# Backboarding w/out collar



## shademt (Apr 30, 2014)

In regards to backboarding a patient, do we always automatically use a C-collar if we need to backboard a patient or can we backboard without a collar?

For example, say a patient fell and fractured a thoracic bone in the middle of her back but with no specific NECK pain, C-collar?

Thanks for the info


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## OnceAnEMT (Apr 30, 2014)

I would. The argument of whether they immobilize effectively or not aside, C-collars serve as a reminder that the Pt really needs to try and be still. Forces at the neck most certainly transfer to some extent to more distal vertebrae.


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## shademt (Apr 30, 2014)

makes sense. thanks


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## mycrofft (Apr 30, 2014)

1. See your protocols.
2. No way to know how many locations are hurt nor how bad in the field, so that single thoracic injury could be that and a subluxated C1-2 that hasn't displaced far enough to cause disastrous results until you walk them to the ambulance litter then roll it up to the stops in the ambulance. Or hit a pothole on the way to the hospital.

I am still grinning ruefully at studies that show a PROPERLY selected and PROPERLY sized collar PROPERLY applied doesn't immobilize the neck versus say being unconscious or riding in an ambulance on the road, especially if combined with KED and/or a properly blocked long spine board.I'd like to tell these researchers to _*try it some time*_ then get back to me. It may not be perfect, it may not resist someone fighting it, and it may not *treat* insults to the neck, but it's a tool which when used by a competent and well supplied provider offers benefit during extrication and possibly transport when iatrogenic movement is not improbable.

Don't throw the baby out with the bathwater.


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## Tigger (Apr 30, 2014)

There are many things that seem to make intuitive sense that are not born out by research. That does not invalidate the research.


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## mycrofft (May 1, 2014)

VERY true, or we'd all still be pulling people out of wrecks by their hair a'la 1960. Or pushing chests 60 times a minute instead of 100.

But as I said, _try it_. Like tourniquets, many spinal immobilizations were done in the wrong cases, the wrong way, with the wrong tools.  Don't discard science, but don't discard practical observation, or you get an "Emperor's New Clothes" situation…everyone bows, but no one acknowledges the warts and the seams in any approach.

Which was exactly how spinal immob became so abused.


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## Handsome Robb (May 1, 2014)

Did you know turning your head manipulates your thoracic spine? 

Also, spine boards are falling out of favor.


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## TransportJockey (May 1, 2014)

The patient you have identified in the first post is the perfect patient for a vacuum mat/board {A} {B} 

And they even make some of the vacuum boards w/ a portion that acts as head blocks and can make it so you don't need a c-collar at all


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## OnceAnEMT (May 1, 2014)

TransportJockey said:


> The patient you have identified in the first post is the perfect patient for a vacuum mat/board {A} {B}
> 
> And they even make some of the vacuum boards w/ a portion that acts as head blocks and can make it so you don't need a c-collar at all



Your system has to have the vacuum board before you're able to use it.  That said, I've seen a lot of EMS systems (and their dispatchers) avoid vacuum splinting and tell us ATs not to vacuum splint limbs. If they think that, I doubt they'd even consider a full body one.


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## TransportJockey (May 1, 2014)

Grimes said:


> Your system has to have the vacuum board before you're able to use it.  That said, I've seen a lot of EMS systems (and their dispatchers) avoid vacuum splinting and tell us ATs not to vacuum splint limbs. If they think that, I doubt they'd even consider a full body one.



I'm hoping with backboards going away (finally!) that we can start progressing to them. I'm seeing them in the ABQ metro area lately. And my service is getting one per truck to supplement our existing vacuum splints. We are doing away with boarding altogether it's lookign like


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## OnceAnEMT (May 1, 2014)

TransportJockey said:


> I'm hoping with backboards going away (finally!) that we can start progressing to them. I'm seeing them in the ABQ metro area lately. And my service is getting one per truck to supplement our existing vacuum splints. We are doing away with boarding altogether it's lookign like



Glad to hear y'all are making that switch. Vacuum splints work wonders, and are dumby proof. The only catch is that it requires that the splint and pump be together, and there is a fairly high cost. At the same time though ,they are durable and very much so reusable.


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## TransportJockey (May 1, 2014)

Grimes said:


> Glad to hear y'all are making that switch. Vacuum splints work wonders, and are dumby proof. The only catch is that it requires that the splint and pump be together, and there is a fairly high cost. At the same time though ,they are durable and very much so reusable.



Exactly why we carry them. In fact the set we have is the same ones we had when I worked here three years ago (TX). My NM service, and other NM services are just not playing with them.


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## OnceAnEMT (May 1, 2014)

TransportJockey said:


> Exactly why we carry them. In fact the set we have is the same ones we had when I worked here three years ago (TX). My NM service, and other NM services are just not playing with them.



