How to backboard

Discussion in 'EMS Talk' started by PeteBlair, Nov 26, 2008.

  1. PeteBlair

    PeteBlair New Member

    Location:
    Florida
    EMS Training:
    EMT-Basic
    My question is: in the following scenario, how would you get the patient on to a backboard?

    Call received as a fall in the home; patient with back pain.

    You arrive to find a person in their 80s sitting upright, but in a recliner. Indications are that the patient tripped and took a fall. There was little or no pain at first and patient's spouse had helped patient get up and into the recliner. Severe pain has now set in in the lower back. Patient uses a walker and cannot stand or walk without the use of the walker.

    How would you get this patient on to a backboard?
  2. reaper

    reaper Working Bum

    Location:
    In a Fantasy
    Slide it under legs and hips and slide them down the board. Lay flat and strap down!
  3. KEVD18

    KEVD18 New Member

    Location:
    mass
    so your talking about a seated immobilization situation, right?

    do we maybe have a device specifically designed for just such a call.

    the ked isnt just for extrication from a motor vehicle.

    if its deemed necessary, ked them and then transfer to a long board. once their in the ked, you have much greater latitude in how you can move them.

    what i mean by if its deemed necessary is if a board is actually needed. how about a little lateral thinking. is this action going to help my patient or hurt them? you have an 80 y/o female s/p fall from standing height resulting in low back pain. minimal mobility at baseline. taking her from the chair, putting her onto a hard flat board and strapping the question mark right out of her back is very painful, especially in the case of arthritis, osteoporosis and all the other degenerative bone and joint diseases. so is the board really necessary? is there a peripheral neurological deficit(sensation/movement)? is there a palpable deformity? is the pain reproducible with light touch? its it mobile? is there anything to lead you down the road to a spinal injury dx or are you looking at minor muscular/skeletal discomfort after a fall?

    maybe this patient would be better off being transported in a position of comfort instead of being unnecessarily tortured. i understand a lot of protocols dont allow for the emt to actually be able to think for themselves. but you have to understand that protocols dont cover every situation and sometimes you have to think outside the box and see the big picture. in some cases where the emt has been drilled mercilessly into believing that spinal precautions are required, they will do quite a bit more harm than good.
  4. Sapphyre

    Sapphyre New Member

    Location:
    Los Angeles County, CA
    EMS Training:
    EMT-Basic
    I'd say this is one indication for the KED. We'd probably GS though.
  5. Kendall

    Kendall New Member

    Location:
    Alberta, Canada
    I agree with Kev. If and only if there was any other indication of spinal injury would I have immobilized this patient. 80 y/o female; we have to consider the patient. In all likelihood the patient is suffering from arthritis and or osteoporosis and may have underlying medical problems that will be aggrevated by being immobilized unnecessarily. Also, the patient was able to move since the fall and situate herself in the nice comfy recliner. Spinal immobilization is not as harmless a procedure as many think. Try spending a few hours on one!

    The patient may not have a true position of comfort - they're obviously in pain while at rest in the recliner otherwise we wouldn't be there, but one of our objectives is to reduce pain and suffering. Spinal immobilizing this patient would do the opposite.

    Personally I'd help the patient on to the stretcher, find the position most comfortable and support with blankets/pillows, etc. I'd consider analgesia before moving the patient, probably Entonox if the patient tolerates it.

    Nifty thinking though! If the patient is stable and immobilization is truly warranted then take the time to do proper a immobilization; KED and then board. Otherwise as reaper said, legs & hips on board, slide down and strap!
    Last edited by a moderator: Nov 26, 2008
  6. Scout

    Scout Para-Noid

    Location:
    Ireland
    Dum, where is the pain in the back, can you estabish if it is soft tissue?

    Other than that i'd be looking at ked, Is it one of these nifty electric recliners?
  7. reaper

    reaper Working Bum

    Location:
    In a Fantasy
    Yeah, Kev got it. I did not read the scenario, just BB from a chair.

    I would defiantly use a KED on that lady, if warranted. Most elderly do not take a LSB very well. If you need to immobilize them, some times I will use a scope stretcher. It is a little more comfortable and can be taken out without rolling them.

    Guess I should read the posts better at 0200!
  8. PeteBlair

    PeteBlair New Member

    Location:
    Florida
    EMS Training:
    EMT-Basic
    Hey guys and gals! I really appreciate the answers to my original question. Here's another related question. Some of you have indicated that you would first try to determine if the source of the pain was soft tissue or bone related. Here's my next question. Expressed as a percent, what is your confidence level that you could detect/determine a potentially crippling spinal fracture during an assessment? By the way I'm relatively new and have never actually encountered a "known spinal injury."
  9. Ridryder911

    Ridryder911 EMS Guru

    Personally, I would palpate the spinal column itself. Chances are if there is no s/s of paresthesia, etc. then I would transport in position of comfort. If there is no history of spinal problems and it appears to be paravertebral muscular spasms then a safe and smooth transfer to a position of comfort with pillow and blanket immobilization. Remember all one is doing on a LSB is preventing movement and not actually splinting.

