# When to use backboard and collar on infant/toddler



## tcd (Mar 22, 2012)

Hi All,

I'm not an EMT, but will start EMT-B in April, so I don't have much knowledge at all, hence this question:

You arrive to a scene with an 18mo old child laying flat on a couch, unconscious, unresponsive to attempts to wake them up, but has a good pulse and respiration.  

The mother says that they were walking on the sidewalk and the child tripped and fell, banged their head on the concrete, and was unconscious since.

What would be the next step before transport to hospital?  

a. Do you board and collar the child just in case of potential neck or back injury?  

b. Carefully lift them without board or collar onto a gurney and roll them to the ambulance? 

c. Or do you pick the child up with one arm and carry them to the ambulance and put them on the gurney there, then secure their head and neck?

My first, and admittedly uneducated, inclination is to play it safe and board & collar them on the couch, then lift them, and either carry to the ambulance or to a nearby gurney.  

The reason I ask is that I saw this scenario on a reality show about Fire/EMS and they carried the child with one arm, bascially dangling with no neck support, to the ambulance and then secured head and neck for transport.  Just seemed a bit odd to me given the potential severity of the injury.


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## beantown native (Mar 22, 2012)

I personally always used a K.E.D for this. It makes a perfect papoose... If it is too big, just fold down the sides.


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## Anjel (Mar 22, 2012)

No collar because the ones we have are too big and would cause too much movement, but i would find someway to secure the child. Probably the ked board and some towels around the head.


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## bigbaldguy (Mar 22, 2012)

KED is great for kids.
But that's not one of the possible answers so let me walk you through what I would be thinking if I ran across this scenario.

 Tripping and falling would be very unlikely to cause enough force to knock them out much less do so for any length of time so I would immediately be suspicious of the mothers story. I would assume that whatever the moi was that it had to be fairly significant to cause unconsciousness so even though the "story" doesn't indicate taking c spine precautions I think I would do so anyway. I would board the child and if protocols indicate it use a collar as well. Seeing as the child is unconscious I don't see any harm in doing this as it won't cause the child the stress that it causes alert children. Again beantowns advice about the KED is good, you put them in it and they usually go to sleep. I would transport the child ASAP.

When injuries/symptoms a child presents with aren't consistent with the story the guardian is telling you always keep your suspicious cap on for abuse. do a detailed physical exam of the child enroute to hospital and note any other injuries new or old, bruises ect. Give the hospital staff a heads up if your spidey sense goes off and don't assume they will catch it anyway so you don't need to share your suspicions with them.


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## SoCal911 (Mar 22, 2012)

We have this thing called a pediboard that I love.


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## SoCal911 (Mar 22, 2012)

Or if the mother has a car seat available use that and place towels on the sides of the head to stabilize, then use med tape to secure the head. Answer - when in doubt always board. Any kind of head trauma with neck or back pain or any mental status changes following any trauma.


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## MasterIntubator (Mar 22, 2012)

Protocol should dictate that.  For instance, ours advises that <18 y/o get fully immobilzed based on a fall/mechanism of injury indicating spine/head trauma.

This kid would get immobilized for me.

Peds can be tough to immobilize, and on top of that you have emotion that tends to get in the way and clouds good judgement at times ( it happens ).  Some of those infants are near impossible to get anything around their neck.  The trick is to have devices that can immobilize the head and body as one and allow as much assessment space as possible during your care. 

We use a iron duck Pedi Air-align board and ambu head wedge/or laerdal head bed.  With good technique, you will get little, if any,  movement at all, collar or not.

For us, the KED has been phased out as a peds board in the late 80s with the introduction of pediatric boards.  There are good ped boards, and some not so good ped boards.  Most are better than a KED when it comes to proper immobilization and assessment.  
One major setback in the KED is lack of assessment area on a child.  Once immobilized, you loose out on the back of the head, sides of the head, chest, abd and most of the legs... without undoing your work.  Those little heads will wiggle around unless you have some good KED folding and trickery skills.  Its a good backup in a mass cass situation...  but these days I think we should be doing better than just wrapping them up papoose style for transport.  The KED used to be my board of choice.... but once I used the right equipment, it was night and day.


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## bigbaldguy (Mar 22, 2012)

MasterIntubator said:


> One major setback in the KED is lack of assessment area on a child.  Once immobilized, you loose out on the back of the head, sides of the head, chest, abd and most of the legs... without undoing your work.



Very good point and one that hadn't occurred to me. We've always done full body assessment on scene (usually difficult because they are freaking out) then put em in the KED for the move to the truck but if they were really critical and you needed to do assessment during transport I can see now how the KED would cause problems.


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## bigbaldguy (Mar 22, 2012)

SoCal911 said:


> Or if the mother has a car seat available use that and place towels on the sides of the head to stabilize, then use med tape to secure the head. Answer - when in doubt always board. Any kind of head trauma with neck or back pain or any mental status changes following any trauma.



I'm not a fan of the car seat thing unless it's an MVA and they are already in it. I just don't think it really does much in the way of limiting their spine neck movement. In ths particular case I wouldn't want to move the infant any more than usual and rolling them onto a board and securing seems like it would cause less additional movement of c spine than bringing them up into a seated position to put them into a car seat.


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## systemet (Mar 23, 2012)

bigbaldguy said:


> KED is great for kids.
> Tripping and falling would be very unlikely to cause enough force to knock them out much less do so for any length of time so I would immediately be suspicious of the mothers story.  [...]  When injuries/symptoms a child presents with aren't consistent with the story the guardian is telling you always keep your suspicious cap on for abuse. do a detailed physical exam of the child enroute to hospital and note any other injuries new or old, bruises ect. Give the hospital staff a heads up if your spidey sense goes off and don't assume they will catch it anyway so you don't need to share your suspicions with them.



This is very good advice.


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