Sasha
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After the I'm Confused thread, I did a little bit of searching for articles on backboarding, and here's two articles I found interesting
Previously I was in the "What could it hurt?" camp. According to this article, it can hurt quite a bit!
The article also refrences another study which uses five criteria to rule out the need for immoblization
And the results:
And here's a study that there may be less benefit to backboarding than EMT texts lead you to believe.
And looking at it from a personal, non sciencey side... I, like many others, was backboarded (although only for a short time) in EMT school by practicing classmates. In the short time I was backboarded I found myself squirming around in the C-Collar, headblocks and straps trying to get comfortable and I was completely okay and cognizant of what was going on. I couldn't imagine having to in those for any length of time. Would you not think that a person is less likely to try and move laying down on a slightly more comfortable stretcher for a nice ride to the hospital, or immoblized in an uncomfortable, unanatomically correct position? Look at your spine, then look at a spine board. We have some natural spinal curvatures! We're not flat, and we aren't meant to be.
Previously I was in the "What could it hurt?" camp. According to this article, it can hurt quite a bit!
The act of immobilizing a cervical spine is not a completely benign process. It taxes the patient financially and physically. Spinal immobilization is estimated to cost $15 or more per patient, leading to more than $75 million a year in extra medical expenses.2
According to current ATLS teaching, a cervical spine is not immobilized properly unless the patient is placed in a semi-rigid collar, then strapped and taped to a rigid backboard.3This can be an uncomfortable and traumatic procedure in itself. It has long been known that long-term exposure to a c-collar and backboard can lead to decubitus ulcers and pain.
In a study of 21 healthy individuals placed in full spinal immobilization, all were found to have immediate pain, with six patients complaining of delayed symptoms from the immobilization 48 hours later.4 There also is the possibility of further damage to a spinal injury from manipulating it into a cervical collar.
The researchers found less disability (even in the patients with fractures) in the nonimmobilized patients than the immobilized patients.5The study has limitations, but it certainly supports further investigation into the value of cervical immobilization in all trauma patients.
The article also refrences another study which uses five criteria to rule out the need for immoblization
The five criteria are no focal neurologic deficits, no intoxication, alert and oriented times three, no distracting injury, and no midline cervical vertebral tenderness.
And the results:
By using these criteria on 34,069 patients, 810 of 818 cervical spine injuries were identified and filmed appropriately. Of the eight missed injuries, only two were considered clinically significant. In addition, 240 of the total fractures were deemed clinically insignificant, occurring in either the spinous or transverse processes and having no risk of neurologic injury. Of the 34,069 patients enrolled in this study, it was estimated that by using these five criteria, 4,309 patients did not need to be evaluated with x-rays
And here's a study that there may be less benefit to backboarding than EMT texts lead you to believe.
A 5-year retrospective chart review was carried out at 2 university hospitals. All patients with acute blunt traumatic spinal or spinal cord injuries transported directly from the injury site to the hospital were entered. None of the 120 patients seen at the University of Malaya had spinal immobilization during transport, whereas all 334 patients seen at the University of New Mexico did.
There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04). This corresponds to a <2% chance that immobilization has any beneficial effect. Results were similar when the analysis was limited to patients with cervical injuries (OR 1.52; 95% CI 0.64-3.62; p = 0.34). CONCLUSION: Out-of-hospital immobilization has little or no effect on neurologic outcome in patients with blunt spinal injuries.
And looking at it from a personal, non sciencey side... I, like many others, was backboarded (although only for a short time) in EMT school by practicing classmates. In the short time I was backboarded I found myself squirming around in the C-Collar, headblocks and straps trying to get comfortable and I was completely okay and cognizant of what was going on. I couldn't imagine having to in those for any length of time. Would you not think that a person is less likely to try and move laying down on a slightly more comfortable stretcher for a nice ride to the hospital, or immoblized in an uncomfortable, unanatomically correct position? Look at your spine, then look at a spine board. We have some natural spinal curvatures! We're not flat, and we aren't meant to be.
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