# Spineboard Types



## mmumeda (Dec 27, 2012)

What kind of spineboards do you use and what county are you located in? In Honolulu, we typically use folding metal spineboards.


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## NomadicMedic (Dec 27, 2012)

Everybody in my neck of the woods uses a Ferno long plastic spineboard, with the reusable Ferno orange headblocks.











Our medic units carry disposable CIDs with our boards, but they rarely get used, as we tend to use the BLS gear from the ambulance. 

As an aside, Spider Straps are unheard of here. Nobody uses them.


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## Handsome Robb (Dec 27, 2012)

Couldn't tell you the company, pretty sure they are Ferno though. We use the disposable yellow head blocks. Spider straps are awesome once you get used to using them and placing them properly, which is rare to actually see. Well placed spiders are about as close as you are going to get to true immobilization rather than just motion restriction. 

We are supposed to be switching to the hybrid scoop/LSBs here soon. At least one per truck plus a couple of the boards we have now.


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## Tigger (Dec 27, 2012)

I think the ones we "borrowed" from city fire (given to us by a medical division member) are made by Iron Duck. We've got the spider straps along with disposable yellow blocks and semi disposable Hartwell vacuum splints to use instead of blocks if possible. We also have a Ferno athletics board that is probably 25% wider than typical and close to seven feet long. Thing is gigantic. 

I can imagine using a metal board, talk about cold.


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## mycrofft (Dec 27, 2012)

No kidding, from Bedrock EMS, we used to make our own. 3/4 or 1 inch marine plywood, 2X1 runners, and reclaimed seat belts for straps. Had to make short boards too (no runners). Many hours cutting, sanding, dusting, waiting for varnish or varathane to dry than sanding again, glueing and screwing, and finally a couple coats of auto wax.


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## Veneficus (Dec 27, 2012)

NVRob said:


> Couldn't tell you the company, pretty sure they are Ferno though. We use the disposable yellow head blocks. Spider straps are awesome once you get used to using them and placing them properly, which is rare to actually see. Well placed spiders are about as close as you are going to get to true immobilization rather than just motion restriction.
> 
> We are supposed to be switching to the hybrid scoop/LSBs here soon. At least one per truck plus a couple of the boards we have now.



Those things really suck.

Also note the hinges are metal and make radiology useless.


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## mycrofft (Dec 27, 2012)

They're under the feet...???


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## Veneficus (Dec 27, 2012)

mycrofft said:


> They're under the feet...???



yea, and at 0'dark 30, the head and feet don't always wind up on the proper side. 

The hinge knocks out the whole cspine area on xray and on ct makes the scan all but useless.


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## mycrofft (Dec 27, 2012)

Well, turn 'em around! Spoiled hospital types....:rofl:


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## mycrofft (Dec 27, 2012)

ANd update their protocols: "The patient must be placed with head and neck unobstructed by metallic portions of any and all orthopaedic appliances...":wacko:


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## Veneficus (Dec 27, 2012)

mycrofft said:


> Well, turn 'em around! Spoiled hospital types....:rofl:



It is easier to just take them off the board, but we try to leave them on in order to help the people who actualy have to do the lifting and carrying.


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## DesertMedic66 (Dec 27, 2012)

This is the backboard type I prefer to use due to the fact it's not flat. 





We also carry the normal backboards. 





Our pediatric backboard. 





D-ring straps 10-15 feet long





Our single use head beds.


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## EpiEMS (Dec 27, 2012)

What we use: Iron Duck, some fancy CID by Laerdal (SpeedBlocks®™ etc.), nylon weave belts with buckles, Laerdal StiffNeck®™ etc. C-collars.

What we should be using based on EBM: Maybe nothing, maybe C-collars (viz.: http://www.ncbi.nlm.nih.gov/pubmed/23079144, etc. and obviously not for penetrating trauma as per http://www.ncbi.nlm.nih.gov/pubmed/19820585, etc.)

Don't get me wrong, boards are great for moving people to the stretcher, but I'd like to see them discontinued as immobilization devices where possible.


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## Tigger (Dec 27, 2012)

Veneficus said:


> It is easier to just take them off the board, but we try to leave them on in order to help the people who actualy have to do the lifting and carrying.



Doesn't the literature now suggest that all patients come off the board as soon as possible? Those hover mats do a good job moving patients to CT (unless you're me and they still drop you a foot onto three fractured vertebrae). 



firefite said:


> Our single use head beds.



Must light on fire nowz.



EpiEMS said:


> Don't get me wrong, boards are great for moving people to the stretcher, but I'd like to see them discontinued as immobilization devices where possible.



