Back Board vs Vacum Bag

SkiPatrol

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I'm a ski patrol at resort in the Canadian Rockies...our protocol for a back injury has always been a collar, back board and a nice toboggan ride to meet you guys at the bottom of the hill.

Recently, we acquired a couple of full body vacum bags which we use for extractions...there is some slight axial movement with the bag but not much and it allows us to transport in the position found (no straightening etc). On the theory that axial immobilaiztion is paramount once we've secured the pt in the bag we then strap both onto a board.

Lately we've been hearing that there isn't much evidence that immobilzation has better medical outcomes than restricted/gentle axial movement. Some of us are wondering if we shouldn't be using bags even when there is room for a board. We've heard some US protocols now accept either.

Comments??
 
To be honest, the jouncing from a basket or toboggan ride is going to cause shifting no matter what kind of immobilization you use. The vacuum splint is going to keep your folks warmer, and may provide comfort to the patient as you're doing your evac because they feel more secure in it. If they're claustrophobic, it's not a good deal at all. Also, you have less access for vitals, IVs, etc (depending on what you do).

You're never going to fully immobilize someone and there's a lot of studies showing that LSBs don't do much except start pressure ulcers and cause discomfort. I would say use whatever you think will make the patient most comfortable, because your immobilization is going to be pretty similar with the beanbag or the board.

Wendy
CO EMT-B
 
I haven't encountered the claustrophbia issue yet but I can see your point. As for patient comfort if it were me I'd take a bag any day. Particularly in the winter. I have however had the bag (its really slippery on snow) and patient start sliding down hill on me...They didn't get far but I can tell you it got my heart rate up in a hurry!!
 
Last I checked YOSAR (Yoemite SAR) uses the bag a lot. the Trauma Centers that recieve those patients like them; a lot of advantages from what I hear... but have no experience with, sorry. Due to our teams background in Water Rescue, Mine Rescue, and Rope Rescue, the Team made the desision long ago to use Millar Boards. Not my personal favorite, but for what we primarily do, a good choice all around and we will barrow other gear from Fire, EMS, or Ski Patrol if needed. On the other hand, in my time on SAR I have never boarded anyone, believe it or not. We clear the spine the few times spinal trauma was a possibilty.

As I have said before, remember what the end goal in spinal imobilization is. What is the best and (in the widlerness environment) the easiest way to achieve the goals while providing the best care you can for the patient. LSB over the Bag... I think the bag (despite any issues that any method is likely to have) is the best bet. In fact, I might look into them for the next budge, if it doesn't get smaller... LOL
 
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We've always been discouraged to use the vacuum suits, even when I was in training. My boss calls them the "death suits". I don't know why but he just hates them. We carry them of course, but the only time I've ever used one was when I was putting it on my partner to see how it worked. He could still move a bit, didn't think it was any better than backboarding, especially if you're a master at d rings.
 
If you are talking about the vacuum bean-bag type devices, they are amazing if properly applied. They are supportive but much more gentle and easier on the skin, muscles, and nerves than a hard board. We use them for WSAR and our CCT medical director just approved them for use on pediatric trauma transfers.
 
I've used the the vacuum bean splinting type devices at uni and found them to be far superior to any other kind of splint.

More relevantly though, I believe our HEMS guys use vacuum mattresses and when it comes to instituting new procedures/equipment in our state service, you can't sneeze without doing a literature review, so you can bet that it was well thought out. I should think the only reason why the rest of us aren't using them is because they cost more than the moon landing. Long boards are just silly.
 
I've heard a lot of SAR teams out here use them and love them. We have one that's OOS due to a leak that I don't think we ever even used in the field or in training... I didn't even know we had it while I was in charge of EMS equip. inventory :wacko: (it was hidden and nobody ever mentioned it and it wasn't on any of my lists).

As Eydawn referred to, I've heard they're great for cold-weather type situations, and because they don't cause the same problems with pressure points, they're really good for elderly patients.
 
Did some research...

A Cochrane review concluded that there were no relevant RCTs (randomised controlled trials). However, studies done on volunteers have shown that the vacuum splint is more comfortable than long spinal boards with no loss of stability. A large randomised trial in trauma patients is required.
The vacuum mattress provide comparable spinal immobilisation to the long spinal board with increased comfort.

Ahmad, M. and Butler, J. 2001. Spinal boards or vacuum mattresses for immobilisation. Emergency Medicine Journal 18:379-380.


In general, spinal immobilization is recommended for all mountain rescue casualties injured in a fall. The preferred method is a vacuum mattress with an appropriately sized rigid cervical collar.

Ellerton, J., Tomazin, I., Brugger, H., Paal, P., and International Commission for Mountain Emergency Medicine 2009. Immobilization and splinting in mountain rescue. Official recommendations of the International Commission for Mountain Emergency Medicine, ICAR MEDCOM, intended for mountain rescue first responders, physicians, and rescue organizations. High Alt Med Biol 10:337-342.



It was shown that the vacuum mattress prevents significantly more movement in the longitudinal and lateral planes when subjected to a gradual tilt. Perceived comfort levels are significantly better with the vacuum mattress than with the backboard.

The backboard has good longitudinal rigidity whereas the vacuum mattress will collapse if supported solely at each end, with potentially disastrous results. While this is not the recommended carrying technique it means that it may not be carried by two persons alone, limiting its use for a paramedic crew.

What is clear from this and other studies is that no single system appears to provide the ideal for extrication and transport of a trauma casualty, but that each system has its own qualities. A combination of systems may confer benefit. However, before disregarding one system in favour of another, careful consideration should be given to the advantages and disadvantages of each, as the potential for serious injury is great. The vacuum mattress provides a solution to some of the drawbacks of the long spinal board.

Luscombe, M. D. and Williams, J. L. 2003. Comparison of a long spinal board and vacuum mattress for spinal immobilisation. Emergency Medicine Journal 20:476-478.
 
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I worked for a service that used them extensively; they were purchased and used at the urging of the medical director. Here are a few things I noticed:
•Need to be appropriately sealed.
•Some are fairly short, which can be a hassle with taller patients.
•Positioning can make access to the patient difficult.
•Hospitals occasionally have a fit when using them or attempting to use them—most noticeable when you first arrive, and when they're going to CT.
•Much, much better than a spineboard as far as compressing body parts...no pain from use.
•Can be problematic when a patient has multiple large problems...but that comes down to using one's intelligence.

If they're used correctly, I think they're a nice tool in many situations.
 
My former SAR team in Wyoming uses the full body vaccum splint instead of spine board when appropriate.
 
Wow!!

I've been away for a while and when I logged in I was really surprised and pleased with the response!! Thanks.
 
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