Spinal Precautions

Follow protocols unless in an unequipped situation.

And by unequipped I mean a richter 7.9.
Part of your head to toe survey ought to be the neck, and that is completed before stopping to immobilize. Establish no exterior wounds, no foreign objects, and if you see angulation, it's either a normal variant or your pt's probably unconscious, dead, screamig in pain or wondering why they can't feel their extremities.
Your ambulance should have the full equipment. Also, how many spinal patients can you safely transport at a time? If you have used up your equip and there are more pt's, you need more units, and they will have the equip...unless as I say there's been a total breakdown of structure.
If you are not transporting, stop and call for an ambulance. Spinal precautions are for movement and transport to prevent further harm, they are not curative or treatment. Keep the pt still and calm. I've seen numerous pts get wild once they are boarded, it hurts and they get claustrophobic.

Pools have spineboards because of the high potential for spinal injury plus near-drowning; you may be forced to move the pt to safety, or rescuscitate, when spinal injury is very likely.

Ditto trapeze artists over the lion cage!
 
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IN fact..

No, I'll start another thread. "What every EMT should be required to experience before they graduate".
 
I know a number of people who preferance board before collar in a standing takedown.
 
I find it interesting that we are debating the use & application of a spinal collar.

Isnt the first thing you do to TALK to the patient. That will give you an idea even before an exam of any spinal injury. Lets be more specific & define what we are talking about here.

There are spinal injuries & spinal cord injuries.

One can have a spinal injury, including fractures, without spinal cord involvment. The actual incidence of spinal cord injury is nominal & we need to look at the true reason for immobilisation is to prevent an insult to the cord.

Hard collars provide some reduction in movment, about 35%, but that is nowhere near enough. The use of an extrication device will increase that to arount 90%.

The use of a hard back board should only be for extraction, not for transport as the discomfort afforded that patient can actually increase their desire to move, thus increasing their risk of insult to the spinal cord.

What order should we do it?

Collar (it is pard of any extrication device)
Extrication device
Backboard & then, as part of your full exam, roll them on the backbaord for a full spinal exam & remove it.
 
Downunda, that's what we learnt in '78.

Makes sense to me.
I have to restrain my coworkers from "putting on a backboard" once or twice a quarter. No medical benefit here, best to keep 'em quiet and wait for the squad.
 
downunderwunda said:
Hard collars provide some reduction in movment, about 35%, but that is nowhere near enough. The use of an extrication device will increase that to arount 90%.

The use of a hard back board should only be for extraction, not for transport as the discomfort afforded that patient can actually increase their desire to move, thus increasing their risk of insult to the spinal cord.

What order should we do it?

Collar (it is pard of any extrication device)
Extrication device
Backboard & then, as part of your full exam, roll them on the backbaord for a full spinal exam & remove it.
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That makes sense in a situation where the patient has to be extracted. I assume you're talking about a KED or something similar?

But I don't know of any option to transport other than on the long back board. Unfortunately, for better or worse (mostly worse), they are the standard in the US. What are you suggesting as an alternative for transport? Simply putting them on a cot won't be enough.
 
EMSLaw said:
That makes sense in a situation where the patient has to be extracted. I assume you're talking about a KED or something similar?

But I don't know of any option to transport other than on the long back board. Unfortunately, for better or worse (mostly worse), they are the standard in the US. What are you suggesting as an alternative for transport? Simply putting them on a cot won't be enough.
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We are fortunate enough that our stretchewrs are rated for spinal. If yours are not, then I would suggest you begin the long arduous process of getting them.

Patient comfort in this situation is better than morphine.

Yes I refer to a KED. However, no they do not just have to be used for extrication. I have used them in other situations as well very sucessfully. You need to open your mind & think outside the square. If you think they have a spinal injury, that has a chance of spinal cord involvment, put it on (by the way, it is easier to put it on when they are not in a car), what does it matter.

Just because it is called an extrication advice does not mean we can only use it for extrications.
 
Scout said:
I know a number of people who preferance board before collar in a standing takedown.
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Really? Why? I'm very curious.
 
Please forgive this question, as I have have read several threads that discuss different points on this topic. I have seen firsthand how patients react to the backboard, more often than not, the backboard makes them more uncomfortable, more in pain than not. I realize, the board is meant to be a stable immobilization platform, but an eldery person with a hip fracture laying on a solid piece of plastic for 40 minutes....ouch! (common here as hospital is generally 30 miles away)

I readily admit that I am a beginning EMT-B student and I don't have much experience or education. I know from FF experience the purpose of spinal immobilization, backboards, KED's C collars and so forth. But, has there been studies done that say a backboard actually helps in that type of injury, or is it more of a case of the 1 in 100, but is done to prevent a suit? Just curious.

