Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
354745532
label
"SCI Digest - Summer 1979"
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
354745532
contentType
document
title
"SCI Digest - Summer 1979"
citationUrl
collections
Lex Frieden Collection: Records on Disability Rights
Printed Materials
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
354745532
levelOfDescription
fileUnit
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
171745005098a0f6
ocrText
Originally Processed With FOIA(s):
FOIA Number:
S
S
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the George Bush Presidential
Library Staff.
Record Group/Collection:
Donated Historical Materials
Collection/Office of Origin:
Frieden, Lex, Collection
Series:
Printed Materials
Subseries:
Periodicals
OA/ID Number:
52132
Folder ID Number:
52132-004
Folder Title:
"SCI Digest - Summer 1979"
Stack:
Row:
Section:
Shelf:
Position:
MODEL SYSTEMS'
Volume One
Summer - 1979
SCI
DIGEST
REHABILITATION SERVICES
ADMINISTRATION,
U.S. DEPARTMENT OF HEALTH,
EDUCATION AND WELFARE
AL
WA
MODEL SPINAL CORD INJURY
SYSTEM COMPONENTS
AZ
VA
National
Data
CA
Research
TX
Center
CO
PA
FL
NY
IL
MO
MA
FRONT COVER:
This schematic diagram is symbolic of
the functional interrelationships between the Regional Model
Spinal Cord Injury (SCI) Systems, the National SCI Data Re-
search Center and the Rehabilitation Services Administra-
tion, U.S. Department of Health, Education and Welfare.
Each circle represents an individual Regional SCI System
with the appropriate State abbreviation within the circle
showing the location of each.
Copyright© 1979 by the National Spinal Cord Injury Data Research Center, Good Samaritan Hospital, Phoenix, Arizona.
All rights reserved. No parts of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical including photocopy, recording or any information storage or retrieval system, without permission in writing from the
National Spinal Cord Injury Data Research Center.
MODEL SYSTEMS'
Volume One
Summer - 1979
SCI
DIGEST
In This Issue
From the Data Bank
EDITORIAL. John S. Young
2
Featured Guest
THE RUSSIAN EXPERIENCE. Robert R. Jackson
3
Featured Articles
A SYSTEM APPROACH TO EMS FOR
SPINAL CORD INJURY VICTIMS.
Philip R. Fine, Samuel L. Stover, and Michael J. DeVivo
5
SPINAL CORD INJURY AND THE EMT
Philip R. Fine and Samuel L. Stover
8
ARIZONA EMERGENCY MEDICAL SYSTEM
John M. Vivian and Carolyn J. Mitchell
28
System Statistics
STATISTICAL INFORMATION PERTAINING TO SOME OF
THE MOST COMMONLY ASKED QUESTIONS ABOUT SCI
- PART II. John S. Young and Nancy E. Northup
11
DATA BANK - CURRENT STATUS
36
This-N-That
ASIA NOTE
22
CORRECTION
24
FROM THE DATA BANK
DEPARTMENT OF HEALTH,
EDUCATION AND WELFARE
THE NITTY-GRITTY OF DATA COLLECTION
Office for Human Development
Services
"Let's collect some data!" This lau-
Arabella Martinez, Assistant
datory proposition is a bit like say-
Secretary
ing "Let's get married!" Exciting
Rehabilitation Services
revelations and the pursuit of hap-
Administration
piness are envisioned with little
Robert R. Humphries,
heed given to future implications or
Commissioner
Medical Research Office
consequences. We can contem-
J. Paul Thomas, Project
plate the ectasy now and deal with
Manager
the agony later.
In 1970, the Southwest Regional
PUBLISHED BY:
System for Treatment of Spinal In-
National Spinal Cord Injury Data
jury (SWRS) was funded by the
Research Center
Rehabilitation Services Administra-
Good Samaritan Hospital
tion (RSA), U.S. Department of
1130 East McDowell Road
Health, Education and Welfare, to
Suite A-6
demonstrate a regional system of
Phoenix, Arizona 85006
John S. Young, M.D.
spinal cord injury (SCI) care. Among
John S. Young, MD, Director
the objectives of the program was the development of a data
A.M. Bowen, Adm. Director
base to document the results achieved, particularly rehabili-
tation outcomes and cost effectiveness.
