3:00 a.m., road outside the city of Mombasa. Sirens pierce the silence of the night. A young motorcyclist lies motionless on the asphalt after a high-speed impact. The rescue team knows that decisions made in the next few minutes could mean the difference between a full recovery and permanent disability. It is precisely for these critical moments that the World Health Organization has published new 2024 guidelines for the management of spinal cord injuries.
In the world of emergency care, the management of spinal cord injuries (SCI) represents one of the most critical challenges. Suboptimal management in the first hours after injury can significantly affect the prognosis of patients, with long-term outcomes ranging from permanent disability to serious secondary complications. For this reason, the World Health Organization (WHO) has recently published the document "Minimum Technical Standards and Recommendations for Spinal Cord Injury Management in Emergencies" (2024) , a fundamental resource for all prehospital and hospital professionals involved in the management of SCI.
A Document Born from Field Experience
This document is based on experience gained in complex emergency settings, such as natural disasters, armed conflicts and other health crises, where the management of spinal cord injuries is often complicated by lack of resources and the need to adapt to extreme operating conditions. WHO, in collaboration with international experts and organizations such as the International Spinal Cord Society (ISCoS), has developed these guidelines to standardize SCI management practices, ensuring that patients receive appropriate care even in critical settings.
Spinal Cord Injuries (SCI) Numbers from Trauma |
500,000 new cases/year worldwide |
40% of injuries are due to road accidents |
60% of patients are under 30 years old |
Direct healthcare costs can exceed 1 million euros per patient |
Critical Updates for Emergency Medical Teams
The new WHO document is part of the framework of minimum technical recommendations for emergency medical teams (EMTs), providing detailed guidelines on various aspects of SCI management in emergency scenarios. Key points addressed in the document include:
Optimized prehospital approach , with precise indications on immobilization, transport and early management of SCI.
Clinical standards for in-hospital treatment , including surgical and non-surgical management of SCI.
Continuity of care plans , with a focus on early rehabilitation and reduction of complications.
Ethical and decision-making aspects , with particular attention to resource management in settings with limited access to advanced care.
What's New in the Prehospital Approach
While many of the recommendations are in line with current EMS practices, the WHO document introduces some important operational innovations for the pre-hospital context, which update the existing guidelines:
1. Selective immobilization and patient management
Reduction in the systematic use of rigid cervical collars confirmed, with greater emphasis on manual in-line stabilization (MILS) and lateral head blocks.
Importance of timely removal of spinal boards to reduce the risk of pressure ulcers.
Greater flexibility in managing agitated or uncooperative patients, allowing for more comfortable positioning .
2. Transport and transfer
Minimize multiple transfers by referring patients directly to trauma/spinal centers when possible.
Thermal protection is mandatory for all patients with SCI.
Introduction of the use of antiemetics to prevent vomiting in immobilized patients.
3. Management of neurogenic shock
Target mean arterial pressure (MAP) ≥85 mmHg for at least 7 days after cervical or high thoracic SCI.
Limit the use of prehospital vasopressors to continuous monitoring settings only.
Greater attention to the differentiation between neurogenic and hypovolemic shock .
4. Prehospital Neuromonitoring
Repeated documentation of neurologic function to detect any deterioration during transport, emphasis is placed on ongoing neurologic monitoring.
Recommendation to use the International Standards for Neurological Classification of SCI (ISNCSCI) / American Spinal Injury Association (ASIA) Impairment Scale (AIS) for more precise assessment.
Confirmation of the inapplicability of the Canadian C-Spine/NEXUS rules in polytrauma.
Conclusions and Implications for the Future
The integration of these new guidelines into the first level protocols represents a fundamental step forward to ensure management based on the best available evidence. Updating EMSy protocols based on these WHO recommendations will allow:
Optimizing the prehospital approach in SCI, reducing the risk of secondary damage.
Standardize operational practices across emergency response teams.
Improving survival and quality of life of patients with SCI.
Over the coming days, we will be working to integrate these recommendations into the EMSy guidelines, ensuring that our protocols are always aligned with the latest scientific evidence. Stay tuned for more details on operational updates!
Take Home Messages
📌 Immobilization must be selective and based on specific clinical criteria
📌 Thermal protection is as essential as immobilization
📌 Neurological monitoring must be continuous and documented
📌 Management of neurogenic shock requires specific blood pressure targets
📌 Systematic use of antiemetics in the pre-hospital setting.
🔗 SOURCE: https://iris.who.int/handle/10665/380527
