Ground level fall and the Backboard

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Rhyse

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I few days ago i went on a call for a ground level fall, where a woman tripped in a parking lot and she fell to the ground. She did not have any LOC, didnt hit her head, etc.. she only complained of arm pain (which we splinted), a twisted ankle which was immobilized, and after a few minutes laying supine on a very hot parking she said her she had a few back spasms...

My question is...should she be boarded and collared?

This is a hot topic in my service right now and i'm curious what people think.

Thank you
 
In my option we did not need to board and collar the patient because the patient did not have and pain, swelling or tenderness in the head, neck or back. The fall was also witnessed and witness said that the pt didnt hit her head. There was also no significant mechanism of injury that would suggest the use of the board and collar either.
 
Rhyse said:
There was also no significant mechanism of injury that would suggest the use of the board and collar either.
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This.
 
medichopeful said:
This.
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Agreed.

I wouldn't have boarded her. In all honesty it probably would have made the "spasms" worse.

How old was she?

People could argue that she had painful distracting injuries but that's a pretty subjective thing. Is she screaming and freaking out about her arm and ankle or more "my arm and ankle hurt" but still answering questions and engaging you during assessment? You can argue any injury is distracting but unless they are so wrapped up in that injury that they are making assessment difficult then I wouldn't call them distracting.
 
She wasn't freaking out about the injuries, she was more calm and saying "hey, my arm really hurts" and the ankle was even less than that...So as for distracting injuries, i considered that on scene. And Pt, who was in her late 40s, was even joking around with us after we got her on the stretcher.
 
This lady did not need a board.

if laying on the hard flat ground put her back in spasms, laying on a hard flat board would too.

Do no harm.
 
Agreed, but don't expect to see "swelling" in a cervical or other spinal injury case. Not to say a protrusion from a herniation or "slipped" disk, or local spasm in a small part of the paraspinals, is not palpable, but these would require maneuvering the pt to palpate, and might still be unhelpful especially if you don't know the pt's baseline. Not a good ratio of benefit to risk if spinal trauma is suspected.
 
It takes a lot of convincing to get me to put someone in a board and collar if there is no serious MOI.

Boarding and collaring often makes people worse, or people who are fine uncomfortable.

Useless treatment and it should be abolished from EMS.


Collar yes board no.

When's the last time you went in an ER and saw someone on a backboard? Hospitals don't even own backboards I'm sure it must be a really viable and proven treatment.
 
Rhyse said:
Why a collar but no board?
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I'm not saying I do that because unfortunate I am a mindless robot forced to follow a set of steps but this is how hospitals do it.

Collars do in fact limit neck movement. Backboards are just dumb. There's a reason ONLY EMS uses backboards.

Flat board curved spine, uncomfortable constraining device. Almost none of our patients ever have a spinal injury and when they do it's probably cervical and we make it worse.
 
No collar or board.

I don't know why anyone would consider immobilisation in this patient.

The distracting injury part only applies if you are clearing the pt. If you don't suspect a spinal injury in the first place then distracting injuries are irrelevant.

If someone cuts their hand off with a power saw you don't say, "Oh dear a distracting injury, better collar them". You don't suspect spinal involvement in the first place.

It used to be common practice here to only use a collar and if you did use the board, to remove it once the pt was on the stretcher. My understanding was that boards were only ever really an extrication aid. Then they came along with a guideline change that stated if we did it at all it had to be the whole lot. I don't know why. They said something about a collar not immobilising the whole spine. I suspect it probably has something to with motion restriction during transport. Honestly the amount people wiggle about on long boards thanks to discomfort, we'd be better off without them. I hate long boards. I've hated them ever since I was immobilised during university for practice. I very quickly realised how incredibly uncomfortable, and indeed pain producing, they are and how completely useless they are at motion restriction.
 
Melclin said:
The distracting injury part only applies if you are clearing the pt. If you don't suspect a spinal injury in the first place then distracting injuries are irrelevant.
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THANK YOU!! I've got in that argument more times than I can remember! "Oh, he got shot in the arm then fell on the ground; we should immobilize him because a gunshot wound is a distracting injury!" :glare:
 
PoeticInjustice said:
THANK YOU!! I've got in that argument more times than I can remember! "Oh, he got shot in the arm then fell on the ground; we should immobilize him because a gunshot wound is a distracting injury!" :glare:
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Standing height falls with no head strike in young healthy people. Honestly. Its like people's common sense goes out the window. Teaching spinal immobilisation, I give scenarios like this to FRs and FAs and they often jump straight to immobilisation. How many times has each one of them fallen over in their lives and gotten straight back up. Boggles the mind.
 
Melclin said:
Standing height falls with no head strike in young healthy people. Honestly. Its like people's common sense goes out the window. Teaching spinal immobilisation, I give scenarios like this to FRs and FAs and they often jump straight to immobilisation. How many times has each one of them fallen over in their lives and gotten straight back up. Boggles the mind.
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"But my instructor's cousin's brother-in-law's neighbor saw a guy that fell down and if he had moved his head this much...."
 
usalsfyre said:
"But my instructor's cousin's brother-in-law's neighbor saw a guy that fell down and if he had moved his head this much...."
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4 years in one of the busiest surgical trauma centers in the US, I never saw a guy who would have been paralyzed if he moved this much.

I saw a lot of people who came in with deficits and many who came in without.

I call urban legend.
 
Veneficus said:
4 years in one of the busiest surgical trauma centers in the US, I never saw a guy who would have been paralyzed if he moved this much.

I saw a lot of people who came in with deficits and many who came in without.

I call urban legend.
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Agree completely, just illustrating the normal argument.
 
My department uses an Assesment Based Spinal Immobilization protocol. In which I can determine wheather or not my patient needs immobilized.

In this case I would not have backboarded this patient. They did not meet the criteria that is in my protocol.
 
Backboards are great for transferring from the stretcher to the ER bed :P

Plus , Sam Jackson from unbreakable could have used one when he fell down those stairs!

Plus..... Ketamine.

Wait, what were we talking about?
 
A spineboard is a splint (for transport or extrication). How many unpadded splints do we use?

Again and again and again, the national Department of Transportation's Highway and Traffic Safety Administration (NHTSA) invented EMT's partially to get spineboards into use, around 1970. Provider organizations started boarding everyone to cover their butts and because field workers needed to be taught and directed for the lowest common denominator.
 
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