# Pediatric Immobilization



## MedicPrincess (Jul 6, 2008)

We all know that youngin's can present a special challenge in just about everything we try to do with them.  For the ones that are injured requiring spinal immobilzation, and are not lucky enough to already be in a car seat, what do you use?

Pediatric spine boards seem to be in short supply.  We don't have short boards on our trucks.

Last shift we had a 1 year old who did the flying baby stunt out of his crib, landing flat on his back on hardwood floor.  Period of unresponsiveness, per the paniced mother, of about 1 minute.

I used out long leg cardboard splint.  Pts arms down to his sides.  Sheets and towels for padding.  Fold the sides up, hold in place with 2" tape across the knees, pelvis, chest, head areas. The baby cannot wiggle around like they do.  I still have access to him for exam, monitoring, treatments.  It also provides an additional level of comfort, especially for the ones that are swaddled.

When we got him to the ER, the ER physician and nurses were extremely impressed with the immobilization.  The Dr left him as he was, to be taken to CT like that.

I have done a few little ones like that.  Its only good for up to about 2 years old.  Much older and they are to long and to heavy for it.  You also have to be very careful not to tape it up to tight, or possibly cause respiratory compromise.  The heliocopter crews have all expressed how much they like them "packaged for flight" that way.


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## Ridryder911 (Jul 6, 2008)

You don't carry KED's or similar devices? I use KED's all the time on my ped.'s Place the head in the appropriate place and & roll the extra down and then place the arms inside the device. The legs may hang over or out a little but I still place them onto a LSB. 

I personally never heard of or seen a pediatric spinal board... never knew there was such a critter. 

R/r 911


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## firecoins (Jul 6, 2008)

Ridryder911 said:


> I personally never heard of or seen a pediatric spinal board... never knew there was such a critter.
> 
> R/r 911




One of my employers has one. Never had an opportunity to use it.


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## Ridryder911 (Jul 6, 2008)

firecoins said:


> One of my employers has one. Never had an opportunity to use it.



Amazing, I teach PEPP, PALS, PHTLS .. I have never seen or heard of one in 31 years. I have seen Papoose boards that many assume are a spinal board, but when in fact they are not. 

R/r 911


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## MedicPrincess (Jul 6, 2008)

Ridryder911 said:


> You don't carry KED's or similar devices? I use KED's all the time on my ped.'s Place the head in the appropriate place and & roll the extra down and then place the arms inside the device. The legs may hang over or out a little but I still place them onto a LSB.
> 
> I personally never heard of or seen a pediatric spinal board... never knew there was such a critter.
> 
> R/r 911


 

I have used the KED as well for kids.  The long leg splint contraption works out nice because they could put the entire thing through X-Ray/CT, keeping the pt immobile until after procedures. 

Pedi Boards..... long spine boards, only shorter length....  When I was with the county provider they were about 4ft in length, and 2/3 as wide.

This one is a little fancier than the others....

http://www.lifemedicalsupplier.com/lsp-infantpediatric-back-board-mri-ref-908l484c-p-821.html


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## mikeylikesit (Jul 6, 2008)

i use the KED since it is available and i rarely use it on adults anyways. i have used the cpr board before, splints and tape...lots of tape.


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## el Murpharino (Jul 6, 2008)

Ferno makes a "pedisleeve" board for infants, and our agency carries pediatric boards that has head flaps (they're not as bulky as head blocks) on top, and two or three straps that go over the chest and pelvis area.  I've used them several times...very useful.  

http://www.lifemedicalsupplier.com/...oducts-pediatric-immobilization-c-73_123.html


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## karaya (Jul 6, 2008)

mikeylikesit said:


> i use the KED since it is available and i rarely use it on adults anyways. i have used the cpr board before, splints and tape...lots of tape.


 
You rarely use a KED on an adult?  Then what do you use?


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## Grady_emt (Jul 6, 2008)

We carry Pedi-Boards on all our units, Im on shift tonight and tommorrow night, ill see if I can snap a picture or two of it.


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## mikeylikesit (Jul 6, 2008)

karaya said:


> You rarely use a KED on an adult? Then what do you use?


 basically since the FD gets there on scene before we do they always use the short board. i have used the KED when i have time out here and we get on scene first but other than that there are not that many opportunities to use it.


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## mikie (Jul 6, 2008)

Ridryder911 said:


> I have seen Papoose boards that many assume are a spinal board, but when in fact they are not.



Really?  I've used one once for immobilization.  Can you explain why they aren't?  

Thanks!


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## karaya (Jul 6, 2008)

mikeylikesit said:


> basically since the FD gets there on scene before we do they always use the short board. i have used the KED when i have time out here and we get on scene first but other than that there are not that many opportunities to use it.


 
Well I'm glad to hear this.  For a moment I thought you were one of those X-Ray visioned medics I run across from time to time. :glare:


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## Jon (Jul 6, 2008)

Ridryder911 said:


> Amazing, I teach PEPP, PALS, PHTLS .. I have never seen or heard of one in 31 years. I have seen Papoose boards that many assume are a spinal board, but when in fact they are not.
> 
> R/r 911


You mean I know something Rid doesn't? This day will go down in history.






