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CHAPTER 12
collapse, may prove disastrous. Before transferring the injured to the nearest hospital
the first medical attendant should ascertain, wherever possible, the level of the lesion
and, in particular, the completeness of the motor and sensory paralysis and a written
statement should accompany the patient. The diagnosis of level of the cord lesions is not
difficult even for non-medical first aiders if the injured is conscious. The patient very
often complains of pain in his back at the level of the fracture. If he can move his arms,
hands
and
fingers the cord lesion is obviously in the thoracic region. If he can bend
his forearms, and extend his wrist but cannot extend his forearm and has no or greatly
reduced finger movements the cord lesion is situated in the mid-cervical region.
(d)
Transfer to a spinal centre
Whenever possible a traumatic paraplegic or tetraplegic should be transferred to a Spinal
Unit as soon as the patient's condition allows transfer, where the most favourable condi
tions exist for treating all aspects of paraplegia from the start by a specialized staff. This
should apply both in war and peace. This has been recognized by increasing numbers of
surgeons during recent years and several hundreds of patients have been admitted to
Stoke Mandeville within the first 24 hours after injury. Gregg & Wilmot (1964) have
organized a Flying Squad from the National Medical Rehabilitation Centre in Dublin,
consisting of a doctor, two nurses and two orderlies who are available to go out immediately
on request to any part of Ireland to collect and bring in under supervision any acute
traumatic case of paraplegia or tetraplegia. The acute case is usually collected from the
hospital nearest to the place of accident. If direct transfer to a Spinal Centre is not possible
and the patient has to be admitted to the Casualty Department of the nearest hospital,
the medical officer in charge of the case should make contact with the nearest Spinal
Centre for immediate transfer of the patient. If this is not possible, the medical officer
should seek advice regarding the initial management, in particular of the bladder.
(e)
Air transport
In recent years, a steadily increasing number of patients with spinal cord injuries have
been admitted to Stoke Mandeville by helicopter; during 1966, 34 cases. Service cases
were flown to the Centre from Germany within 24 or 48 hours and from Singapore,
Aden and Christmas Island within a few days of injury. This has proved a life-saving
measure, in particular in paraplegics and tetraplegics complicated by associated injuries
to other parts of the body. Fig. 72 shows the admission of a tetraplegic patient to Stoke
Mandeville by helicopter. He is just being taken out and note how the doctor holds the
head traction to keep the head in line with the axis of the body. Recently Ruge (1969)
suggested that 'if the transportation is going to require an hour or more an indwelling
catheter should be inserted into the bladder'. This extraordinary recommendation really
ignores the principles of proper initial management of the paralysed bladder—the more
so as Ruge does not give any details how and by whom this catheterization should be
carried out. Actually, there is no indication whatsoever for such a procedure, unless
transportation by sea would take many weeks or transport by air has to be delayed for
