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

Abstract

Study design: Descriptive study. Objectives: To describe patient handling at injury site, number of healthcare centre transfers to reach tertiary trauma centre, modes of transportation, and time from injury to reaching tertiary trauma centres among individuals with acute traumatic spinal cord injury (tSCI). Setting: Acute SCI rehabilitation centre, Nepal. Methods: All individuals with new tSCI admitted for rehabilitation over period of 1 year were eligible for enrolment. Following written, informed consent, enroled individuals participated in structured one-on-one interview. Data collected included demographics, injury details, pre-hospital handling techniques, and transportation specifics to tertiary trauma centre. Results: In total, 211 individuals were enroled in the study. Eight (4%) individuals were assisted by first responders or traffic police, with majority (n = 203, 96%) assisted by untrained individuals. One was transferred from injury site using spinal motion restriction measures. Half were transported exclusively by ambulance while others used combinations of transportation. Six (3.4%) individuals were cared for by trained medical person during transport. Half required two or more hospital transfers prior to reaching a tertiary trauma centre. In total, 98 individuals required >24 h to reach the tertiary trauma centre. Conclusions: Individuals sustaining a tSCI in Nepal often experience improper handling, multiple hospital transfers, and prolonged time to reach tertiary trauma centres following acute tSCI. Further expanding emergency medical response systems throughout the country, training and equipping first responders in spinal motion restriction techniques, and establishing clear referral pathways for individuals with suspected tSCI are warranted. Development in these specific areas may reduce morbidity and mortality following acute tSCI.