# Spinal Precautions



## Ridryder911 (May 18, 2008)

After teaching a PHTLS course, I am curious on what type of spinal immobilzation device one uses on a trauma with significant injuries?


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## DBieniek (May 18, 2008)

Rid, we typically use the long spine board. I cannot recall any situation in which I have variated.

I have been hearing a good deal about PHTLS lately, where can one take this course?


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## br16 (May 18, 2008)

Id say in response to which we use most, it has to be the long spine board.  but each major trauma is different i feel and will never be able to be taught a hard and solid way because sometimes we have used a multitude of different immobilization devices.  I liked the phtls course alot, learned alot from it.  

In response to where you can take it. You would have to check with your local training center to see if they offer it.  Some dont and you may have to travel a little ways away to get it.


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## MSDeltaFlt (May 18, 2008)

I'll use what I got.  Personally, I like the LSB, but if I have more pts than I have LSB's, or LSB's won't fit, I'll use something else.  

In EMS, you're trained to think outside of the box.  In most protocols, when spinal precautions are needed, extremeties are not mentioned in reference to restrictions.  Hence the inventions of SSB's, KED's, and the like as you are aware.  Anything of significant length, width, and rigidity that can be strapped and/or taped to a pt's back from their head to their butt will suffice.  Radiolucency is not required.  

Case in point, I've been on a scene flight where we beat EMS on scene.  Our aluminum aircraft cot makes a great LSB in a pinch, however, XRays cannot go through them.  Shoulda seen the look on the trauma team's faces when we showed up with that one.^_^

You do what you gotta do.  Apologies for the rant.


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## MedicDoug (May 18, 2008)

Generally a long spine board, but since I'm old I'll reach for the scoop more often than some of my partners... an under-rated piece of gear for sure. Sometimes there's less patient movement with a scoop, especially if we're short handed on scene. 
MSDeltaFlt is right, though... the EDs do get a little cranky sometimes ;>)


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## Short Bus (May 18, 2008)

usually a long board, but we carry scoops and Reeves as well.  KEDs and XP1 are on there too.  We can use whatever we feel that we need to.  If they go on a KED, they go onto a LBB as well.  We also have the peds boards that have the legs seperate.  They work well if they kid is the right size.

KEDs work great for the peds since I am guessing that is what the question was talking about.


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## Summit (May 19, 2008)

Full body vacuum splint + stokes litter or sked


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## ERnurse17 (May 19, 2008)

long spine board, three straps and a collor


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## stonez (May 19, 2008)

Long spine board, head blocks, spider harness.
We also sometimes use a KED


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## stonez (May 19, 2008)

oh and I forgot to add a collar!!


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## medicdan (May 19, 2008)

On the street I use the LSB exclusively. I have been thinking a lot about my newly gained wilderness skills and knowledge. There are really some amazing opportunities for improvised spinal immobilization devices, and with some creativity, they can be much more comfortable then LSB+Collar+blocks. 
OTOH, I also learned how to clear spines, so I have started thinking about when I really should and shouldn't immobilize a pt.


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## emtwacker710 (May 19, 2008)

Summit said:


> Full body vacuum splint + stokes litter or sked



how well do the full body vacuum splints work? we have a set of vac-u-splints for the extremities but I have never had the chance to use a full body one nor does my agency have one..


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## mdkemt (May 19, 2008)

In most cases we use a Long spine bored with 4 straps a multi-collar and blocks.
Some cases we use a ked and short spine board but that is rare with our service.
Personally I hate vacume splints.  Find it wastes to much time on scene but that could also be to the lack to experience I have using them on scene.

MDKEMTB)


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## BossyCow (May 19, 2008)

Long board, straps, head bed. 

I like a scoop for the pelvic fracture at home, because its easier to set under the pt. But the long board is easier to wedge under an MVA pt. for extrication. Different tools for different instances.


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## Summit (May 19, 2008)

emtwacker710 said:


> how well do the full body vacuum splints work? we have a set of vac-u-splints for the extremities but I have never had the chance to use a full body one nor does my agency have one..



