High-dose steroids for acute spinal cord injury in emergency medical services.

Acute spinal cord injury (ASCI) is a potentially disabling condition that has been extremely resistant to treatment. Emergency medical services (EMS) providers are often among the first members of the health care team to treat victims of ASCI. Although initial human and animal studies indicated that highdose corticosteroid therapy might be an effective therapy for ASCI, subsequent human and animal studies have not been able to reproduce the beneficial effects described in the earlier research. Highdose corticosteroid therapy for the treatment of ASCI was introduced to prehospital care in the 1980s. It was postulated that early administration of corticosteroids could limit the severity of neurologic deficit associated with ASCI by stabilizing neuronal membranes and reducing inflammation and swelling. The recommended corticosteroid for acute spinal cord injury was methylprednisolone (MP), and the doses were large. Prior to this recommendation, many EMS services carried standard doses, typically 125 mg, of MP for use in severe allergic