My second question is, is there anyway to improve the backboard, maybe with some inflatable airbags that could give some sort of cushion, support, comfort, yet still maintaining purpose? I am not talking a home rig, something straight from the supplier, built in so forth...
 
dragonjbynight said:
My second question is, is there anyway to improve the backboard,
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Stop using it, Scoop onto a vacuum mattress, Use the board as an aid to extrication.

MedicHope, It is their belief that the gap between the chin and shoulders changes as you lye down. Personally it does for my neck, I go from regular to short.
 
dragonjbynight said:
Please forgive this question, as I have have read several threads that discuss different points on this topic. I have seen firsthand how patients react to the backboard, more often than not, the backboard makes them more uncomfortable, more in pain than not. I realize, the board is meant to be a stable immobilization platform, but an eldery person with a hip fracture laying on a solid piece of plastic for 40 minutes....ouch! (common here as hospital is generally 30 miles away)

I readily admit that I am a beginning EMT-B student and I don't have much experience or education. I know from FF experience the purpose of spinal immobilization, backboards, KED's C collars and so forth. But, has there been studies done that say a backboard actually helps in that type of injury, or is it more of a case of the 1 in 100, but is done to prevent a suit? Just curious.

My second question is, is there anyway to improve the backboard, maybe with some inflatable airbags that could give some sort of cushion, support, comfort, yet still maintaining purpose? I am not talking a home rig, something straight from the supplier, built in so forth...
Click to expand...


There is no study that says transport on a spinal board improves outcomes.

The body has many natural hollows & the back board will not mould to suit these.

The best thing you can use, it provides comfort, support & stability for the spinal area is a vac pack.
 
dragonjbynight said:
My second question is, is there anyway to improve the backboard, maybe with some inflatable airbags that could give some sort of cushion, support, comfort, yet still maintaining purpose? I am not talking a home rig, something straight from the supplier, built in so forth...
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There is a product called the "BACKRAFT" which is an inflatable pad that sticks to existing long boards. We used them at my old service out west and they worked pretty well especially since we had some extended transport times.
 
The main thing to remember, regardless, is a long board is used to assist with extrication. It is an extrication device. It is not intended as a transport aid. Transport to your stretcher, but take the patient off it.

They will thank you & be far more compliant than insisting they suffer with any length of transpord on that hard uncomfortable board.

Most people dont think to take the pt off through sheer laziness cause it is easier to move the pt at the hospital on the board rather than slide & do it properly.
 
downunderwunda said:
Transport to your stretcher, but take the patient off it.

... Most people dont think to take the pt off through sheer laziness cause it is easier to move the pt at the hospital on the board rather than slide & do it properly.
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Well, maybe that is the Australian way. But the last dozen or so EMS books that I've worked on do not support your concept; at least at this time they don't. The issue here in the States is that back-boarding after extrication and leaving the backboard on the patient is the current standard of care that is taught in EMT schools. Perhaps some services that have C-spine clearing protocols after extrication your concept may be supported.
 
I have to agree with Karaya, I have never heard of protocols in the northern Hemisphere which allow the removal of a Spinal Board after its been applied due to concern for C-Spine In Pre-Hospital setting. Personally I wouldn't feel comfortable removing one, sure they're uncomfortable and yes the pt's don't like them, but once i explain to my pts that i'm worried about the spine due to MOI, and the possible outcomes of damaging the spine without using one in transport.....they're usually content with staying on them.....

not to mention the legal aspect the pt is risking by coming off one....example being.....pt in mva hit by driver on wrong side of road, you extricate on board remove board....pt arrives at hosp and when xray compete it shows pt has Fx, Pt now paralysed...pt takes legal action against driver who caused mva.....when it is checked what tx you provided and that you removed a spinal immobilisation device....and subsequently pt is now paralysed...pts lawsuit goes out window cause the defendant cud claim Ambulance crew paralysed pt.........Simple option.....Leave Pt on Board til ED clear C-Spine by Diagnostic Exams......Cover your own ***!!!!!!!!
 
I still find it hilarious that we're debating over the proper use of a device that, to the best of my knowledge, has never been proven to prevent secondary spinal injury.
 
JPINFV said:
I still find it hilarious that we're debating over the proper use of a device that, to the best of my knowledge, has never been proven to prevent secondary spinal injury.
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Here Here.
 
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