They work very well but must have a rigid backing to be considered true immobilization. They are very comfortable and warm for the patient. On extended extrications, you may have to repump them to keep the vacuum as they will leak a bit. They are also much easier to carry than a LSB. 

It would be interesting if someone could make a collapsible titanium scoop that doubled as a litter.


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## daedalus (May 19, 2008)

I tend to use liquid nitrogen to freeze the patient into place, preventing further injury. I saw it once on that TV show SLIDERS which aired on SciFi.

I really like to use LSB. Used it at an accident once and will continue to do so since I made the move to 911. That is unless the paramedic wants something different.


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## Jon (May 20, 2008)

Short Bus said:


> ...but we carry scoops and Reeves as well...



Just to clarify... R/R911 is talking about a Reeves Sleeve - which goes over a backboard and acts in place of the standard CID's and Straps. Proponents say that it does a much better job at immobilizing patients... Detractors say it takes too long to apply (just like the KED).








And he's not talking about the more common Reeves Flexible Stretcher. On a side note - I was once shown that a 2x8 inside a Reeves is a good MacGuyverism if you are in the middle of nowhere with no backboard. Of course... since I'm usually in the middle of nowhere with a bunch of Boy Scouts... I'll just have them lash a few sticks together and make me a backboard... but quickly, because I want to be back in time for desert (Mmmm... Cobbler).


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## LH4B (May 20, 2008)

LSB. We're supposed to KED a pt every time they are still sitting in the car when we get OS, but if they're in real bad shape, rapid extrication to a LSB with a collar. We have the short spine boards but I have never seen them used nor had need to use one.

Who would use a scoop? We use that primarily for hip injuries.... it doesn't offer any spinal support.

Oh, and call fire for a stokes for sledding accidents.


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## BossyCow (May 20, 2008)

The new scoops do offer spinal protection. They are also lighter, easier to clean. They re-engineered the hinge mechanism as well as the strapping.


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## TKO (May 20, 2008)

Here in BC, Canada (again with this start, huh?) we use the scoop or "clamshell" almost exclusively.  Coming from Saskatchewan, I trained on LSBs and rarely used the scoop either.

But here we use the LSB for rapid extrications mainly.  We can use the KED as well, but few EMS personnel here do.  Anyone well trained with the KED can typically extricate just as quickly with it as those with the LSB.

Just some info on the scoop: it is rated for spinal immobilization now and it is also more comfortable for the pt for extended transfer times vs. the LSB.  There is also the option to make up a "bed" of blankets on a #9 and then place the immobilized pt onto, then remove the scoop, and replace the scoop under the blanket bed (holding the blankets taught) and restrap.  This is a huge benefit to pts with very long transfer times, especially on fixed-wing transports that get real bumpy.

But I do miss the headblocks of the LSB because they were easier than sandbags rolled in towels and taping (or the ridiculous headbed).


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## Outbac1 (May 20, 2008)

Mostly a long spine board with collar and Ferno head blocks. We have Keds on the trucks but they rarely get used. We also have a pedi board (the name of which escapes me just now), with multiple colored straps for pedi pts. Fortunatly it gets very little use.


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## Short Bus (May 22, 2008)

Jon said:


> Just to clarify... R/R911 is talking about a Reeves Sleeve - which goes over a backboard and acts in place of the standard CID's and Straps. Proponents say that it does a much better job at immobilizing patients... Detractors say it takes too long to apply (just like the KED).



This works great for low slope evac and combative pt as well.  They can not hurt themselves if they are in a Reeves sleeve


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## Ops Paramedic (May 28, 2008)

Hi rid!

The mainstay is the LSB with collar, beadblocks, baseplate and spider harnass as mentioned by stones.  Sometimes the scoop also has its place, ie if the patient is on the floor outside the wreck, or when doing an ICU transport where the patient is ventilated (I prefer to still  fully package).  Should you however transfer for a CT scan, we try and use the LSB (Plastic one), that will save you from having to scoop the patient on and off the CT bed.  Fot the long distance transfers we will use the vacuum mattress.

The crews this side often cross the head straps for the blocks across the forehead, in stead on one over the chin, and one over the forehead, moreso when there is a c-collar or an O2 mask in situ.  Do you guys do the same?


