"To Spine Board or Not"- Suggestions from a Paramedic

The Gathering of Eagles is held in Dallas Texas every year and is a source of many new ideas for the EMS Community.  It's members are many of the leading Medical Directors in the country.

In their 2014 conference Dr. Valenzuela and Dr. Fowler discussed the topic "To Spine Board or Not".  

We believe this analysis will provide a third way to address this issue other than use them or don't use them.

Analysis: Backboards are a tool for transporting  patients that must remain supine.  A subset of this group is patients that require spinal immobilization.  These two groups are not equal.

There are many instances where patients require transport in the supine position but don't require spinal immobilization.  Some examples are:

• patient is unresponsive or has an altered level of consciousness
• patient cannot sit up
• patient is obese, lying on the floor and unable to get to a standing position
• patient can't walk and the exit won't allow for a stair chair (scissor staircase or tight corner)
• patient is bed confined or bed ridden
• patient is paraplegic
• patient is most comfortable lying down (position of comfort)
• patient requires compressions during transport

If a patient is in a building that does not allow for a gurney to be rolled to the location (e.g. upper floor with no elevator, mobile home, etc.) then they must be transported to the gurney before placing in the ambulance

 In all of these situations a backboard or stretcher is required.

 Two additional issues that have been raised relative to the use of backboards:

• The overuse of spinal immobilization and its potential to do harm.
  
  
• Pressure sores caused by prolonged contact with hard surfaces.
  
  

Proposed Solutions

• First, clarify that backboard use for supine patient transport is acceptable when circumstances do not allow access with a gurney.
  
  
• Secondly, clarify that spinal immobilization should be minimized to use only when appropriate;
  
  
  • Provide specific guidance, such as in IL region 10's In-field  Spinal Clearance protocol, to clarify when spinal immobilization should or should not be used.
    
    
  • This protocol considers mechanism of injury (MOI), signs and symptoms (S&S) and patient reliability (PR).
    
    
  • Some examples are;
    
    
    • MOI - High velocity MVC equal to or greater than 40 mph
      
      
    • MOI - falls equal to or greater than twice the patients height
      
      
    • MOI - ejection from vehicle
      
      
    • S&S - pain in neck or spine
      
      
    • S&S - paralysis or abnormal motor exam
      
      
    • S&S - tenderness/deformity of neck or spine upon palpation
      
      
    • PR - abnormal mental status
      
      
    • PR - communications difficulty
      
      
    • PR - signs of intoxication
      
      
• Establish procedures that allow removal of patients from backboards upon arrival at the hospital to minimize pressure sores. 
  
  
  • Examples
    
    
    • Froedtert Hospital (A Level I Trauma Ctr. in Milwaukee, WI)  already practices this procedure.
      
      
    • We developed the Patran slip sheet procedure for use with the WauK® board to allow transfer at the ER with no discomfort to the patient.  http://www.waukboard.com/ems-cot-stair-chair-backboard/literature/slip-sheet-procedure.pdf
      
      

Summary

We believe that if the patient transport function of backboards is allowed-for in all those instances where supine rescue is required, and if spinal immobilization is only used when necessary as delineated by Medical Directors, such as in the IL Region X example, then "To spine board or not" can be eliminated as an issue.

 Garry and Brian Bandel

 About the Authors

For the last 11 years, Brian Bandel has been a fireman and paramedic in Waukegan, Il. He is the inventor of, and the patent holder for, the WauK® board.

 Garry Bandel retired as a Director of Quality of Assurance from the Pharmaceutical Industry after a 32 year career.  He is Brian's business partner.

 They can be contacted at:
Garry Bandel or Brian Bandel
Principals @ Bandel Innovations, LLC

Ph. or Fax. -  866-806-08898 www.waukboard.com

gpbandel@waukboard.com