This is what Princess posted, and what we use at both the vollie squad and the full-time paid service. It works pretty well... if you take the time to put it on correctly. It falls into the same category as the Hare traction, though, because we don't often use it, and therefore spend precious time onscene trying to remember how it works.

How it works:
There are separate Velcro straps for each leg, the pelvis, the chest, the head, and the arms. These can be adjusted to fit the patient.

EMP even has a category for pediatric backboards:
http://www.buyemp.com/category/Backboards-Pediatric-.html


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## fma08 (Jul 6, 2008)

We have Pedi-Boards as well... I would place them on a LSB in addition to using it, otherwise lots of towels and tape.


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## reaper (Jul 6, 2008)

We have Pedi LSB's. They are the same as a LSB, but only 4 ft long.


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## Ridryder911 (Jul 6, 2008)

Basically a Reeves sleeves that has been modified. Good idea, but not practical. Why have one, when an adult board will do? 

I might have seen them at conferences but paid no attention to them. Thanks for sharing.. 
R/r 911


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## Jon (Jul 6, 2008)

Ridryder911 said:


> Basically a Reeves sleeves that has been modified. Good idea, but not practical. Why have one, when an adult board will do?
> 
> I might have seen them at conferences but paid no attention to them. Thanks for sharing..
> R/r 911


Actually... it is a stand-alone device, in a smaller scale.... but yes, it functions like a Reeves sleeve.


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## WuLabsWuTecH (Jul 7, 2008)

What about a vacumn splint?


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## ffemt8978 (Jul 7, 2008)

WuLabsWuTecH said:


> What about a vacumn splint?



How would you vacuum splint the torso without interfering with breathing and such while keeping immobilization?


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## mikie (Jul 7, 2008)

I saw above Rid mentioned that papoose boards aren't sufficient for spinal immobilization.  

May I ask why?  Perhaps the device I used on a pedi (the only time I've had to immobilize one) is different then what we're talking about.


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## Jon (Jul 7, 2008)

ffemt8978 said:


> How would you vacuum splint the torso without interfering with breathing and such while keeping immobilization?


I've seen adult and child vacuum mattresses that were sold as being backboards - I don't see why one of mattress size wouldn't work.

I don't think a "limb" size one would work, though.


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## Outbac1 (Jul 7, 2008)

We have the pedi mate and pedi-pac for our peds pts. Otherwise its improvise as required. 







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Images from http://www.lifemedicalsupplier.com/...oducts-pediatric-immobilization-c-73_123.html


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## reaper (Jul 7, 2008)

We also carry the Pedimates. They are great for securing on the stretcher.


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## skyemt (Jul 7, 2008)

Jon said:


> I've seen adult and child vacuum mattresses that were sold as being backboards - I don't see why one of mattress size wouldn't work.
> 
> I don't think a "limb" size one would work, though.




be verrrry careful here... in many places, included mine, vacuum mattresses for immobilization are out of protocol for a very good reason... they leak.

we use them for pelvic injuries, etc, but having used them a ton of times, they do develop tiny leaks and lose their rigidity..  would be very embarrassing  to bring someone in on a floppy vacuum splint, who needed to be immobilized.


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## Grady_emt (Jul 7, 2008)

As promised, Pics of out Pediatric back boards.  The straps are a wrap-around nylon and velcro that is bomb-proof when applied properly.  It works great, have used it several times and once one becomes proficient in applying it, it takes no longer than a regular LBB.


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## traumateam1 (Jul 11, 2008)

For all the pediatric calls involving immobilization we just use the KED.. works real great.


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## mikie (Jul 11, 2008)

so these papoose boards....why aren't they good for spinal immobilization?  I've only come across one encounter where a pedi. needed immobilization so far


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## Nycxice13 (Jul 11, 2008)

Use a vest type immobilization device (KED)


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## WuLabsWuTecH (Jul 12, 2008)

skyemt said:


> be verrrry careful here... in many places, included mine, vacuum mattresses for immobilization are out of protocol for a very good reason... they leak.
> 
> we use them for pelvic injuries, etc, but having used them a ton of times, they do develop tiny leaks and lose their rigidity..  would be very embarrassing  to bring someone in on a floppy vacuum splint, who needed to be immobilized.


Hmmm... We never learned about that!  We were taught that they can be used as full immobilization!  Where do they leak?  from the initial site that you draw from?  Ours had a cap on it but I don't know if that makes any difference.


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## EMT192229 (Aug 14, 2008)

this is the board that we have onboard our trucks, they work goood for us. We bought them from EMP last  year. The y secure the pt well,But as you know its hard to secure a PED's PT whne they are screaming and thrashing around


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## BossyCow (Aug 14, 2008)

EMT192229 said:


> this is the board that we have onboard our trucks, they work goood for us. We bought them from EMP last  year. The y secure the pt well,But as you know its hard to secure a PED's PT whne they are screaming and thrashing around



Still, I'd rather have screaming and thrashing than quiet with a peds call.


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## Grady_emt (Aug 14, 2008)

BossyCow said:


> Still, I'd rather have screaming and thrashing than quiet with a peds call.




Amen to that, but at what point are you doing more harm than good, both mentally and physically, by trying to forcefully immobilize a pedi pt?


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