# Another backboarding Scenario



## jefftherealmccoy (Aug 10, 2013)

Ok, I know this is probably beating a dead horse here, but let's see.

17/f ATV accident.  pt has obvious femur fracture, elbow pain.  no pain anywhere else until spine is palpated.  pt has pain in lumbar region.  pt says she has scoliosis and the pain is in the location of the curvature of her spine.  some pain there is normal she says.  we traction splint and decide away from backboard because of the scoliosis, and chances are it isn't due to the accident.  

Surprise! she has a broken L1 along with the femur.  with the curvature we probably did the right thing putting her in a possition of comfort, i'm pretty confident with that.  but if it were a normal pt with "old" back pain, to board or not to board?


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## chaz90 (Aug 10, 2013)

Most protocols, taken exactly as written, would have you stuck immobilizing due to the "distracting injury." With the scoliosis, depending on how well the patient was tolerating the pain from the femur (distraught/frantic or fairly calm), and the only spinal complaint of "old pain," you could potentially avoid it. 

Think too about what even the most ardent dinosaurs of spinal immobilization propose are the potential benefits. Lumbar immobility really isn't the goal, or even expected. As horrible as the concept of Cervical spine motion restriction is with a C-Collar and long backboard, lumbar motion restriction is even less likely. I'd agree with you that you did the right thing for this patient. Whether a patient ends up having a spinal column injury or not, SMR would still likely not have provided any benefit to this patient. Also remember, you can always use the Kelly Grayson method and clearly explain the risks/benefits to the patient and allow them to make an informed decision for their own care.

Quite honestly, much of this scenario depends on how your protocols are written and how benevolent the receiving doc is feeling. If he's a Victorian era traditionalist who hasn't had his morning coffee, God help the crew who didn't backboard the kid with a broken vertebra. Someone who sees the future of LBB extinction may be much more merciful.


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## Tigger (Aug 10, 2013)

If I was your patient I'd be thanking you. I got put on a backboard after a few lumbar fractures and it made the pain quite a bit worse. 

I'd be thinking about scooping the patient onto the cot and transporting on the mattress, possibly with additional padding for the lumbar region. 

Even if the patient also had cervical pain I'd hope cooler heads could prevail and just utilize a collar.


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## TheLocalMedic (Aug 13, 2013)

Although I keep catching crap from the local ALS FD (non-transport medics who, if I may be honest, have no business even being medics seeing as they cannot be expected to maintain their edge because we are always on scene within about a minute of them if we aren't there already), I hardly ever board anyone.  I constantly have to explain my rationale and they get all hot and bothered, but I absolutely WILL NOT board anyone unless it's truly warranted.  

Neuro deficit

C-spine tenderness with decent mechanism

Major multi-system trauma (and even this one often doesn't get a board unless they're altered)

That's pretty much it.  We're currently exploring options like just putting a collar on if anything, seeing as boarding really doesn't make too much of a difference no matter how well you do it.


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