Lodhi Athar, Khan Shahbaz Ali, Ahmed Ehtisham, Fatima Sadia, Fatima Fozia, Pasha Tousif, Alvi Hamid Fazeel
Department of Accident and Emergency, Ayub Teaching Hospital, Abbottabad, Pakistan.
J Ayub Med Coll Abbottabad. 2011 Oct-Dec;23(4):10-2.
Spinal injuries are one of the most devastating and crippling conditions known to mankind. Natural calamities follow no rules, and all have the potential of devastating medical and public health resources, earthquakes being the deadliest. The incidence of spinal injuries increases by leaps and bounds in such calamities. Improper pre-hospital management and inadvertent manipulation of the spine during rescue and transfer can aggravate the damage. This study was conducted in order to access the level of pre-hospital care that had been provided to the patients with spinal injuries reaching Ayub Teaching Hospital, Abbottabad after the October 2005 earthquake.
This study was conducted in the department of Neurosurgery, Ayub Medical College after the earthquake of October 2005. 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 like spinal immobilisation, intravenous access, fluid resuscitation, catheterisation, pain killers and intravenous steroids administration were also recorded.
Out of the 83 patients with spinal injuries, 55 (66.26%) were females and 28 (33.7%) were males. Age ranged from 12-68 years (mean 26.6 +/- 13.2 years). At the time of presentation 70 (84.3%) patients had complete spinal injury whereas 13 (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 spinal immobilisation on the spinal boards. Intravenous line was maintained in 24 (28.9%) patients and only 18 (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 of patients. Only 10(12%) were brought in properly equipped ambulances.
Poor pre-hospital management of spinal injured patients depicts the lack of emergency preparedness as well as the lack of basic knowledge rescue teams and health care providers about the common trauma management measures. There is a dire need of educating rescue workers and volunteers about spinal injury in order to save lives minimise the secondary damage to already affected spine.
脊柱损伤是人类已知的最具毁灭性和致残性的病症之一。自然灾害毫无规律可循，所有自然灾害都有可能破坏医疗和公共卫生资源，其中地震最为致命。在这类灾害中，脊柱损伤的发生率会急剧上升。院前管理不当以及在救援和转运过程中对脊柱的不当操作会加重损伤。本研究旨在评估2005年10月地震后送至阿伯塔巴德阿尤布教学医院的脊柱损伤患者所接受的院前护理水平。
本研究于2005年10月地震后在阿尤布医学院神经外科进行。所有脊柱损伤患者均纳入研究。记录年龄、性别和入院时间等人口统计学数据。还记录了院前护理的重要方面，如脊柱固定、静脉通路、液体复苏、导尿、止痛剂和静脉注射类固醇的使用情况。
在83例脊柱损伤患者中，55例（66.26%）为女性，28例（33.7%）为男性。年龄范围为12 - 68岁（平均26.6 +/- 13.2岁）。就诊时，70例（84.3%）患者为完全性脊柱损伤，而13例（15.6%）为不完全性脊柱损伤。61例（73.5%）患者为截瘫，22例（26.5%）为四肢瘫。只有8例（9.6%）患者在使用脊柱板进行适当的脊柱固定后被送往医院。24例（28.9%）患者维持了静脉通路，只有18例（21.7%）接受了某种形式的液体复苏。三十八例（45.7%）进行了导尿。18例（21.6%）在患者入院时接受了某种形式的胃肠外止痛剂，4例（4.8%）接受了类固醇。只有10例（12%）乘坐配备适当的救护车送来。
脊柱损伤患者的院前管理不善表明缺乏应急准备，以及救援团队和医护人员对常见创伤管理措施的基本知识欠缺。迫切需要对救援人员和志愿者进行脊柱损伤方面的教育，以挽救生命并尽量减少对已受损脊柱的二次损伤。
