Patient handling and transportation from site of injury to tertiary trauma centres in Nepal following acute traumatic spinal cord injury: a descriptive study

Spinal Cord Series and Cases, 2022 · DOI: https://doi.org/10.1038/s41394-022-00545-3 · Published: August 11, 2022

Simple Explanation

This study looks at how people with spinal cord injuries are handled and transported to hospitals in Nepal. It found that most people are helped by untrained individuals, often experience multiple hospital transfers, and take a long time to reach specialized trauma centers. The research highlights that there's a need for better emergency medical services in Nepal, including training first responders in proper spinal motion restriction techniques. Establishing clear referral pathways for patients with suspected spinal cord injuries is also crucial. Delays in reaching the appropriate medical facilities and improper handling can lead to further complications and worsen the outcomes for individuals with traumatic spinal cord injuries.

Study Duration

1 year

Participants

211 individuals with new traumatic spinal cord injury (tSCI)

Evidence Level

Descriptive study

Key Findings

1
The vast majority (96%) of individuals with tSCI were initially assisted by untrained individuals at the injury site.
2
Only a small fraction (0.5%) of individuals received spinal motion restriction using a spine board at the injury site.
3
A significant portion (46%) of individuals required more than 24 hours to reach a tertiary trauma center after their injury.

Research Summary

This descriptive study examined the pre-hospital care and transportation of individuals with acute traumatic spinal cord injury (tSCI) in Nepal. It assessed patient handling at the injury site, the number of healthcare center transfers, modes of transportation, and the time taken to reach tertiary trauma centers. The study found that most individuals with tSCI were assisted by untrained responders, experienced multiple hospital transfers, and faced prolonged times to reach tertiary trauma centers. Proper spinal motion restriction was rarely applied at the injury site. The authors conclude that there is a need to improve emergency medical response systems, train first responders in spinal motion restriction techniques, and establish clear referral pathways to reduce morbidity and mortality following acute tSCI in Nepal.

Practical Implications

Improve First Responder Training

Implement comprehensive training programs for first responders and traffic police in Nepal, focusing on proper spinal motion restriction techniques and the importance of timely intervention.

Establish Clear Referral Pathways

Develop and disseminate clear referral pathways for individuals with suspected tSCI, ensuring rapid and efficient transportation to tertiary trauma centers.

Enhance Emergency Medical Services

Expand and standardize emergency medical services throughout Nepal, including increasing the number of adequately staffed and equipped ambulances and improving road access.

Study Limitations

1
The rehabilitation-based sample selection may limit generalisability, representing only those individuals who have progressed to acute SCI rehabilitation.
2
People with less severe SCI who recover fully during acute care may be underrepresented.
3
The sample may underrepresent those who died on-site or during the acute phase, given sub-optimal care and delays in treatment.

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