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Will Spinal Cord Injuries Fall Through the Cracks in Haiti?

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Haiti Needs Spine-Specific Medical Aid, Doctors Say

Medical professionals are concerned that one class of injury — spinal cord trauma — may not be getting proper response in the aftermath of the earthquake that struck Haiti Tuesday.

Spinal cord injuries will be one of the most critical traumas faced by those trapped or injured in the wake of the disaster face, says Dr. Colleen O’Connell, secretary of Helping Hands for Haiti, a non-profit dedicated to providing medical rehabilitation services in Haiti.

Trauma to the spinal cord requires immediate and highly specialized care to prevent further paralysis or possible death, she says, but given the state of Haiti’s health care, she fears it will be a nearly impossible to get victims of spinal cord injuries the help they need without outside aid.

“Unfortunately, in Haiti, there is no infrastructure to deal with this kind of injury in the best of conditions,” says Dr. William Gibbs, medical director of the department of rehabilitation at New York Hospital Queens, let alone in the face of such a disaster.

Even before the earthquake, O’Connell adds, the survival of people with spinal cord injury was “dismal” considering “there are no trained spinal surgeons, no neurosurgeons, and only a number of orthopedic surgeons” in Haiti.

“Access to any comprehensive spinal cord care does not exist,” she says.

“You couldn’t pick a more poorly infrastructured, minimally-resourced country for this to happen to,” she says. “And it [struck] the capital, which was the only place that had some semblance of health care.”

Treating Spinal Trauma after the Earthquake

“Earthquakes cause a huge sudden number of spinal cord injuries,” says Dr. Andrew Haig, president of the International Rehabilitation Forum. “Buildings collapsing are a real set-up for the spinal cord to be crushed.”

And the slew of spinal injuries that can result from an earthquake are more difficult to treat than typical spinal injuries in a number of ways.

First of all, how the injury is handled in the first minutes and hours after the trauma can make all the difference, but given the sheer number of victims, it is nearly impossible for all to get immediate care.

Additionally, unwitting rescuers often exacerbate the initial injury by dragging or carrying the victim away from rubble without any efforts to stabilize the person’s spine.

“Local teams need to be really aware that a person with a back or neck ache may become paraplegic if they move them wrong,” Haig says.

But “many survivors probably cannot be ‘immobilized’ properly before extricating from the debris,” Andrew M. Casden from the Spine Institute of New York says. “A cervical collar and transport on a hard board are standard, [but] probably not realistic in this situation.”

With the general hospital in Port-au-Prince collapsed and all of the downtown hospitals damaged to some degree, O’Connell says, care is taking place in tents set up outdoors and it can be hard for patients to even get a spot at a hospital.

Unfortunately, Casden says, “I do not think there is a chance that the care can be up to standard in a horrible situation like this one.”

This lack of resources poses a formidable challenge for healthcare workers attempting to stabilize those with spinal cord injuries.

In an urgent situation like this, patients with spinal cord injuries or other serious traumas may find themselves pushed aside for people with minor injuries that use fewer resources and have a better shot at recovery, Casden points out.

“These patients require tremendous resources to care for them — ventilators, special beds, tube feeding, MRIs, complex surgery often. More acute life threatening situations may ‘bump’ the care of stable yet very sick spinal cord injury patients,” he says.

And what will happen when these patients are released from medical care back into the community?

When earthquakes occur in impoverished areas such as Haiti, there is little infrastructure available to support paralyzed patients.

Coping With the Earthquake Aftermath, a Rush for Medical Aid

O’Connell says that at the Helping Hands for Haiti rehabilitation center, it is not “uncommon for us to see people within days of their injury, discharged without proper management of their injuries.”

“If you don’t jump onto the rehabilitation process within a few days, you are going to lose some people,” Haig says. “Oftentimes the disaster planning process looks at rehabilitation as something that comes weeks or months down the road from an injury — they don’t take into account this need.”

“This is going to be an extraordinarily consequential disaster for Haiti,” says Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University Mailman School of Public Health.

But many non-profit and health-care organizations are mobilizing to meet the need of earthquake victims in Haiti — several specially targeted at helping those with spinal cord injuries.

Helping Hands for Haiti, Doctors Without Borders and Handicap International all have medical personnel on site and/or plan to send medical specialists to aid the crisis in Port-au-Prince and several more organizations will discuss aid options as well, O’Connell says.

“There has to be an urgent, coordinated influx of orthopedic and trauma surgeons and neurosurgeons into the country as soon as possible,” she says.

Gibbs couldn’t agree more: He says he plans to travel to Haiti with a team of doctors — including a neurosurgeon — whose focus will be on spinal cord injury patients. The team plans to work out of the floating naval hospital when it arrives.

“Organization is key to getting adequate relief faster,” Redlener says. “The lessons we have taken from events like [Hurricane] Katrina is the coordination and organization of response so we can respond faster.”

“I don’t think the world can forget about Haiti,” O’Connell says. “We’ll be in this for the long haul.”

ABC News Medical Unit
ABC’s Lara Salahi contributed to this report
Copyright © 2010 ABC News Internet Ventures

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