Rigid Spine Boards

[Ken Lawson-Williams <Macgyver@FlightMedicMail.com>]

Dear list,

A thought to consider. Recent discussions on another list (in the UK) have been very firm against the use of traditional spineboards and log-rolling as opposed to scooping onto a vacuum mattress. Long boards only used as an extrication tool. 

Many of the comments, a good number from ER docs, relate to there being no proof of safety in the proceedures we use in North America. And highlite the tissue necrosis that can occur, not to mention the effect on semi-conscious patients who then struggle a LOT against the straps in an atttempt to relieve the pain of the pressure points and straps during the 2+ hours from board application to removal in the hospital.

One of the studies quoted was: Am J Emerg Med 1996 Jul;14(4):369-72; "Comparison of a vacuum splint device to a rigid backboard for spinal immobilization." Johnson DR, Hauswald M, Stockhoff C.;New Mexico EMS Academy, University of New Mexico School of Medicine, Albuquerque 87106, USA.

In this study, comparison of a vacuum splint device to a rigid backboard
was made with respect to comfort, speed of application, and degree of
immobilization. The vacuum splint was judged to be significantly more comfortable on a 10-point scale than the rigid backboard after subjects had been lying on each device for 30 minutes (P < .001). It was also faster to apply: 131.6 +/- 24.3 seconds versus 154.6 +/- 22.2 seconds (P < .001). Various measures of immobilization were similar for the two devices. The vacuum splint provided better Immobilization of the torso and less slippage on a gradual lateral tilt. The rigid backboard with head blocks was slightly better at immobilizing the head. 

So my questions are, what does everyone do? Especially those with extended transport (ground or air) times? Is there in fact research that shows what we do is safe and does not move the spine? And that placement on a board does not cause motion of unstable fragments from their 'position found' in such a way as to cause damage? Can vomiting be well managed with a non-intubated somewhat obtunded (ETOH etc) patient with the typical suction and board roll to the side without spine movement? How much movement (and in what planes and at what level) is too much? Is the only reason we (generally) tend to use the rigid/unpadded backboard over here one of the economics of equipment supply? and, should we be critically analysing our practice in this area and changing it based on the results?
 
Fly Safe. 
Ken L-W GN/CCEMT-P/WMT

Duct tape is like the force, it has a light side and a dark side, and it holds the universe together.

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