PUBLICATION STAFF
The original data base - long on fantasy and short on prag-
EXECUTIVE EDITOR
matic realism - contained 472 variables designed to answer
John S. Young, MD
all of the clinical, psychological, social, vocational and eco-
nomic questions of interest to the multiple professional dis-
EDITOR
ciplines involved in providing or paying for the services re-
Roberta McCutchen
quired by the spinal cord injured. The number of variables
STAFF EDITORS
adopted for inclusion in the data base almost became a status
Nancy E. Northup
symbol for each specialty. Medical social workers wanted so-
Ann M. Peters
cial data. Vocational counselors needed vocational data.
Physical and occupational therapists required functional data.
Worst of all, orthopedists, neurosurgeons, psychiatrists, plas-
CONTRIBUTING EDITORS
tic surgeons, urologists, pulmonary physicians and other
Lorraine Buchanan, PA
Lorna Christenson, VA
medical specialists were anxious to acquire statistical "re-
Michael J. DeVivo, AL
sults" of their clinical contributions.
Glenn Goldfinger, NY
Over the course of the first year, it became apparent that such
Marsha Hanak, NY
a "shotgun" approach was counter productive. The volume
Marianne Kaplan, IL
of data required was uncollectable, unmanageable and quite
Roberta Koontz, MA
Yvonne Lopez, AL
meaningless when the variance indigenous to spinal cord in-
Carolyn J. Mitchell, AZ
jury was compounded by the relatively small number of cases
Cathy Muhlbauer, CO
represented in the data bank. The original 472 variables were
James O'Heir, FL
then reduced to 108, sacrificing "completeness" for credibility.
Carol A. Smith, TX
As additional Regional Model SCI Systems were funded by
Erwin H. Sprengel, CA
Karen Wagner, MO
RSA, a mechanism for pooling common data was obviously
C. Gerald Warren, WA
necessary to create a sample large enough to minimize the
(continued on page 34)
2
Model Systems'
Volume One
FEATURED GUEST
THE RUSSIAN EXPERIENCE
Robert R. Jackson*, MD
Medical Director
Craig Hospital
Director, Rocky Mountain
Regional Spinal Cord
Injury System
In recent years, several spinal cord injured American Citizens
have journeyed to the Polenov Institute in Russia for reportedly
"new" treatment of their injuries. All these visits were widely pub-
licized by the news media in the United States. The great outcry
in the media spilled over into demands from various groups that
the Federal establishment as well as private agencies not only
investigate this Russian phenomenon but also support the use of
these reportedly "new" treatments for the spinal cord injured in
the U.S.
The time has come to place this matter in perspective. The work
reported by Dr. L.A. Martinian is admittedly an effort at extending
the work begun in this country (U.S.A.) over 30 years ago. The
original investigators were primarily Drs. L. W. Freeman, William
Robert R. Jackson, M.D.
F. Windle and William W. Chambers who reported on experimen-
tal work with animals. They noted that certain pyrogens and, later, certain enzymes seemed to
influence the recovery of central nervous system function in what were otherwise spinal injured
laboratory animals.
Dr. Martinian's work is summarized in English in the book, Experimental Studies in Regeneration
of Spinal Neurons (V.H. Winston and Sons, 1977, Editor: Tat'yana Nesmeyanora). In essence,
the claim is made that the trypsin experiments started by Dr. L. W. Freeman, University of Indiana,
have been extended using various enzymes including hyaluronidase and lactase. Apparently,
these endeavors were translated into an unknown number of human experiments by Dr. Veniamin
Ugriumov, Director of the Leningrad Research Institute of Neurosurgery. He used not only the
enzymes but also hyperbaric oxygen in his human experiments.
In June 1976, both Drs. Martinian and Ugriumov visited the United States in May and June at the
invitation of the National Institute of Neurological and Communicative Diseases and Stroke
*Dr. Jackson is now Executive Vice-President,
Rehabilitation, CASE MANAGEMENT, INC.,
Denver, Colorado.
SCI DIGEST
3
Summer - 1979
(NINCDS), National Institute of Health (NIH). The Russians did not offer any details of their work
but rather spoke in broad terms about a general attitude and approach to therapy. The number
of patients they'd treated was not given. (For a more detailed description of the treatment program
in question, please see the article by Dr. E. Mannarino in the Paraplegia News, 32, p., 79, or The
Journal of the American Paraplegia Society, II, March 1979.)