Gimme da scoop!


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## KellyBracket (Dec 27, 2012)

Tigger said:


> Doesn't the literature now suggest that all patients come off the board as soon as possible?



You bet. That's the new policy at my place - EMS and the RN remove the board, while maintaining spinal precautions.

I'm moderately surprised that there are still EDs running patient through the CT on a backboard. A good reason for EMS to purchase metal backboards, IMHO. Somewhat passive-aggressive...


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## EpiEMS (Dec 27, 2012)

Tigger said:


> Doesn't the literature now suggest that all patients come off the board as soon as possible? Those hover mats do a good job moving patients to CT (unless you're me and they still drop you a foot onto three fractured vertebrae).



That's what I've seen as well, but I suppose that there's enough of a chance of actual spinal injury with those who have severe pain or meet some sort of clinical criteria that I'm unaware of.



Tigger said:


> Gimme da scoop!


 I hear that (Gimme tha loot!) I'd like to use it more often...hmm...methinks I shall.


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## EpiEMS (Dec 27, 2012)

KellyBracket said:


> You bet. That's the new policy at my place - EMS and the RN remove the board, while maintaining spinal precautions.
> 
> I'm moderately surprised that there are still EDs running patient through the CT on a backboard.



Loving the policy, btw -- saw it on your blog! I wish you could make it part of protocols for services bringing in to St. V's, too, to clear them ASAP...


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## Tigger (Dec 27, 2012)

KellyBracket said:


> You bet. That's the new policy at my place - EMS and the RN remove the board, while maintaining spinal precautions.
> 
> I'm moderately surprised that there are still EDs running patient through the CT on a backboard. A good reason for EMS to purchase metal backboards, IMHO. Somewhat passive-aggressive...





EpiEMS said:


> That's what I've seen as well, but I suppose that there's enough of a chance of actual spinal injury with those who have severe pain or meet some sort of clinical criteria that I'm unaware of.
> 
> I hear that (Gimme tha loot!) I'd like to use it more often...hmm...methinks I shall.



Metal boards (and scoops) are cold. If you don't have a plastic scoop, try and get one!


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## Veneficus (Dec 27, 2012)

KellyBracket said:


> You bet. That's the new policy at my place - EMS and the RN remove the board, while maintaining spinal precautions.
> 
> I'm moderately surprised that there are still EDs running patient through the CT on a backboard. A good reason for EMS to purchase metal backboards, IMHO. Somewhat passive-aggressive...



I think I could count on one hand EDs that remove the board before CT that I have seen on that side of the pond.

I wonder if it is relative to the time it actually takes to get the pt to CT?


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## mycrofft (Dec 27, 2012)

If I'm going to use one, give me the following:
1. SKED (if I have to board them, they are likely to REALLY need it, and that means probably extrication and/or very strict spinal immobilization..unless it causes more pain and deficit, in which case they can sit with me and run the siren.
2. SINGLE PIECE LONG BOARD WITH PINS IN HANDHOLDS FOR STRAP CLIPS. As long as ALL sides except head end are tapered like a wedge, the sides are off the floor. Like the spinal/blood groove on the Ferno shown above.
3. STRAPS: single-use with end clips for board and double-back plastic buckles for closure and tension adjustment. No "D"-rings, no Velcro.
4. Any non-reuseable headblock, no adhesives (fail in rain or CSF), velcro OK.
5. Four trained brawny users!!


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## mycrofft (Dec 27, 2012)

Or, in a disaster, a door or tabletop with three distraught relatives.


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## KellyBracket (Dec 27, 2012)

EpiEMS said:


> Loving the policy, btw -- saw it on your blog! I wish you could make it part of protocols for services bringing in to St. V's, too, to *clear them ASAP*...



Thanks for trying out the policy! Just try to make my life easier at work, and avoid calling it clearance. We passed the policy because it is (correctly) viewed as *board removal*, but _not_ clearance. Perhaps it seems like a small point, but it's a world of difference to many of the staff. 

As for the risk in people with severe pain, even ATLS, as conservative as they are, recommend that a trauma patient *with paraplegia *be removed from a board ASAP. Again, they aren't _cleared_, they just have the dangerous board _removed_, using log-rolling, etc.

I apologize if I chime in with this topic often, but it's pretty darn interesting. See you in room 4!


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## NomadicMedic (Dec 27, 2012)

I spend more time calling the doc at the ED for a "board and collar deferral" than I do actually putting people on boards. 

If I had my druthers, we'd have no boards, just a scoop and reeves for moving patients.


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## Veneficus (Dec 27, 2012)

n7lxi said:


> If I had my druthers, we'd have no boards, just a scoop and reeves for moving patients.



