‘A base plate, flanked by waterproof sponge head blocks, is used to secure the patient’s head,’ Stewart adds. ‘This is vital because improper immobilisation can worsen an unstable vertebral, move fractured bony fragments, or cause dislocated vertebrae to affect the cord and lead to secondary injury.’
If treated correctly, some people with SCI may regain some function between a week and six months after injury. Although spontaneous recovery is unlikely after six months, rehabilitation can minimise long-term SCI disability.
Clinically reviewed by Dr Vernon Wessels.