Interventional Therapy: Emergency Protocols for the Spinal Injectionist
by Richard M. Rosenthal, MD
 On January 15th, 2009 there was a
bright blue sky over the Hudson River. This was the backdrop to one of the most dramatic
airline emergencies in history. Prior to take-off in New York City, everything was normal.
There was nothing during pre-flight inspection that gave cause for alarm. A maintenance
check required every 550 flight hours had recently been performed. However safety
inspections were not enough to prepare them for what happened next.
The plane took off from Runway 4 at 3:25pm, to begin its ascent to 15,000 feet.
However, at 3,200 feet, the plane’s windscreen turned dark brown and the pilots heard
several loud thuds. Both engines quickly lost power and the plane started its lifeless
decent. Captain Sullenberger called to the air traffic controllers, “Hit birds;
We’ve lost thrust on both engines.” A migrating flock of Canadian Geese had
flown into the airplane causing both engines to fail. “We’re turning back
towards LaGuardia,” said the Captain to air traffic control. “Got emergency
clearance if you want to try and land…” air traffic control reported.
“Unable,” replied Sullenberger, “…maybe Teterboro?” Teterboro
airport in New Jersey was the closest airport en route with the airplanes current
direction. Seconds later, Sullenberger reported: “We can’t do it…we’re
gonna be in the Hudson.”
Capt. Sullenberger navigated the unpowered plane into the Hudson River. Emergency
rescue teams were immediately dispatched and all 155 occupants were safely evacuated as
the plane flooded with water. Sullenberger was immediately recognized as a hero. However,
he attributed his heroics to his many years of experience and training for emergencies in
an airline simulator. He stated, “I think that it allowed me to focus clearly on the
highest priorities at every stage of the flight without having to constantly refer to
written guidance.”
Memory Retention of Spinal Intervention Emergency Protocols
In the same way, spinal interventionalists should not only be qualified in providing
expert procedural care but also in management of emergency situations that arise during
performance of procedures. There is an implicit understanding between patient and
physician that, should an emergency arise, the physician will be able to provide the care
needed to resuscitate the patient. Last month’s article in Practical Pain Management,
entitled “Avoiding complications from interventional spine techniques,”
described the types of complications that can occur during a spinal injection.1
The purpose of this article is to provide physicians with guidelines for resuscitation
should the need arise. Finally, the authors hope to motivate readers to mentally and
physically rehearse, on a regular basis, the steps necessary to provide appropriate care
in an emergency.
Please refer to the April 2010 issue for the complete text. In the event you need to order a back issue, please click here.
— April 2010
The full article is now available as a PDF and may be
purchased for $5 and downloaded immediately:
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