DELAY IN SPINAL CORD INJURY CARE AMONG THE US IMMIGRANT COMMUNITY

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Abstract

Authors: Matthias Linke DO1, Thomas N. Bryce MD1, 1Department of Rehabilitation and Human Performance, Icahn School of Medicine and Mount Sinai

Background: Fear of deportation prevents immigrants from accessing medical care. 1 Undocumented day laborers in the United States usually do not have health insurance, more than half do not seek medical care after an injury, and are more likely to seek care in free or cash based clinics. 2 For injuries to the spine, immobilization with early surgical intervention for spinal cord injury has been shown to improve neurological outcome.3 This case demonstrates a poor outcome for a laborer after a motor vehicle accident (MVA) due to lack of knowledge of spinal immobilization and delayed treatment in an immigrant employment setting where police and emergency medical services (EMS)were not called at the time of the accident.

Methods: The medical record was reviewed from his hospitalizations and the patient was interviewed after sustaining a spinal cord injury with delay in treatment after initial injury.

Results: 54-year-old male immigrant from South America working for cash at a slaughterhouse involved in a MVA late in the evening when the truck was too tall to go underneath and overpass. The patient struck the windshield with his shoulder and head. The patient was immediately paralyzed unable to feel or move his arms or legs; however, EMS and police were not called even with repeated requests from the patient. The other passenger left the scene of the accident and the driver drove the truck back to the warehouse. The patient remained wedged against the dashboard and floorboard unable to move. Upon return to the warehouse the patient was pulled out of the truck by his boss and driver, propped up against a crate and the driver left. EMS were finally called by the boss and the patient was admitted at a local trauma center where the patient found to have a C6-C7 fracture requiring C4-6 laminectomy with posterior fusion. The patient required a tracheostomy and feeding tube and 4 months later was subsequently admitted to acute rehabilitation where he was diagnosed with C4 AIS – A tetraplegia. In addition to spinal fractures the patient was found to have Diffuse Idiopathic Skeletal Hyperostosis (DISH) on imaging. The patient lives with his wife and 3 children in a second story walk-up apartment.

Conclusion: MVAs account for the most spinal cord injuries in the United States.3 Safety improvements in vehicles and acute treatment of spinal cord injury has improved the outcome of those injured. 3 Despite the advances in care of the spinal cord injured patients the immigrant population has delayed access to spinal cord injury care due to fear of deportation or medical repatriation. 4,5 United States Immigration and Customs Enforcement has designated hospitals as sensitive locations limiting enforcement actions. Injuries occur daily to immigrants with detrimental outcomes when adequate health care is delayed or omitted. There is opportunity for basic education of neurological emergencies to the immigrant communities to avoid serious adverse events and reassurance from the medical community that hospitals are safe places to seek medical care.

References:

  1. Sarría-Santamera A, Hijas-Gómez AI, Carmona R, Gimeno-Feliú LA. A systematic review of the use of health services by immigrants and native populations. Public Health Rev. 2016;37. doi:10.1186/s40985-016-0042-3
  2. Leclere OA, López RA. The Jornalero: Perceptions of Health Care Resources of Immigrant Day Laborers. J Immigrant Minority Health. 2012;14(4):691-697. doi:10.1007/s10903-011-9516-z
  3. Shank CD, Walters BC, Hadley MN. Current Topics in the Management of Acute Traumatic Spinal Cord Injury. Neurocrit Care. 2019;30(2):261-271. doi:10.1007/s12028-018-0537-5
  4. Young MJ, Lehmann LS. Undocumented injustice? Medical repatriation and the ends of health care. N Engl J Med. 2014;370(7):669-673. doi:10.1056/NEJMhle1311198
  5. Nienhusser HK, Oshio T. Awakened Hatred and Heightened Fears: “The Trump Effect” on the Lives of Mixed-Status Families. Cultural Studies ↔ Critical Methodologies. 2019;19(3):173-183. doi:10.1177/1532708618817872

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