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## mikeylikesit (May 28, 2008)

spider starps, long board, c-collar, head blocks and a butt load of tape.


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## PapaBear434 (May 28, 2008)

Ops Paramedic said:


> Hi rid!
> 
> The mainstay is the LSB with collar, beadblocks, baseplate and spider harnass as mentioned by stones.  Sometimes the scoop also has its place, ie if the patient is on the floor outside the wreck, or when doing an ICU transport where the patient is ventilated (I prefer to still  fully package).  Should you however transfer for a CT scan, we try and use the LSB (Plastic one), that will save you from having to scoop the patient on and off the CT bed.  Fot the long distance transfers we will use the vacuum mattress.
> 
> The crews this side often cross the head straps for the blocks across the forehead, in stead on one over the chin, and one over the forehead, moreso when there is a c-collar or an O2 mask in situ.  Do you guys do the same?



I would much rather just use the old standard belt straps than those stupid spider straps.  Not only do I have nothing to tie down the hands to keep them from flopping around, but they are a pain in the *** to apply and clean off afterwards.


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## BossyCow (May 28, 2008)

PapaBear434 said:


> I would much rather just use the old standard belt straps than those stupid spider straps.  Not only do I have nothing to tie down the hands to keep them from flopping around, but they are a pain in the *** to apply and clean off afterwards.



Cracks me up how dedicated people are to their method of choice. Personally I prefer straps as well, but have heard those who use them often rave about spiders and how they wouldn't use anything else. Precisely why we carry both on our rigs.


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## mikeylikesit (May 28, 2008)

we carry all type...and a whole role of duct tape.B)


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## mdkemt (May 28, 2008)

Ahh Yes!  Never forget the duct tape.  Works wonders LOL!!!
We just started to use spider straps here it is nice!

MDKEMT


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## rescuepoppy (May 30, 2008)

We mostly use LSB Headblocks and Spider straps. But as always you have to treat the patient or situation so it is nice to have other options and know how to use them. Dont get so hung up on one method that you dont know how to use other things that are at your disposal.


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## ffemt8978 (May 31, 2008)

TKO said:


> Here in BC, Canada (again with this start, huh?) we use the scoop or "clamshell" almost exclusively.  Coming from Saskatchewan, I trained on LSBs and rarely used the scoop either.
> 
> But here we use the LSB for rapid extrications mainly.  We can use the KED as well, but few EMS personnel here do.  Anyone well trained with the KED can typically extricate just as quickly with it as those with the LSB.
> 
> ...



I'm curious as to what the ER thinks of this...

Our LSB's are XRay transparent, but our scoops are made out of aluminum.  The ER would have to remove the patient from our scoop to XRay C-Spine to clear it.


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## Ridryder911 (May 31, 2008)

The reason I asked this question is PHTLS as ITLS, etc. is now suggesting to remember that the scoop type device on patients. It is easy to apply, provides good spinal precautions, etc. Upon ER they can be removed easily as other potential spinal arrangements can be made, as well as the "pressure" concern is removed. 

Alike everyone else, LSB is most commonly used  because it is more of a habit than thinking of the best device for the patient. Although, I agree I too use it way to often, LSB has very serious complications to patients that have to be on one for an extended period of time (>30 minutes). 

Just something to think about...


R/r 911


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## enjoynz (May 31, 2008)

We use a Scoop stretcher for suspected spinal injury patients.
We are only allowed to use LSB as an extrication device (Slide),
re our protocols.

Cheers Enjoynz


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## PapaBear434 (May 31, 2008)

Newbie fresh out of training here.  And yeah, scoop stretchers are nice, but we don't use them often.  Pretty much only under certain circumstances were we told it was to be used.

1) Expedient move.  If you need to move a patient quick due to a hazardous environment like rising water or some such thing, and you don't have enough time to do a proper roll with at least two people, the scoop is nice.  

2) Too small for a traditional longboard.  Not enough room to get enough people in a small bathroom to roll the patient or something like that.

3) Mud.  Mud can be a biatch, and sometimes it's easier to just pull them out.  Yes, they specifically taught us mud.

