Spinal Cord Injury Patients: Immediate action and Pathway?

Spinal cord injury (SCI) patients represent one of the most vulnerable groups of patients. The optimum care of an acute spinal cord injury patient involves not only an understanding of the biomechanics of spinal stability and spinal alignment but also of the multifaceted physiological and related problems of the spinal cord injured person.

Competency in their management involves not only the requisite technical skills but also a full understanding of the pathophysiology of the spinal cord injured person and the functional consequences of any treatment. (NSCISB 2010)

Example Spinal Cord Injury Centre

An example of a specialist SCI centre where a SCI patient should be sent as soon as they can.

Image Courtesy of The Bucks Herald

 Spinal Cord Injury Patient Pathway

The following quote is from the National Spinal Cord Injury Strategy Board (NSCISB) and explains the pathway that people with Spinal Cord Injuries should take:

“It is the view of the National Spinal Cord Injury Strategy Board (NSCISB) that all newly injured SCI patients should be referred and transferred to a specialised SCI Centre (like the one above) at the earliest opportunity after their injury. It applies equally to trauma patients and to those whose injury is of non-traumatic origin”.

“Spinal cord injured patients may require admission to other acute hospitals because of co-existing injuries, the need for complex spinal or other surgery, the need for other complex therapy such as endovascular treatment or renal dialysis, or simply because there is no SCI bed available”.

“Every hospital receiving trauma should have a defined link with a specified partner SCI Centre, allowing the joint development of written protocols for management of the general complications of spinal cord injury to be agreed. 24 hour image transfer will be required to allow appropriate decision making. Where immediate transfer to the SCI Centre is not possible because of a head or other severe injury, the newly injured patient should still be referred to the SCI Centre immediately, so that the SCI Centre can advise on the appropriate management of the patient, and provide acute outreach services”.

“Similarly, if the SCI Centre has no bed immediately available, they should provide telephone advice on the management of the patient, and provide acute outreach services”. (NSCISB 2010).

Example of nurse on the phone

Nurse on Phone – indicating phone support if a SCI centre isn’t immediately available

 Image Courtesy of Nurse.com

 The management of Spinal Cord Injuries in England is a Specialised Service within the NHS Commissioning Framework (SSCT 2012) designed around a network of 8 Spinal Cord Injury Centres. Through the work of the NSCISB, NHS England has evolved seven individual care pathways which encompass the lifetime care needs of SCI people from first diagnosis through to end-of-life care (www.mascip/sci-roadmap.aspx), Guidelines for the acute care and management ofSCI patients can be found in the Reintegration Care Pathways.

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National Spinal Cord Injury Strategy Board. (2010) Meeting the Needs of People with Spinal Cord Injury in Planning for Trauma. NSCISB. London.

NHS Clinical Advisory Group on Trauma (2010) Regional Networks for Major Trauma. http://www.excellence.eastmidlands.nhs.uk/welcome/improving-care/emergency-urgent-care/major- trauma/nhs-clinical-advisory-group/

Multidisciplinary Association of Spinal Cord Injury Professionals (MASCIP) (2009) Moving and Handling Patients with Actual or Suspected Spinal Cord Injuries. MASCIP. London.