Why we shouldn’t backboard

[cointosser13]

I know a lot of places are still into backboarding every patient that complains of back pain and/or neck pain even if the car was going 5 mph...like my agency. I also know many agencies are slowly pulling away from backboarding every patient. I have a wonderful OMD who’ll listen to us paramedics and get input. That being said I still have to come up to him with more than just a “hey can we not backboard every patient”. Can you guys help me build a good case and prove to him that we shouldn’t backboard every patient. If you don’t backboard every patient you come across after an accident, can I see what set protocols you have in place? My OMD is really into graphs, tests, articles and statistics. If you guys have links please share. If the research was proven/written by an MD that will help my case even better!

 

[DesertMedic66]

We are actually to only use the backboard as a means of transporting a patient to the gurney and then are to remove the backboard immediately.

Our protocols simply have us use the NSAID criteria and then state what I posted above about the use of backboards.

I can look up some links and research for you tomorrow since it is late. If I recall correctly a google search has resulted in a fair amount of documents in the past for me.

 

[zacdav89]

This study here may be a good primer for your medical director. It's what lead to the Nexus criteria, a tool developed to see who needs radiological studies for cervical spine Injuries. It found that unless the patient fell Into the any of the categories that the patient was highly unlikely to have a cervical spine injury
https://www.google.com/url?sa=t&sou...FjAEegQICRAB&usg=AOvVaw0KCbMKILZqcYiDzYoBc8DR

Here is a link to the Denver metro protocols it's protocol 8090.
http://www.dmemsmd.org/protocols

 

[DrParasite]

Here are somethings you can use to get you started as to where to look. pay special attention to the footnotes among the presentations

http://epmonthly.com/article/ditch-the-board/
http://www.1.wildernessdoc.com/assets/lectures/2010/Spine Appendix Notes CSEC 2010 Smith.pdf
http://roguemedic.com/2014/03/more-ems-agencies-eliminating-backboards/
http://www.naemsp.org/Documents/201...urning the Backboard [Compatibility Mode].pdf
http://regionstraumapro.com/post/2082983892
http://thesocialmedic.net/2015/03/nyc-remac-eliminating-backboards-from-spinal-immobilization/
https://www.ebmconsult.com/articles/the-use-of-backboards-for-spinal-immobilization
https://www.nasemso.org/Councils/MedicalDirectors/documents/SpinalImmobilization-GeorgeLindbeck.pdf
http://www.gatheringofeagles.us/ACEP2014/GilmoreWaysToProvideSpinalImmobilization.pdf

My OMD is really into graphs, tests, articles and statistics. If you guys have links please share. If the research was proven/written by an MD that will help my case even better!

How about this: Write a chart showing how many backboards prevented spinal injuries (the number will be 0). Show him a list of studies that show that backboards are clinically beneficial to patient care (the list will be empty). Is your OMD a supporter of evidence based medicine? Maybe he can show you how the application of a LSB is beneficial to the patient, according to EBM. if he can't (and he won't be able to), that should tell him something.

There is 0 evidence that backboards are good patient care, but many MDs won't remove them due to fear of litigation (they are waiting for someone bigger than them to do it first, than they more willing to take the chance), or until the "standards" that we have followed for decades change.

 

[Summit]

I learned the NEXUS criteria in 2004 in my initial WEMT certification (Desert Mountain Medicine / Colorado Mountain College).

Scoop >>> spine board
Full body vacuum splints >>>>>>>> spine boards

I used scoops at my first ambulance job in 2004
I've been using vacuum splints since 2003.

It blows my mind we are still having this conversation in EMS.

We are actually to only use the backboard as a means of transporting a patient to the gurney and then are to remove the backboard immediately.

Literally its designed purpose

 

[NPO]

We also only use backboards to move patients from one place to another. And infact, we have backboards that separate down the middle like a breakaway flat for easy removal.

There are numerous studies that show why we don't back board people. I'll give you the highlights:
- EMS is worse as splinting the spine than the patient
- backboarding cause more spinal manipulation than careful ambulation.
- backboards can cause pressure sores to start to develop in under an hour.
- backboards do not adequately immobilize the spine.

 

[DrParasite]

And infact, we have backboards that separate down the middle like a breakaway flat for easy removal.

also known as the scoop backboard

 

[NPO]

also known as the scoop backboard

That's the one.

 

[RocketMedic]

IMO, the only reason for a backboard is to be a gorked-up trauma spatula. Like a "we need a way to get this mangled person quickly to the hospital on without moving them much."

Putting 95% of the people we put on boards is unjustifiable, IMO.

 

[VFlutter]

IMO, the only reason for a backboard is to be a gorked-up trauma spatula. Like a "we need a way to get this mangled person quickly to the hospital on without moving them much."

Putting 95% of the people we put on boards is unjustifiable, IMO.

Backboards make loading people into single engine helicopters much smoother and easier.

 

[RocketMedic]

Backboards make loading people into single engine helicopters much smoother and easier.

That's pretty much the best reason for them

 

[Peak]

It blows my mind we are still having this conversation in EMS.

Exactly my thoughts. I remember when we were having the conversation about ambulating patients to the stretcher instead of placing them on a back board almost 10 years ago, but that was still only if we couldn't rule them out with the NEXUS criteria. Our standard was a collar, ambulate if possible, vacuum splint if not (though we did use scoops on the engine).

We used backboards for rescue and extrication and not really anything else. Even in my current agency we have one for state requirements but I have yet to see it ever used.

 

[MackTheKnife]

Here are somethings you can use to get you started as to where to look. pay special attention to the footnotes among the presentations

http://epmonthly.com/article/ditch-the-board/
http://www.1.wildernessdoc.com/assets/lectures/2010/Spine Appendix Notes CSEC 2010 Smith.pdf
http://roguemedic.com/2014/03/more-ems-agencies-eliminating-backboards/
http://www.naemsp.org/Documents/2015 Annual Meeting Handouts/MDC 2015 Handouts/Wednesday/1500Domeier Burning the Backboard [Compatibility Mode].pdf
http://regionstraumapro.com/post/2082983892
http://thesocialmedic.net/2015/03/nyc-remac-eliminating-backboards-from-spinal-immobilization/
https://www.ebmconsult.com/articles/the-use-of-backboards-for-spinal-immobilization
https://www.nasemso.org/Councils/MedicalDirectors/documents/SpinalImmobilization-GeorgeLindbeck.pdf
http://www.gatheringofeagles.us/ACEP2014/GilmoreWaysToProvideSpinalImmobilization.pdf


How about this: Write a chart showing how many backboards prevented spinal injuries (the number will be 0). Show him a list of studies that show that backboards are clinically beneficial to patient care (the list will be empty). Is your OMD a supporter of evidence based medicine? Maybe he can show you how the application of a LSB is beneficial to the patient, according to EBM. if he can't (and he won't be able to), that should tell him something.

There is 0 evidence that backboards are good patient care, but many MDs won't remove them due to fear of litigation (they are waiting for someone bigger than them to do it first, than they more willing to take the chance), or until the "standards" that we have followed for decades change.

If it was good enough for Johnny and Roy, then it's good enough for me! LOL!

 

[Tigger]

Of note, there isn't research suggesting that vacuum mattresses or any other device effectively splint the spine or prevent secondary injuries. The mattresses are at least comfortable.