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Challenges faced by UK HEMS clinicians when managing awake patients with traumatic spinal cord injuries: a
Madeleine Symes1, Amy Hughes2, Danë Goodsman2
1Alumni of the Intercalated BSc in Prehospital Medicine, Barts and The London School of Medicine and Dentistry, London, UK madeleine.symes@doctors.org.uk.
Background:
Helicopter emergency medical services (HEMS) provide critical prehospital care to patients with traumatic spinal cord injuries (tSCI). While immobilisation strategies have been extensively studied, little is known about the specific challenges clinicians face when treating awake tSCI patients, who present unique physiological and psychological needs. This study aimed to identify the key challenges faced by UK HEMS clinicians managing awake tSCI patients in prehospital settings.
Methods:
We conducted a cross-sectional survey of UK HEMS clinicians between January and March 2024. The structured questionnaire, developed through literature review and academic supervision, comprised multiple-choice and free-text questions exploring clinical, communication and logistical challenges. Demographic data were limited to professional role and service location to preserve anonymity. Responses were analysed descriptively and thematically using Braun and Clarke's six-step approach.
Results:
In total, 62 clinicians from 16 UK HEMS services completed the survey (76% service response rate; 58% doctors, 42% paramedics). A total of 293 free-text comments were collected. Thematic analysis identified three overarching themes. The predominant theme was communication and psychological challenge, with prognostic questioning rated the most difficult (29%) and patient fear and anxiety second (19%) causing significant emotional burden on clinicians. Second, clinical and environmental challenges, encompassing haemodynamic uncertainty (73% encountering hypotension, 52% bradycardia), ventilatory management (44%), pain control complications (52%) and thermal challenges (40%). Finally, training gaps and learning preferences, where patient-led education was most valued (50%) but available in only 10 of 16 services, despite simulation training (63%) and standard operating procedures (68%) being widely accessible.
Conclusion:
Communication and emotional support demands were rated more difficult than haemodynamic management by HEMS clinicians managing awake tSCI patients-a finding that challenges traditional training priorities. These findings highlight the need for enhanced training incorporating patient perspectives, structured protocols for prognostic communication and improved shock differentiation approaches.