At this point, what would otherwise have been a little noticed clinical experiment became the sub-
ject of great interest and speculation as a result of extensive publicity by the lay press in the United
States. Multiple endeavors by the Director of the Stroke and Trauma Program of NINCDS, by the
Chairman of the Medical Advisory Committee of the National Spinal Cord Injury Foundation and
by many other interested individuals, both inside and outside our government, failed to produce
any results confirming those reported in the Russian literature. No verifiable solid scientific evi-
dence has been found to confirm that the course of human central nervous system trauma is
altered by the reported treatments at the Polenov Institute in Leningrad. Dr. Robert White's com-
ments on his endeavors at the 1979 ASIA Meeting substantiates the lack of confirming evidence
reported by other U.S. scientists.
Furthermore, under the auspices of NINCDS, Dr. Lloyd Guth and others attempted to repeat the
Martinian experiments. (The results of these experiments were reported at the 1979 American
Association of Neurological Surgeons in April.) Dr. Guth found that if he used the reported Martinian
technique for sectioning the spinal cord of a rat that, indeed, a number of the animals apparently
did achieve neurological recovery. However, when the animals were sacrificed, and the spinal
cords examined, some intact anterior fibers were found. Apparently, these fibers were left intact
by the sectioning technique used by Martinian. It has been known for years that if as little as five
percent of the animal's cord is left intact, significant apparent neurological recovery can occur.
Dr. Guth then refined the sectioning technique to ensure complete severing of the spinal cord. In
those animals, with complete sectioning of the cord, no neurological recovery occurred. Following
these studies, U.S. investigators stated that "the report of spinal recovery following transection
was probably due to the incompleteness of the transection rather than to enzyme treatment."
Thus, serious doubt now exists about the validity of Dr. Martinian's findings and about their appl-
icability to the treatment of spinal injury in humans.
Further efforts in this country and elsewhere to repeat the Martinian experiments led to the con-
clusion that - as reported by NINCDS - "No evidence was found that enzyme treatment sig-
nificantly reduced scar formation or affected restitution of sensation, posture or locomotion in
spinal rats."
Disregarding the failure of a number of qualified investigators to get hard facts from the Soviet
Union and the inability of qualified research personnel to repeat the Martinian experiments, the
rather provocative United States news stories have continued thus raising the expectations of a
"cure" for many of the spinal injured. As a matter of fact, Messrs. Waldrep, Hurt, and Turcotte
three U.S. Citizens who visited the Soviet Union for treatment - have announced the formation
of a new foundation to pursue further exploration of the Russian techniques. They are promoting
the intrathecal enzyme combined with hyperbaric oxygen as a procedure for the treatment of spinal
cord injured humans.
From interviews - both audio/visual and printed - with these three gentlemen and other U.S.
Citizens who visited the Soviet Union, there is no question that the intensive and virtually one-on-
one physical therapy program, which continues throughout the treatment day, does have a ben-
eficial effect on existing musculature and the patient's general outlook on life. However, all U.S.
Citizens who received the "Russian" treatment remained paraplegic - any "improvements" are
clearly those attributable to intensive physiotherapy and psychological support.
(concluded on page 34)
4
Model Systems'
Volume One
FEATURE ARTICLE
A SYSTEMS APPROACH TO EMS FOR
SPINAL CORD INJURY VICTIMS
Philip R. Fine, PhD, MSPH,
Samuel L. Stover, MD,
Michael J. DeVivo, MPH
UAB Spinal Cord Injury System
University of Alabama in Birmingham
Birmingham, Alabama
The eventual medical outcome for the spinal cord injured patient is dependent, in great part, on
the handling the victim receives at the injury scene and the appropriateness of the emergency
management. The spinal cord injured patient when initially examined is frequently found to have
a number of unique problems with which emergency medical personnel must cope. Experience
has shown that the likelihood of adverse consequences may be significantly reduced if a rapid but
appropriate decision making procedure is followed. 1
The sequence of steps in decision-making may be shown in a flowchart format commonly referred
to as an algorithm. Steps or junctures in a process of this nature are designated by a series of
standard symbols frequently used by computer programmers. 2
In the remainder of this article, the general Operational Algorithm currently being implemented by
the Regional Model Spinal Cord Injury (SCI) System, located at the University of Alabama in Bir-
mingham (UAB), will be described. Although certain processes or steps (particularly those per-
taining to reporting or recordkeeping requirements) are unique to the UAB Center, the general
scheme is suitable for numerous other applications.
The portion of the algorithm discussed herein is restricted to the Emergency Medical Service (EMS)
component of an overall management/care system. Since the Regional Model SCI System is a
functional unit of a larger general rehabilitation facility, the rehabilitation steps are not included, but
they do exist and are available on request.
BACKGROUND
A major objective of the federally sponsored Regional Model Spinal Cord Injury Program is the
development of an organized continuum or "system" of care for the spinal cord injured patient. For
investigative purposes, satisfaction of very specific criteria determines whether the patient is con-
sidered "System," or "Nonsystem". Yet, when a patient is admitted to the Spinal Cord Injury Sys-
SCI DIGEST
5
Summer - 1979
tem, regardless of research category classification, all activities and services are initiated and pro-
vided without further distinction; that is, all patients receive exactly the same medical and allied
health services.
The current Operational Algorithm was included with the Fifth and Sixth Annual Reports of the
UAB SCI System (a limited number of copies are available through the Center). The Algorithm or
Systems flowchart is the product of considerable effort and activity expended in developing a suit-
able "front end" or Emergency Medical Service (EMS) component.
SEQUENCE OF DECISIONS AND RECOMMENDED PROCEDURES
The extreme left portion of the algorithm designates the point of trauma. After notification and
arrival of appropriate EMS personnel, decisions regarding immediate disposition, care, and man-
agement of the patient must be made. It must be determined whether life support is required;
whether immobilization of the patient is necessary; and, in the case of accidental events resulting
in entrapment of the patient, whether special extrication procedures are needed. An affirmative
determination at any decision point results in the provision of the particular service or requirement
cited. Such a response is depicted as a Systems Loop.
During disposition and handling procedures, the patient must be continually monitored and reas-
sessed for changes in life-support requirements. If, in fact, changes in life-support requirements
are observed, they must be provided by EMS personnel.
At this point, the patient is more thoroughly evaluated for the possibility of spinal cord injury. If
such an injury does not appear to exist, the patient is transported to the closest appropriate hospital
or trauma center following radio notification by EMS personnel of patient evacuation and probable
arrival time.
EMERGENCY MEDICAL FACILITY
If the patient is believed to have sustained a spinal cord injury, the distance from the accident site
to the Regional Spinal Cord Injury Center is determined. If the accident site is more than 25 miles
from a Regional SCI Center, the patient is transported to the nearest appropriate medical facility.
Simultaneously, the Regional SCI Center is notified by radio of the patient's evacuation to that
emergency medical facility.
On arrival at the emergency room, the patient's medical status is further evaluated, and the pre-
liminary spinal cord injury diagnosis is reassessed. A medical decision as to the stability of the
patient's general medical condition is then made. If the patient's condition is stable, and appropriate
immobilization of the spine is confirmed, the Regional SCI Center is so notified. The patient is then
transferred to the Regional SCI Center without being admitted to the local hospital.
If the patient's medical condition is unstable and additional emergency medical attention is re-
quired, the attending physicians then become responsible for making appropriate arrangements
for medical and/or surgical care. This will most likely require a short term admission of the patient
to the local hospital.
REGIONAL SCI CENTER CARE
If the accident site is 25 miles or less from the Regional SCI Center, the patient is evacuated, in
most instances, directly to the Center bypassing other hospitals. Hospital "drive-by" may be for-
gone if:
The patient's condition deteriorates enroute to the SCI Center.
Local transfer agreements and evacuation protocols require local hospital evaluation.
6
Model Systems'
Volume One
Nonetheless, after admission to the Regional SCI Center/Acute Care Area, no further distinction
is made between patients whose trauma sites were more or less than 25 miles from the Center.
Following admission to the Acute Care Area of the Regional SCI Center, appropriate medical and
data collection activities are initiated. For example, upon admission to the University of Alabama
in Birmingham Hospital through the Emergency Department, standing orders exist which result in
immediate notification of the following services: Neurosurgery, Urology, Orthopedics, Trauma, and
Rehabilitation Medicine. The primary admitting service very likely will be Neurosurgery. However,
by virtue of the University Cooperative Agreement, all services identified above participate from
the onset in patient care activities.
The SCI Registry is queried to determine whether early notification of the particular patient's injury,
as called for in the algorithm, occurred, and if not, the Registry is notified accordingly.
At this point, provision of acute medical care is continued until the patient is ready for transfer to
the rehabilitation facility.
SUMMARY
Recapping the Operational Algorithm and the team which serves the needs of the spinal cord
injured patient: the numerous disciplines represented by a variety of health professionals assume
roles and responsibilities of equal importance. Fundamental to an approach of this nature is co-
ordination of individual activities coupled with an appreciation and, understanding of the profes-
sional roles of other participating disciplines.