    One can not be 100% certain, hence the reason we still use immobilization devices however; there is more and more research displaying that crippling injuries occur during the even and not while being treated. Does this remove us from immobilizing no but also consider on the MOI and possibly related injuries.


    R/r 911
  10. Tra

    Tra New Member

    Location:
    here
    old people have funny backs
  11. MSDeltaFlt

    MSDeltaFlt Lawn Dart

    Location:
    Cleveland, MS
    It does take a thorough assessment. I believe studies have shown that decubiti can occur on geriatrics in as little as 20 min. The level I trauma center I fly to will generally pull my geriatrics off the board as soon as they get them depending on their assessment as they are assessing. I asked them why and they told me a geriatric can get a stage II decubiti in as little as 20min. I wasn't told where I can see that data. Do you or anyone else know?
  12. BossyCow

    BossyCow New Member

    Location:
    Rural (no... really, really rural) Washington Stat
    EMS Training:
    EMT-Basic
    I'd sure want to get as much info as I could regarding the location and quality of the pain. Palping the spine, making sure it was spinal and not hip. Getting as much info as possible about the MOI and the event. Fall to the ground? Twisting? Down stairs? Fall against furniture?

    Once the pt is on a backboard, you lose any further opportunity to assess or visualize the affected area so since they are seated, take as much time as needed to fully assess the injuries. Like the rest, if it was spinal, I would probably use the KED, but with an elderly person I would want to rule out hip as well, and possibly use a pelvic immobilizer/mast pants if indicated.
  13. Ridryder911

    Ridryder911 EMS Guru

    I believe you can find most of these studies will be form ostomy nurses that study and research skin breakdown. Any pressure upon even the micro capillary perfusion level can cause immediate break down.

    R/r 911
  14. mycrofft

    mycrofft Still crazy but elsewhere

    Location:
    Central California
    I'm trying to figure out soft tissue back pain versus spinal back pain.

    Soft tissue: Renal, pleural, cholecysitis, referred gut, penetrating trauma, blunt trauma (and the last two could raise index of susp re spinal or neuro injury). Low back pain: mostly spinal or neural.

    Hip pain can be lumbosacral distribution. And yes people can get into a comfy place and then develop major pain.

    A study I have here somewhere shows continuing LSB in-hospital is not usually affective to the outcome, hence the prompt removal sometimes after clincial clearance. I can tell you it can be affective, by holding a person supine who has trouble maintaning airway (CPAP pts included)...affected negatively.

    KED isn't that uncomfortable.

    If the pt is really in dire need, consider having the FD muscle take the arm(s) off the chair.
  15. Buzz

    Buzz New Member

    Location:
    Michigan
    My partner and I recently got this same speech after back boarding a woman who was alert but not oriented after an unwitnessed fall in her room at a nursing home. We couldn't assess her beyond the objective findings--even had she been oriented, neither my partner and I nor anyone of the nursing staff spoke cantanese. He started the whole speech with "I know you guys are just following protocols but are we just torturing an old lady here? " He then proceeded to basically state everything you said.

    Since then, I've been more conscious of comfort levels with backboarding... double layering some blankets on the board can at least take some of that pressure off and provide a little more comfort as well as insulate the patient from the cold plastic.



    On a lighter note about the KED board: Back in school, we would occasionally have KED board races... We teamed up in a groups of three. We would then proceed to see who could be KED boarded the fastest and then the "patient" would race down the hallway. Stupid? Yes. Fun? You betcha. Gotta love open lab days.
  16. mycrofft

    mycrofft Still crazy but elsewhere

    Location:
    Central California
    KED kornering...

    Need some photos, man, need some photos.
  17. rhan101277

    rhan101277 Active Member

    That comment is extremely helpful.
  18. mycrofft

    mycrofft Still crazy but elsewhere

    Location:
    Central California
    If you think kyphosis and collapsed discs are funny...

    ...you might fit right in here!;)
  19. mycrofft

    mycrofft Still crazy but elsewhere

    Location:
    Central California
    But seriouisly, folks...

    The latest time my co-workers used a backboard, the next day I found half the straps sitting in the exam room (and so presumably not used on the pt)as well as a cervical collar. We were missing no collars. We don't have a head block, and I'm trying to get them to get rid of the LSB altogether until we get the operation up to that level.<_<
  20. PeteBlair

    PeteBlair New Member

    Location:
    Florida
    EMS Training:
    EMT-Basic
    I never ceased to be amazed at the insightful answers and responses I receive as a result of my posts. I'm thinking I owe the patient who sparked my original question an apology. I'm thinking that probably the greatest thing that experience, plus conversations such as this, teaches is where to put the hard and fast rules aside. The next time I run into a situation like this, I'm going to send a lot more time palpating in a home-fall situation before I break out the collar and back board. Thanks to all who have and will continue to answer.

    Pete

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