As far as worrying about x-ray, we've been taught to put them onto a traditional board as soon as possible and to remove the scoop from under them.  It's too cold and tends to pinch things, and making a trauma patient even more uncomfortable tends to be frowned upon.


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## traumateam1 (May 31, 2008)

Here in BC, Canada our clamshells are xray transparent so when the p/t is wheeled into the ER, if needed they can go right into xray. Also from training I find that the clamshell is a lot more comfortable for the p/t while still providing good spinal percautions. And I find that the clamshell moves the patient a lot less when packaging.


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## PapaBear434 (May 31, 2008)

Yeah, ours are cold, stiff aluminum with no comfort factor in mind.


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## BossyCow (Jun 1, 2008)

We just bought the Ferno EXL Scoop. Plastic, light, easy to clean, no x-ray issues. Better attachment for straps. Also warmer and easier to close. Hated the way the clasps worked on the old one. If they weren't lined up perfectly, you couldn't get them to latch.


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## PapaBear434 (Jun 1, 2008)

BossyCow said:


> If they weren't lined up perfectly, you couldn't get them to latch.



Here here!  Dang I hate those things for that reason alone.  Not only is it a pain to deal with it, but if the patient is conscious, they think you are a boob that doesn't know how to work your gear.  Last thing you want is for the person you're trying to help to think you incompetent.


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## Ridryder911 (Jun 1, 2008)

Over the past 30 years of using the "scoop" I have found two main reasons for having a hard time of closing or fastening scoops. 

1) Equipment not serviced. The latching mechanism has to be greased with white graphite, periodically. 

2) Really weather is regardless, but one has to gently roll the patient slightly to one side & then another to assure the device is placed correctly. As well, I have found closing the head portion first is much easier. 

Alike, any other device, practice is essential. I have found most were more unfamiliar using scoops than LSB. Ironically, since the recommendation I have been using scoops more than LSB on real trauma patients. I can place them onto ER beds and remove them with ease, as well as x-ray tables, flight service stretchers, etc. Remember, LSB may cause more harm than good. Also, I do not loose a piece of equipment.


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## mikeylikesit (Jun 2, 2008)

Ridryder911 said:


> Alike, any other device, practice is essential. I have found most were more unfamiliar using scoops than LSB. Ironically, since the recommendation I have been using scoops more than LSB on real trauma patients. I can place them onto ER beds and remove them with ease, as well as x-ray tables, flight service stretchers, etc. Remember, LSB may cause more harm than good. Also, I do not loose a piece of equipment.


except when you have to get them in for an MRI ASAP...then you can't bring them in with the patient...but why would you. i like the scoop because it can be done much quicker and with minimal risk to moving the patient for proper placement. the only thing i don't like is with the LSB you get the back exam and the procedure for moving them onto the device all in one sweep.


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## Ridryder911 (Jun 2, 2008)

mikeylikesit said:


> except when you have to get them in for an MRI ASAP...then you can't bring them in with the patient...but why would you. i like the scoop because it can be done much quicker and with minimal risk to moving the patient for proper placement. the only thing i don't like is with the LSB you get the back exam and the procedure for moving them onto the device all in one sweep.



True, usually there is no such thing as an emergency MRI. A CT, etc. is used to rule out before use of MRI, as well they are usually transferred to another device before going to an MRI. 

The point I was attempting to make is remember another spinal immobilization device. It has been proven to be more beneficial to the patient, quicker and easier. 

R/r 911


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## mikeylikesit (Jun 2, 2008)

Ridryder911 said:


> True, usually there is no such thing as an emergency MRI. A CT, etc. is used to rule out before use of MRI, as well they are usually transferred to another device before going to an MRI.
> 
> The point I was attempting to make is remember another spinal immobilization device. It has been proven to be more beneficial to the patient, quicker and easier.
> 
> R/r 911


of coarse i still use them when i can...but i usually get outnumbered on the decision and end up using the LSB.


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## Jon (Jun 3, 2008)

Rid,

Are you suggesting that when I transfer an immobilized patient to a flight crew that I should remove my scoop and take it back?


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