EMS Particular Patient Populations - Spina Bifida

When responding to patients with spina bifida, EMS providers should be aware of the following key points:

1. Understanding Spina Bifida:

   • Spina bifida is a congenital condition characterized by incomplete closure of the spine during fetal development. It can result in varying degrees of spinal cord and nerve damage, leading to physical and neurological impairments.
   • There are different types of spina bifida, including spina bifida occulta (mild, hidden form), meningocele (meninges protruding through a spinal defect), and myelomeningocele (most severe form, with the spinal cord and nerves protruding through an open spinal defect).

2. Neurological Impairments:

   • Patients with spina bifida may experience neurological impairments such as paralysis or weakness in the lower limbs, loss of sensation, bladder and bowel dysfunction, and hydrocephalus (build-up of fluid in the brain).
   • Assess the patient's neurological status, including motor function, sensation, and reflexes, and be prepared to manage any associated complications, such as urinary retention or neurogenic shock.

3. Skin Integrity:

   • Patients with spina bifida, particularly those with myelomeningocele, are at increased risk of skin breakdown and pressure ulcers due to impaired sensation and mobility.
   • Inspect the patient's skin for signs of pressure injuries, and provide appropriate padding and positioning to prevent further skin damage during transport.

4. Bladder & Bowel Management:

   • Bladder and bowel dysfunction are common complications of spina bifida, requiring ongoing management and monitoring.
   • Be prepared to address urinary retention, urinary tract infections, and fecal incontinence, and provide appropriate interventions, such as catheterization or bowel management techniques.

5. Orthopedic Considerations:

   • Orthopedic deformities, such as scoliosis (curvature of the spine), clubfoot, or hip dislocation, may occur in patients with spina bifida and may require surgical correction or orthotic devices.
   • Be aware of any orthopedic issues that may affect the patient's mobility and positioning during transport, and provide appropriate support and accommodations as needed.

6. Hydrocephalus Management:

   • Hydrocephalus is a common complication of spina bifida, resulting from impaired cerebrospinal fluid (CSF) circulation and absorption.
   • Monitor the patient for signs and symptoms of increased intracranial pressure, such as headache, vomiting, or changes in consciousness, and provide timely interventions, such as ventricular shunting or CSF drainage, if necessary.

7. Psychosocial Support:

   • Living with spina bifida can have a significant impact on the patient's emotional well-being, as well as on their family members and caregivers.
   • Provide emotional support and reassurance to the patient and their caregivers, and connect them with appropriate community resources and support networks as needed.

8. Collaboration with Healthcare Providers:

   • Communicate with the patient's primary care provider or specialists, such as neurosurgeons, orthopedic surgeons, urologists, or rehabilitation specialists, to obtain relevant medical history and treatment information.
   • Provide a detailed report to the receiving healthcare facility to ensure that the patient's ongoing medical needs are addressed and that appropriate follow-up care is arranged.

By being knowledgeable about the unique challenges and needs of patients with spina bifida, EMS providers can deliver compassionate and effective care that supports optimal outcomes and enhances the patient's overall well-being.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell