Paralysis, or Death?

January 14th, 2010

Catchy title, eh? Well…it is in line with the story I wanted to talk about. Since I put the title out there, I wonder what people thought when they see that title. I am willing to bet that there are people who would say they would rather die than be paralyzed, but enough of the morbid fascination on questions like this for now.

A study has been published that suggests gun shot victims are much more likely to die if paramedics do a spine stabilization before they rush them to the hospital. Obvious reasoning is that it requires more time to do the spine stabilization than it does to just load the victim into the ambulance.

The problem appears to be delay, researchers report in the January Journal of Trauma. To stabilize the spine, paramedics wrap a cervical collar around a patient’s neck and strap the individual to a long board to keep the vertebrae from shifting during transport. Although these measures immobilize the spine, the patient loses precious minutes.

“Some injuries are very time sensitive,” says study coauthor Elliott Haut, a trauma surgeon at the Johns Hopkins Hospital in Baltimore, which averages one gunshot patient per day. “Sometimes, if you get here in 10 minutes we can save your life, but in 20 minutes we can’t,” he says. Spine immobilization delays a trip to the hospital by two or three minutes on average, but can take more than five minutes, previous research has shown. Same with social security disability if you have to go through that hassle.

Don’t expect this to change anytime soon I would guess. It’s scary to think that a study like this could mean so much to someone’s life, or death. At the same time really not seem to be something of high recognition, or future study.

Although spine stabilization has proved its worth for car-crash patients, no studies had established whether it helps patients with neck or torso wounds from gunshots or knifings, where wounds might include spine damage. So Haut and his colleagues scanned a nationwide database of roughly 45,000 patients treated for such wounds. About 15 percent of patients who received spine immobilization died in the hospital, compared with 7 percent of those not immobilized. When the researchers accounted for differences in wound severity, gender, race and age, the difference remained twofold.

Undergoing spine immobilization didn’t affect death rates from knife wounds. The gunshot wound patients most affected by the immobilization procedure were those with low blood pressure.

Patients with partial spine damage from trauma harbor the greatest risk of vertebrae movement during transport and are most likely to benefit from spine stabilization.