It is apparent that the logistical requirements of a spinal cord injured patient are seriously beyond
the practical capacity of any single discipline or individual. For this reason, we are strong advocates
of the multidisciplinary team approach to their care.
The algorithm depicts, of course, the "ideal" management sequence. It is readily admitted that
real time modification is often necessary because the most complex variable, the patient, frequently
has special requirements which must be met on a practical basis. In fact, an inherent strength of
the system lies in its ability to be responsive to the special needs presented by each individual
patient.
It would be unrealistic to suggest that this model will be suitable for application in every spinal cord
injury care setting. Yet the fundamental structure, in its current state of refinement, is most as-
suredly valid. During the coming year, further refinement of the operational system is anticipated
along with improved efficiency in the delivery of multidisciplinary care to the patient who has suf-
fered spinal cord trauma.
REFERENCES
1. Cheshire, D. E.: The complete and centralized treatment of paraplegia: a report on the spinal injuries center for Vic-
toria, Australia. Proceedings of the 16th Annual Clinical Spinal Cord Injury Conference, Long Beach, California, 39-49,
1967.
2. Alexander, D. E., and Messer, A. C.: Fortran IV Pocket Handbook, New York, 1972, McGraw-Hill, Inc., p. 2-3.
(Reprinted with permission of the BREMSS Newsletter)
SCI DIGEST
7
Summer-1979
FEATURE ARTICLE
SPINAL CORD INJURY AND THE EMT
Philip R. Fine, PhD, MSPH,
Samuel L. Stover, MD
UAB Spinal Cord Injury System
University of Alabama in Birmingham
Birmingham, Alabama
INTRODUCTION
The disparity between the actual and the ideal delivery of medical care is probably most marked
in the handling of patients with spinal cord injury. In few other areas of medicine does the lag
between technical knowledge about a disorder and its actual implementation seem as great. Na-
tional and International experience indicates that patients with acute spinal cord injuries are best
managed at comprehensive health care centers specially equipped to provide a multidisciplinary
team approach to patient care. 1 Yet, the most sophisticated spinal cord injury center can do no
better than the Emergency Medical Service (EMS) component responsible for the immediate post-
injury extrication, immobilization, stabilization and evacuation of the injured person.
The Emergency Medical System is the organized entity which deals, initially, with the spinal cord
injury victim. The Emergency Medical Technician (EMT), who is at the forefront of patient care
activities immediately after the accident, assumes an important role in determining the eventual
outcome of the patient's care and treatment.
EMS AND THE SPINAL CORD INJURED
A well organized system of care for spinal cord injured patients consists of two separate and distinct
components. The first component involves patient care activities from the time of injury until ad-
mission to a specialized spinal cord injury center. The second, concerns patient care activities
subsequent to admission to the specialized medical facility. The injury, its characteristics, prog-
nosis and basic emergency management procedures will be examined.
HOW THE INJURY NORMALLY OCCURS
Injuries resulting in quadriplegia or paraplegia are usually secondary to direct spinal cord trauma
and may result from a fracture or dislocation of the surrounding vertebral elements or from pen-
etrating missiles such as bullets or knife wounds. The characteristics of the bony injury to the spinal
8
Model Systems'
Volume One
column and the neurological injury to the spinal cord and nerve roots must be considered individ-
ually and in detail to accurately assess the extent of trauma, select the proper emergency treatment
and, thus, increase the likelihood of accurately predicting the patient's eventual physical condition.
NEUROLOGICAL INJURY
The neurologic injury to the spinal cord must be differentiated from the neurologic injury of the
nerve roots. Spinal cord injuries which are complete (total motor and sensory loss) for twenty-four
(24) hours are unlikely to have good functional recovery. Nerve roots which are injured in or about
the area of trauma (even with complete cord injuries) may recover.
Spinal cord injury in the cervical area is incomplete if any sensory or voluntary motor function
remains below the level of the cervical cord injury. In the lumbar and sacral areas, the injury
is
incomplete if there is sacral sparing. Spinal shock may affect the spinal cord a segment or two
above the level of actual cord injury. Therefore, with time and disappearance of the spinal shock,
some return of function and sensation may occur in the myotome or dermatome at the level of
injury.
ETIOLOGY
Motor vehicle accidents are the leading cause of spinal cord injury followed by either gunshot
wounds or diving accidents. 2,3,4 Other water sports, stabbings, falls, and industrial accidents ac-
count for the vast majority of all remaining injuries. Statistics from spinal cord injury centers
throughout the United States indicate that three to four times more males suffer spinal cord injury
than females. 2,3,5 The average age group is the mid-to-late twenties with the great bulk of the
accidents involving persons between 15 and 40 years of age.
