Can-SCIP Coach App
  1. Can-SCIP
  2. Recommendations
  3. Guidelines
  4. Section 1 - COMPONENTS OF IDEAL SCI CARE SYSTEM

A - PREHOSPITAL AND EMERGENCY




When there is an immediate threat to an individual’s life and rapid extrication is needed, make all efforts to limit spinal movement while not delaying treatment. (Adapted from NICE 2016, p.8; Level B)
Expeditious and careful transport of patients with acute SCI is recommended from the site of injury by the most appropriate mode of transportation available to the nearest capable definitive care medical facility. Whenever possible, transport to a specialized acute SCI treatment centre is recommended. (CNS-TRANSPORT 2013, p.35; Level C)
First emergency responders on scene should explain to an individual who is planning to self-extricate that if they develop spinal pain, numbness, tingling or weakness, they should stop moving and wait for assistance. (Adapted from NICE 2016, p.9; Level B)
When an individual has self-extricated, support the individual to lay in a recovery position at a safe area from the vehicle or incident. (Adapted from NICE 2016, p.9; Level B)

When an individual is self-extricated, they should be assessed for:

  1. catastrophic hemorrhage
  2. airway with in-line spinal immobilization (for guidance on airway management, refer to the NICE guideline on major trauma)
  3. breathing
  4. circulation
  5. disability (neurological)
  6. exposure and environment
(Adapted from NICE 2016, p.9; Level B)
Do not transport individuals with suspected SCI on a rigid spine board/“longboard.” Laying on such rigid boards for long periods of transport can cause pressure injury, particularly in individuals with a SCI who do not have protective sensation. (Adapted from NICE 2016, p.9; Level B)
Time spent at the scene should be limited to lifesaving interventions only. (Adapted from NICE 2016, p.10; Level B)
The optimal first destination for a patient with a SCI is a major trauma centre with specialized SCI care. Hence, emergency transport personnel who have a patient with a suspected SCI should go directly to such a facility if possible. However, if the patient needs an immediate lifesaving intervention, such as rapid sequence induction of anesthesia and intubation that cannot be delivered by the prehospital teams, the emergency transport personnel should take the patient to the nearest hospital emergency room where such interventions are possible. (Adapted from NICE 2016, p.10; Level B)
Emergency transport personnel should go directly to the nearest trauma unit if a patient has: a suspected acute traumatic SCI (with or without spinal column injury), full in-line spinal immobilization, and needs an immediate lifesaving intervention (such as rapid sequence induction of anesthesia and intubation) that cannot be delivered by the prehospital teams. (NICE 2016, p.10; Level B)