That is my opinion as well.


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## mycrofft (Dec 27, 2012)

KellyBracket said:


> Thanks for trying out the policy! Just try to make my life easier at work, and avoid calling it clearance. We passed the policy because it is (correctly) viewed as *board removal*, but _not_ clearance. Perhaps it seems like a small point, but it's a world of difference to many of the staff.
> 
> As for the risk in people with severe pain, even ATLS, as conservative as they are, recommend that a trauma patient *with paraplegia *be removed from a board ASAP. Again, they aren't _cleared_, they just have the dangerous board _removed_, using log-rolling, etc.
> !



Yeah, clearance means making a decision, removal means specifically a technical skill which can be following a prompt order or a delayed one (e.g., protocol).

Paraplegics, didn't think about them. I'd also consider burns, elderly, hypothermia, positioned on flank, cachectic, obtunded, airway embarrassed (positional asphyxia), nauseated....in other words, nearly everyone. I guess in the old days, with the NHTSA fixation, everything was secondary to preserving spine alignment (even if it was wrong for a particular patient's spine insult).


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## EpiEMS (Dec 27, 2012)

Tigger said:


> Metal boards (and scoops) are cold. If you don't have a plastic scoop, try and get one!



Hmm, that's true. Maybe I can throw a hospital blanket on there? Unfortunately, all I have is the metal scoop... <_<



KellyBracket said:


> We passed the policy because it is (correctly) viewed as *board removal*, but _not_ clearance. Perhaps it seems like a small point, but it's a world of difference to many of the staff.
> 
> As for the risk in people with severe pain, even ATLS, as conservative as they are, recommend that a trauma patient *with paraplegia *be removed from a board ASAP. Again, they aren't _cleared_, they just have the dangerous board _removed_, using log-rolling, etc.
> 
> I apologize if I chime in with this topic often, but it's pretty darn interesting. See you in room 4!



Pardon my mistake  Removal, not clearance. I don't usually transport to Bridgeport, but I'll say hi if I'm there!

(I'll have to take a quick look at ATLS to better understand what the MDs do)


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## mycrofft (Dec 27, 2012)

I once heard someone say aluminum boards are" like mylar space blankets so they reflect the pt's heat back to them".

That is true IF they are not in physical contact. Even the reflective plastic mylar films (and maybe BECAUSE they are vacuum metalized to reflect) will conduct heat off you by contact while still being good reflectors of radiant heat. Aluminum is one of the very best conductors of heat, including away from you.

 I saw an aluminum board left on freezing snow melt in and stick once, had to kick it loose.


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## Veneficus (Dec 27, 2012)

mycrofft said:


> I once heard someone say aluminum boards are" like mylar space blankets so they reflect the pt's heat back to them".
> 
> That is true IF they are not in physical contact. Even the reflective plastic mylar films (and maybe BECAUSE they are vacuum metalized to reflect) will conduct heat off you by contact while still being good reflectors of radiant heat. Aluminum is one of the very best conductors of heat, including away from you.
> 
> I saw an aluminum board left on freezing snow melt in and stick once, had to kick it loose.



In my younger days i worked at a pizza shop that had stainless steel rings with aluminum grating as what the pizza actually sat on. I used to impress people by grabbing the aluminum part with my fingers right out of the oven without touching the steel rim. 

Had to stop doing that though, not everyone saw exactly what I was doing, and the imitators did not fare so well. The owner got really pissed when he ended up paying out of pocket for some ED visits for burns so he didn't have to report it to workman's comp.


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## mycrofft (Dec 28, 2012)

Has anyone heard of a carbon fiber board? Just asking.


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## VFlutter (Dec 28, 2012)

mycrofft said:


> Has anyone heard of a carbon fiber board? Just asking.



http://www.frsa.com.au/index.php/carbon-fibre-spineboard.html

FWIW when I was a patient I was taken off the LSB immediately upon arrival to the ER and then went through CT with just a C-collar.


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## Clare (Dec 28, 2012)

NVRob said:


> We are supposed to be switching to the hybrid scoop/LSBs here soon. At least one per truck plus a couple of the boards we have now.



This is the Combi-Carrier II and what NZ will be switching too as we phase out the old metal scoop stretchers.

Our spinal immobilisation consists of a well fitted hard collar and securing the patient to the stretcher in a supine position with their spine in alignment.  

Combi-carriers and scoop stretchers are for extrication only, not transport.


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## Veneficus (Dec 28, 2012)

Clare said:


> Combi-carriers and scoop stretchers are for extrication only, not transport.