ASSOCIATED INJURIES
Associated injuries sustained by the patient at the time of spinal cord injury may be totally missed
due to loss of muscle control and lack of sensation. 6 The long bones of the extremities
must
be
checked carefully for fractures and appropriate treatment initiated if the patient is to be able to
manipulate a wheelchair or walk with crutches and braces in the future. Joint dislocations, which
may totally disable a person, even if his spinal cord injury proves to be transient, may be easily
overlooked and should always be considered. Intra-abdominal bleeding may be occult (due to the
loss of sensation) and must be carefully evaluated. Intra-thoracic injuries, such as rupture of the
diaphragm, fractures of the ribs, pneumothorax, hemothorax or hemopneumothorax may be
masked by decreased tidal volume in the quadriplegic patient whose intercostal muscles have
been paralyzed.
Associated injuries frequently delay prompt transfer of the victim from the first hospital to a spe-
cialized spinal cord injury (SCI) unit. After initial resuscitation and/or stabilization, however, the
transfer should not be delayed further if a bed is available in a SCI unit. In fact, it is advisable to
require that the patient be transported to the closest designated medical care facility, rather than
to one that may be physically closer to the accident site but is not equipped to provide appropriate
acute spinal cord injury care. Past experience has shown that the long term prognosis for the
spinal cord injured patient is improved if the early acute care is in keeping with accepted stan-
dards. 6 Evidence suggests that simply "getting the patient to any nearby hospital" is, ultimately,
not in the best interest of the patient, unless there is an immediate life threatening situation, such
as uncontrolled bleeding or respiratory shutdown, either of which would preclude transfer to a
designated trauma center.
SCI DIGEST
9
Summer 1979
TRANSPORTATION - ROAD ACCIDENTS
Proper management of a spinal injured patient at the place of injury such as at the site of a traffic
accident, before transportation to an acute care hospital, is extremely important. A fracture of the
spine is usually evident to the first trained medical observer who arrives at the scene. Bystanders
must be instructed to leave the patient in the position in which he is found and to make no attempt
to place the victim in a more comfortable position. Emergency Medical personnel must be trained
to immediately identify a possible spinal fracture, by asking the patient to specify the site of his
pain and to move his extremities. If a spinal fracture is suspected, with or without neurological
injury, a road accident victim must not be moved until appropriate stretchers are available. The
victim should then be carefully moved while maintaining the position of deformity - picked up by
at least three persons as a log and placed on an appropriate stretcher. The spine should be im-
mobilized with special spine splints or with sandbags properly placed about the neck and/or the
trunk. Other associated injuries of the extremities should be splinted in the position in which the
patient is lying.
WATER SPORTS
Patients who suffer paralysis after diving, or while engaged in other water-sport activities, should
be gently pulled from the water. If possible, the cervical spine should be maintained in a neutral
position. If the patient shows evidence of drowning, turn the victim completely on his side, while
carefully supporting his head, with his hips higher than his shoulders to help drain the water from
the lungs. The victim should not be placed in a prone position, and the neck should not be twisted
to one side. Of course, if the patient is in respiratory distress due to drowning, mouth-to-mouth
resuscitation to restore breathing takes precedence but the spine should be very carefully ex-
tended, with sumultaneous traction applied to the tongue to open the airway.
GUNSHOT WOUNDS
Gunshot wounds usually do not result in instability of the spine. These patients can be placed on
a regular litter or stretcher and may be loaded into the ambulance in a supine position. Many
gunshot victims may have associated injuries which will require other emergency medical
procedures.
PREVENTING AGGRAVATION OF THE INJURY
During the first few hours following an injury to the spine, an incomplete spinal cord injury may
progress to a complete spinal cord injury. This may be caused by one of three factors:
Progressive swelling and edema of the cord causing interruption of neural transmission.
Pressure on the vascular supply causing gradual ischemia of the spinal cord area.
Aggravated trauma from rough and/or improper handling.
Approximately 10 percent of all patients have injuries which became worse during the first day.
Spinal cord injured patients must be handled very carefully to ensure that further neurological
damage is not due to traumatic handling. If neurological function impairment is due to edema only,
functional recovery is possible. But, if the impairment is attributable to vascular embarrassment
by venous congestion and gradual infraction, the condition is probably not reversible.
(concluded on page 33)
10
Model Systems'
Volume One