Backboards...with padding

rescue1

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I was lying in bed this morning, and like any self respecting EMSer, I was dreaming of spinal immobilization. Now, most people here (including myself) are deeply suspicious of the effectiveness of the B&C, but for better or worse it looks like its a procedure that will be hanging around for at least a while longer.

One of my biggest complaints with the board is that it is so uncomfortable for patients, especially elderly, arthritic patients who make up a good amount of my spinal immobilization calls. Patients who had minor back pain will develop shoulder, back and pelvic pain from the combination of lying on a hard piece of plastic, and from that plastic bouncing around on Pennsylvania roads (which are a bit rough). I try to pad the board/voids when possible, but sometimes it doesn't work or I don't have enough blankets on scene.

So after torturing another older lady with a spine board on the way to the hospital, I was thinking...why don't we have padded backboards? I'm not talking anything fancy, just an inch or two of padded material, similar to a stretcher mattress, covering the whole board.
I can't imagine that it would compromise the purpose of the board, nor would it make it significantly harder to carry or clean. And it would at least provide some measure of comfort too our patients as we bounce around in the back of the ambulance.

Now, keep in mind I'm still a little sleepy as a write this, so maybe I'm missing something important as to why we don't pre-pad our LSBs, hence why i'm throwing this idea out there. Anyone see why it would be a bad idea? Anyone use something like this?
 

VFlutter

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Why not just use rolled up blankets or pillows to pad where needed? Or those pad things that come with the KED.

How would a padded board effect CPR?
 
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rescue1

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That's what I'm using now, but it's an imperfect system. Not only is it more stuff to carry over, but sometimes you won't know where a patient will feel discomfort until after you've secured them, at which point it's usually too late to shove padding under them.

You make a good point about CPR, though.
 

Christopher

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I can't imagine that it would compromise the purpose of the board...

You do realize there is no purpose for a long spine board right?

No studies showing it works. No studies showing it helps. Not a shred of evidence we should be using them.

Pad away sir, your guess is as good as our current practice. Hell it could be better! Even if it is worse, nobody will care because proving something causes harm is not a reason to remove it if it is the standard of care.
 
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rescue1

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Oh, I know, I've read the studies. My thought with padding would be as a way to make a bad situation better, as (unfortunately) opposed to fixing the root of the problem.
 

Christopher

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Oh, I know, I've read the studies. My thought with padding would be as a way to make a bad situation better, as (unfortunately) opposed to fixing the root of the problem.

They sell commercial padding systems for LSB's. They're fairly comfy considering the alternative. Hell you could probably just buy some foam camping rolls and use those.
 
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rescue1

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That's basically what I was thinking of. Has anyone used these? Are they effective at reducing patient discomfort?
 

Tigger

Dodges Pucks
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Hartwell is selling this now, not sure how much more comfortable it makes the board but I found that the large vac splint positioned from the thoracic region on up was more comfortable when we were coming up with new techniques for spinalling hockey players.
 

Bullets

Forum Knucklehead
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How about a scoop? i have found that it is far more comfortable to lay on, and easier to use then a long back board, as well as reducing movement in the spine as you avoid a log roll. With the curvature of the scoop and the spinal channel, there is less pressure directly on the spinous processes then you see with a LBB

I also love the scoop because i take great personal pride and enjoyment in the strange looks and berating comments from the receiving nurses
 

mycrofft

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You do realize there is no purpose for a long spine board right?

No studies showing it works. No studies showing it helps. Not a shred of evidence we should be using them.

Pad away sir, your guess is as good as our current practice. Hell it could be better! Even if it is worse, nobody will care because proving something causes harm is not a reason to remove it if it is the standard of care.

Your last sentence: I feel your frustration.

The passage I colored blue for you: On the contrary, there are studies cited in the founding of EMS that suggest it works fine when it is used appropriately. However, it became a panacea, and studies show that boards are used too liberally and kept on way to long. It is not a treatment it is a big splint to maintain an pin-linme spinal position for extrication and movement when these are necessary and movement with potential exacerbation of a spinal injury is going to be otherwise unavoidable. Would you extricate someone from the back seat of an minorly-damaged two-door car, complaining of neck pain and paresthesia of the arms/hands, without using a KED and then a spine board? Or skip the Stoke slitter humping someone out of the ski park who fell and has terrible lower back pain?

Would we put it on Granny who fell onto her hands, had a Colles fx and no other c/o, for her hour ride to the town clinic? Heck no!! ;)

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Why not make boards with a sprayed-on layer of medium density closed cell polyurethane foam sort of like that on a SAM splint? Not soft like MAma's lap but a sight better than plywood or heavy duty polyethylene. We used to use the Ferno-Washington folding plasticized canvas litters with sandbags and pillows as needed. We might get them out of a car on a short board if needed, but the litter seemed a lot more humane, we maintained good alignment, and never had a complaint from the hospitals...this during the hayday of the long spine boards.
 
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Christopher

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Your last sentence: I feel your frustration.

The passage I colored blue for you: On the contrary, there are studies cited in the founding of EMS that suggest it works fine when it is used appropriately. However, it became a panacea, and studies show that boards are used too liberally and kept on way to long.

I've yet to find these in my review of the literature, and when you read in-hospital stuff they never mention backboards. Funny enough, while reading Dr. McGonigal 's page today I saw this gem (emphasis in original):
Remember, if your patient actually has a spine fracture, they will be placed on logroll precautions on a soft mattress only somewhere in your hospital! No stiff boards of any kind!
 

wildrivermedic

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Had a medical unit leader on a fireline assignment a couple weeks ago who INSISTED we pad our backboards -- go to supply, get two sleeping pads, cut one to fit and tape it down. The other pad was for lumbar and behind-knee support rolls. He was adamant about the importance of padding in these extended transport situations.

I didn't use mine for a patient but did lay down to check it out myself. Got up again fairly soon, but it was noticeably better than the bare board. That amount of padding wouldn't interfere with immobilization or CPR.
 

bigbaldguy

Former medic seven years 911 service in houston
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Whats with all this crazy talk about taking a patients comfort into consideration? Smells suspiciously of "customer service" to me.
 

mycrofft

Still crazy but elsewhere
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The original studies were done by Dept of Transportation in the Sixties. Became a hot potato when films of young monkeys being punched in the head by pneumatic rams surfaced.
 

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