Pre-and In-hospital First Aid Programs and Specifications for Spine and Spinal Cord Injury in Beijing of China: a Prospective, Multicenter, Case Series Trial

This is a prospective, multicenter, non-randomized controlled trial. The target population consists of 200 acute spinal cord injury patients undergoing pre-hospital treatment in the Beijing Emergency Medical Center and Beijing Red Cross Emergency Rescue Center, and receiving in-hospital treatment in the Peking University People's Hospital, Peking University Third Hospital, Beijing Friendship Hospital Affiliated to Capital Medical University, Chaoyang Hospital Affiliated to Capital Medical University, and Chinese PLA General Hospital, China.

History and current related studies Acute spinal cord injury (SCI) as a clinical common disease is the difficulty of clinical treatment, and frequently occurs in young adults. The incidence of acute SCI is 30-40/million people in Europe and USA, but 60.2/million people in Beijing of China. The complete SCI is very dangerous, and there is no effective medical therapy. At present, the effective treatment of acute SCI should be the first aid and advanced rehabilitation.

24 hours is the best time to rescue spinal cord function after SCI, especially 3-8 hours after injury is the golden opportunity. A large dose of hormone therapy in the 3-8 hours after injury can reduce secondary injury, thereby reducing the degree of SCI. 24 hours after injury, early surgery for relieving spinal cord compression can significantly improve the recovery of spinal cord function. Timely and properly pre-hospital first aid, quick hospital admissions and assessment, and timely surgery are essential for the rescue of spinal cord function. Patients with incomplete SCI can be completely injured and lose the possibility of recovery of spinal cord function due to improper first aid or untimely treatment. Complete SCI will cause more severe injury due to improper treatment. It may be difficult to make up for surgery or rehabilitation training. A sound and rapid treatment system is the basis for improving the treatment level of SCI, but we still lack of this kind of system in China.

In Beijing of China, pre-hospital treatment can be done by Beijing Emergency Medical Center (120 first aid system) and Beijing Red Cross Hospital (999 first aid system). While cooperating with each other, it is also faced with different mechanisms, different treatment patterns and overlapping treatment regions. As for the in-hospital treatment, Beijing has a large number of high-level hospitals, but these hospitals are overcrowding. There is no SCI treatment specialist or professional hospital in Beijing City, so treatment basically relies on various general hospitals. In pre-hospital first aid and in-hospital treatment of Beijing City, the medical information transfer is not smooth; the treatment process is separated, and it lacks of standardized treatment. The ability and level of medical personnels are not consistent, the technology is backward, and there is lack of professional training. Thus, the vast majority of patients with SCI cannot be treated within the optimal treatment time after injury. It is also an important cause of higher mortality and disability in SCI patients in China compared with the developed countries.

In 2006, Professor Bao-guo Jiang, director of the Department of Orthopedics, Peking University People's Hospital, led the establishment of the Traffic Medicine Center of Peking University, involving Peking University People's Hospital, School of Public Health of Peking University, Peking University First Hospital, Peking University Third Hospital, Beijing Traffic Management Bureau, and Beijing Emergency Medical Center in China. Reviewed by the Health and Family Planning Commission, the "National Center for Severe Trauma Training" was set up in 2015, and Bao-guo Jiang served as the director of the center. The Traffic Medicine Center and two emergency centers in Beijing have cooperated for many years, and established an epidemiological database for the treatment of severe trauma and the linkage mechanism of pre-hospital and in-hospital. The treatment of spine injury and SCI is one of important contents for treating severe trauma. With this center as a platform, the database of SCI patients can be specialized; a unified standardized and rapid treatment can be carried out in many participating medical units using the linkage mechanism with the emergency centers; a high level of scientific research can be carried out, and a series of studies can be started, concerning SCI epidemiology, treatment procedures and improvement in treatment effect. Simultaneously, the standardized training for pre-hospital and in-hospital first aid care personnel in each research center and hospital can be completed.