Very cool. Just out of curiosity, how does your system retrieve them? I've never used them in the EMS setting, but what we do in AT is 1 of 2 things:

1. Pt sent to ED with vacuum splint applied, with note to parents saying to keep splint when it is removed to return it to the school (or their AT, if its an athlete on a different team)

2. Pt send to ED, AT meets them there after the game and takes the splint themselves. 

I understand with backboards and sheets and such its more of a here's mine, now I'll take yours type of deal, but vacuum splints are a bit harder to come by, and I wouldn't expect to see one IN an ED.


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## Tigger (May 1, 2014)

Our sports medicine ones were very clearly labelled and someone would just go down to the hospital later and get it out of the EMS equipment bin. Fire, AMR, and some of the outlying places like mine all use the same semi disposable ones so we just grab one out of the bin before we clear.


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## TransportJockey (May 1, 2014)

Grimes said:


> Very cool. Just out of curiosity, how does your system retrieve them? I've never used them in the EMS setting, but what we do in AT is 1 of 2 things:
> 
> 1. Pt sent to ED with vacuum splint applied, with note to parents saying to keep splint when it is removed to return it to the school (or their AT, if its an athlete on a different team)
> 
> ...



We are just about the only service to drop off at our little ER, so that's easy and we just hang around to get it. If I fly them, our flight team usually brings them back (if it's our fixed wing) or another base will get them for us if they get flown somewhere else on rotor.


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## OnceAnEMT (May 1, 2014)

Roger that, figured as much. Thanks guys!


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## mycrofft (May 1, 2014)

I remember hearing about the vacuum boards around 1981! They said that "The Germans have them or something" and that they weren't as in love with supinating the whole pt like we were/are.

I'll go learn more.


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## mycrofft (May 1, 2014)

*Back already*

Here is a well-done article with references about the drawbacks of traditional spine immobilization. It has some shortfalls of ignoring some practical aspects, but not makes its point:

http://www.boundtreeuniversity.com/news/1680079-Vacuum-spine-boards-Transport-devices-of-the-future

Cutting it quickly to the chase, they say straps and blocks do not immobilize the bones which can still move about in the muscles and skin; if you bind the pt ever more tightly in an effort to stop that, the pt can't breathe. (They didn't mention halo cranial devices….ouch). Somehow, probably by allowing a generalized blocking and binding which doesn't have a lethal limit, a vacuum back board works where others don't.
It seems they are comparing common mouse of traditional spinal immobilization versus subjective reports of vacuum splint types being more comfortable, faster to apply (true?), some "sometimes" causing claustrophobia. US Army study showed no improvement in pressure ulcers but the article author raises possibility this is due to the acuity of those pts requiring longer immobility of_* thoracolumbar*_ injury.


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## OnceAnEMT (May 1, 2014)

mycrofft said:


> vacuum splint types being more comfortable, faster to apply (true?),



Will take a look at the article over the weekend. Vacuum splints are definitely more comfortable and much less "awkward" to have on. Pt with a bunch of boards and crevettes tied to them aren't exactly happy or appreciative. Vacuum splints are comfortable and professional looking. About being faster to put on, they are if you know what you're doing. I'm not talking PASG (lol, I said it) type of complicated, but its juuuust above the acuity of giving it to a bystander to immobilize the Pt. If you know how to do it, you've done it before, etc, yeah, it slaps right on. I've seen a few and heard a plenty stories of ATs fumbling with them.


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## mycrofft (May 1, 2014)

Anyone find a video of an auto extrication using vacuum mattress or device? I'm finding a lot with the "rescue boa" idea, but nothing where the entrapped pt is being immobilized; they are all out and supine.


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## mycrofft (May 2, 2014)

mycrofft said:


> Anyone find a video of an auto extrication using vacuum mattress or device? I'm finding a lot with the "rescue boa" idea, but nothing where the entrapped pt is being immobilized; they are all out and supine.



I've emailed the author of the Bound Tree article for any resources he has.


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## Tigger (May 2, 2014)

mycrofft said:


> Anyone find a video of an auto extrication using vacuum mattress or device? I'm finding a lot with the "rescue boa" idea, but nothing where the entrapped pt is being immobilized; they are all out and supine.



No reason to try and extricate someone from a car with a mattress really. Hartwell recommends "traditional" methods substituting a scoop for a board. Lay mattress on ground, place scoped patient on mattress, and then remove scoop.


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## mycrofft (May 2, 2014)

*Light at the end of thee tunnel.*

There is that awkward period between whatever posture you find them (sitting upright, hanging in straps upside down, shoved under dash board) and when you can get them onto a scoop or any board. The rescue boa looks like an interesting concept except that it ignores thoracolumbar concerns. 

I keep hearing people (not Tigger) crying that the LSB is dead, long live the vacuum mattress; yet is is still the LSB used in _*extrication*_…which is exactly what, and only what, it was designed for. 

That means, once you strip the hyperbole away, it's starting to make sense again! Only took forty +/- years.

Now, if they could only make a soft-topped LSB. And how about a KED with a vacuum headpiece or inflatable head block inserts?

And a drug to keep subjects from going crazy from being tied up like that!


