Timing is of the essence when it comes to the early treatment of spinal cord injury, as the quality and timeliness of care will have an impact on the long-term prognosis of the survivor. Due to the necessity of getting the injured person to the nearest facility equipped to deal with spinal cord injury, family and other loved ones rarely have a say when it comes to where the survivor is transported and treated. In most cases, the patient will be sent to the closest Brain and Spinal Cord Injury Program designated acute care hospital. Below are some of the most frequently asked questions during the early treatment phase.
How should spinal cord injury be treated immediately following the injury?
Spinal cord treatment is divided into two phases—the acute phase and the rehabilitation phase. The acute phase starts immediately following the accident, and comprises the care that is received at the scene of the accident, the care that is administered upon admission to the hospital, and all subsequent care prior to the survivor entering the rehabilitation phase.
During the time immediately following the injury, the goal of the medical team is to stabilize the patient to ensure that no further damage to the spinal cord is sustained. Doctors are particularly concerned with reducing or minimizing swelling, as this can cause even more extensive damage to the spinal cord. Other treatment during this phase includes a combination of medication, surgery, bed rest, traction, and immobilization.
Immediately upon arriving at the hospital, the medical team will usually give the survivor a strong course of a steroid called methylprednisone (MP), which is designed to reduce swelling. The key is for this drug to be administered within eight hours of the injury. This will minimize the chances of further damage being done to the spinal cord as a result of swelling. In cases where bone fragments or foreign objects are pressing on the spine and causing additional swelling, surgery to remove these objects will be done.
Bed rest is a very important part of the acute care phase, because it allows the bones of the spine, which bear the majority of the body’s weight, to heal. Spinal traction may also be used to immobilize the spine and prevent dislocation. Sometimes the skull is immobilized with special equipment, allowing the spine to realign during the healing phase.
During the acute phase, the medical team may also indicate that the patient is experiencing something called “spinal shock.” Spinal shock is a condition that causes the survivor’s reflexes not to work, as a result of the trauma the spine has sustained. During the time the survivor is experiencing spinal shock, doctors may be hesitant to discuss long-term prognosis. That’s because it’s very difficult to accurately separate the loss of function that has resulted from the injury from the loss of function that’s occurring as a result of spinal shock. In most cases some function beyond what is seen during the spinal shock stage will return to the survivor.
When all is said and done, the goal during the acute phase is to stabilize the patient and minimize the amount of damage done to the spinal cord. Once the patient has stabilized, he or she will enter into the rehabilitative phase of care.
How do we know the hospital is equipped and knowledgeable to deal with a spinal cord injury?
Family members won’t have time to be choosy about where their loved one is taken, but they can rest assured that they’ll be taken to a hospital that has the experience and ability to handle the acute phase of spinal cord injury.
The main goal of the emergency response team—the group that arrives upon the scene of the accident—is to get the injured person to the nearest Brain and Spinal Cord Injury Program (BSCIP) designated facility. BSCIP-designated hospitals must meet certain standards and criteria set forth by the Department of Health, and must also be approved by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Any hospital that has been designated with the BSCIP label has the experience, personnel, and equipment necessary to see that the patient receives the best care possible. BSCIP-designated facilities are located throughout the country, in a pattern that ensures that every person who sustains a spinal cord injury is able to reach one in a reasonable amount of time.