The same used to be said about long boards.


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## Tigger (Dec 28, 2012)

Veneficus said:


> The same used to be said about long boards.



St. John is very good about not transporting patients on it on the stretcher, or at least as I saw it.


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## Clare (Dec 28, 2012)

Tigger said:


> St. John is very good about not transporting patients on it on the stretcher, or at least as I saw it.



Correct, combi carriers and scoops are for extrication and not transport.  I can't see the point of transporting somebody on an uncomfortable, flat, rigid device, how is that going to help?


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## mycrofft (Dec 29, 2012)

Since boards are so deeply engrained into US EMS culture and protocols, let's make boards more comfortable. It is almost the only splint used without padding.


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## EpiEMS (Dec 29, 2012)

mycrofft said:


> Since boards are so deeply engrained into US EMS culture and protocols, let's make boards more comfortable. It is almost the only splint used without padding.



I could totally get behind boarding if it weren't so darn uncomfortable -- if it's harmless (and certainly useful for extrication), I wouldn't mind it so much.


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## MIT (Dec 30, 2012)

We use spine boards and split stretchers and don't really transport on either. They're both too slippery and uncomfortable. I believe we're allowed to transport on the spine boards if we have to but it's not advised because they're so slippery! 

I would happily transport on a board if it meant that the patient was comfortable and stable on the board.


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## med109 (Jan 7, 2013)

I swear everytime I come to this website, I feel like we are more and more behind the times lol. It sounds like many of you don't backboard, or don't agree with it. We backboard EVERYTHING! SO I am curious about this, is there a thread that elaborates on it. If you have a suspicion of needing spinal protection what do you do? Someone even mentioned the board is dangerous, why?

The ER does seem to remove the board almost immediatley upon our arrival, but we darn sure better have them on it when we bring them in. Last night we had a 1 vehicle roll over, with 3 minor patients. We had to transport because they were minors, but they had no injuries or complaints (some minor cuts from glass, no bleeding was the worst). They had all climbed out of the vehicle on their own and walked around trying to find their cell phones for 45 mins before we arrived. I was pretty sure they didn't need boarded. I called in before leaving the scene and the Dr asked why they wern't boarded. I explained everything and asked if he wanted them boarded, he said yes. I told him that would slow our responce because I would need a second ambulance. He finally agreed if I felt the board was not needed we could just transport.

To stay on topic we use ferno backboards, and for head immobilization we use a c-collar and towel rolls with tape.


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## Handsome Robb (Jan 7, 2013)

Clare said:


> This is the Combi-Carrier II and what NZ will be switching too as we phase out the old metal scoop stretchers.
> 
> Our spinal immobilisation consists of a well fitted hard collar and securing the patient to the stretcher in a supine position with their spine in alignment.
> 
> Combi-carriers and scoop stretchers are for extrication only, not transport.



Well, I like my job and my certification so I'll continue to transport patients on them who meet spinal motion restriction requirements until something changes. 

As to what Vene said about being translucent for imaging, we are supposed to remove them and take them with us at the ER if at all possible. Our ERs are pretty good about getting people off boards relatively quickly. We are supposed to use standard backboards for the most part but "if the scooping action will benefit the patient" we can use them for spinal motion restriction. That's interesting about the hinges. Ours break-away from both sides if I'm not mistaken so I'm not sure if they have a different hinge or no matter which way you position the patient it'll be an issue. I was told there isn't a "head" or "foot" end. 



med109 said:


> I swear everytime I come to this website, I feel like we are more and more behind the times lol. It sounds like many of you don't backboard, or don't agree with it. We backboard EVERYTHING! SO I am curious about this, is there a thread that elaborates on it. If you have a suspicion of needing spinal protection what do you do? Someone even mentioned the board is dangerous, why?
> 
> The ER does seem to remove the board almost immediatley upon our arrival, but we darn sure better have them on it when we bring them in. Last night we had a 1 vehicle roll over, with 3 minor patients. We had to transport because they were minors, but they had no injuries or complaints (some minor cuts from glass, no bleeding was the worst). They had all climbed out of the vehicle on their own and walked around trying to find their cell phones for 45 mins before we arrived. I was pretty sure they didn't need boarded. I called in before leaving the scene and the Dr asked why they wern't boarded. I explained everything and asked if he wanted them boarded, he said yes. I told him that would slow our responce because I would need a second ambulance. He finally agreed if I felt the board was not needed we could just transport.
> 
> To stay on topic we use ferno backboards, and for head immobilization we use a c-collar and towel rolls with tape.



Google "NEXUS" and "The Canadian C-spine Rule"


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