British Association of Spinal Cord Injury Specialists
- Co-operation in the efficient retrieval and early admission of acute spinal cord injured patients for specialised care.
This requires liaison with the Ambulance Service and with all Accident and Emergency and Acute Trauma/Orthopaedic Units in the region. It includes the provision of guidelines for acute care and transportation.
- Admission System
The service must provide full support to Accident and Emergency Centres and Trauma Services, in its catchment area and whenever possible admit directly from the local accident scene
- Accurate and rapid diagnosis of the spinal lesion using modern diagnosis aids.
The service must have access to facilities for full diagnostic investigation including plain X-ray, CT and MR scans on a twenty-four hour basis with other modalities such as neuro-physiological assessment being available as appropriate.
- Specialist management in the acute phase.
With the a im of opt im ising recovery and min im ising complications, the service must have the ability to manage the spinal injury as well as the multi-system malfunction .The support of Specialists from allied disciplines should be available. The centre should have the capability of managing multiple injuries and patients requiring ventilatory support.
- Physical and psychological and multi-system rehabilitation to enable patients to reach their full potential for independent living.
The service must have dedicated Physiotherapy and Occupational Therapy staff with on demand services from Speech Therapy and Dietetics. The team will include Clinical Psychology. Psychiatric Services will be available on demand.
- Discharge of patients to appropriately modify domestic or residential facilities.
The service must have close links to the Social Services and other community providers. It must have the facilities to visit and educate relatives, carers and health care professionals, both in the hospital and in the community.
- Advice and guidance towards further education or gainful employment.
- Provision of after care which encompasses Hospital Outreach Services.
After care for spinal cord injured patients necessitates life-t im e surveillance of state of health, independence and safe functioning of the various systems of the body affected by the paralysis. The Centre must provide community liaison services with open access for consultation by patients, general practitioner and community nursing staff.
- Clinical audit of the process and outcomes of care for acute spinal cord injured patients.
- Readmission of spinal cord injured patients for:
- The treatment of life-threatening complications such as respiratory infections or failure, septicaemia, widespread tissue necrosis with toxaemia due to pressure sores and intractable autonomic dysreflexia.
- Urological surgery, for example for the treatment of renal and vescical calculi, bladder outlet obstruction, and for major bladder and urethral reconstruction.
- Other medical complications related to spinal cord injury.
- Some Centres may choose to develop special expertise in one or more aspects of paralysis that require special skills and that are small in numbers or infrequently required . Some examples are: Major surgery such as thoracotomy for phrenic nerve im plant insertion, spinal canal exploration for the treatment of syringomyelia or for intra-spinal somatic and autonomic nerve im plants, Anterior sacral root st im ulators.