PS: just as Grandfather Charles told me never to trust someone without calluses on his hands and Pappy Miles taught me to never sign a blank receipt (or trust a gun safety), I'll tell you to distrust any extrication device which is always demonstrated in daylight, with the pt sitting up behind the wheel, the car perfectly upright on solid ground, and the passenger cab undeformed. Show me the money: 2 AM, Sunday, and its raining, the car's 3/4 rolled in mud and the door's smashed down/jammed a couple inches.


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## TransportJockey (May 2, 2014)

mycrofft said:


> There is that awkward period between whatever posture you find them (sitting upright, hanging in straps upside down, shoved under dash board) and when you can get them onto a scoop or any board. The rescue boa looks like an interesting concept except that it ignores thoracolumbar concerns.
> 
> I keep hearing people (not Tigger) crying that the LSB is dead, long live the vacuum mattress; yet is is still the LSB used in _*extrication*_…which is exactly what, and only what, it was designed for.
> 
> ...



I'm pretty sure they have released a vacuum board. I saw one in a trade journal months ago. And I think most people have given up on transporting on a backboard.  Even here in NM where we don't board anyome, trucks continue to carry them, specifically for extrication


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## mycrofft (May 2, 2014)

I say, right on.

I've been trying to find you tubes of vacuum extrication devices, but no go. Splints and mattresses.

Back to OP: besides my usual "use protocols", if you are concerned about the back, why not the far more vulnerable neck? Sure, collar away, but do it right and with the right collar.


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## TattooedNay (May 2, 2014)

The only time I do not use a collar when boarding is on a code. Load and go.


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## chaz90 (May 2, 2014)

TattooedNay said:


> The only time I do not use a collar when boarding is on a code. Load and go.



Your immediate response to a cardiac arrest is to backboard then immediately "load and go"?


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## Christopher (May 2, 2014)

TattooedNay said:


> The only time I do not use a collar when boarding is on a code. Load and go.



I use a collar on all of my codes. Best way to keep the head from rolling about and dislodging our airway. (We also don't load and go)

As I teach my EMT's, you should be saying "think and act" instead of "load and go". You'll make mistakes with "think and act", but you're always making a mistake with "load and go".


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## mycrofft (May 2, 2014)

Unless load and go is all you got.
But you do need to decide to load and go, not just bolt.

Custer could have taken some lessons there.


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## TattooedNay (May 3, 2014)

chaz90 said:


> Your immediate response to a cardiac arrest is to backboard then immediately "load and go"?



Not quite what I said....


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## TattooedNay (May 3, 2014)

Christopher said:


> I use a collar on all of my codes. Best way to keep the head from rolling about and dislodging our airway. (We also don't load and go)
> 
> As I teach my EMT's, you should be saying "think and act" instead of "load and go". You'll make mistakes with "think and act", but you're always making a mistake with "load and go".



we have a little wedge to put under the head. Combined with the "sticky" head and chin straps it works just fine.


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## Handsome Robb (May 3, 2014)

TattooedNay said:


> we have a little wedge to put under the head. Combined with the "sticky" head and chin straps it works just fine.




Why are you backboarding cardiac arrest patients?


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## TattooedNay (May 3, 2014)

Robb said:


> Why are you backboarding cardiac arrest patients?



you're kidding


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## Handsome Robb (May 3, 2014)

TattooedNay said:


> you're kidding



No, I'm really not. The floor provides a perfectly stable surface for compressions. If they're on a couch or bed or chair move them to the floor. If you're moving your patients with CPR in progress you're provided substandard care. Read a little bit and figure out why I'm saying that. 

Explain to me what a compression fraction is and why it's important. Now, once you've done that explain to me what moving a patient with CPR in progress does to that compression fraction as well as time off the chest and peri-shock pauses. Have you ever seen what happens to a patient's end tidal CO2 levels after stopping CPR to move them to the gurney then to the ambulance? How about once in the ambulance and transporting. Why is that important to pay attention to?

I'm going to take it a step further, explain to me why we do the things we do for a cardiac arrest patient. Also, you never answered my question, why are you routinely back boarding cardiac arrest patients? Your protocol says to isn't a good answer. 

Learn why you're doing things and keep up with the times or get the hell out of medicine before you cause more harm to your patients.


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## TransportJockey (May 3, 2014)

TattooedNay said:


> you're kidding


A backboard is good for moving a patient after you get ROSC. That's it. My coded patients stay on scene unless they get pulses back or there's actually a reason to transport. Also that way when I call them, I don't lose a backboard or have to get it out from under the body


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## SeeNoMore (May 11, 2014)

Maybe Tattooed Nay is referring to Trauma Arrests at a BLS level? Most protocols I have seen include c - spine immobilization + LSB. And then of course rapid transport once the important EMS stuff is taken care of.


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## CFal (May 11, 2014)

our most recent trauma code we were back boarding him unconscious but breathing, went down hill fast, ditched doing the c collar and just threw him on the board and started CPR, rapid extract.


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