PRE-HOSPITAL MANAGEMENT OF SPINAL INJURIES IN A NATURAL DISASTER
AbstractBackground: 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 immobilisation
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