RE: Rigid Spine Boards

["Gregory J. Rupert" <gregoryrupert@sprynet.com>]

Hi Ken and All:

About two years ago the US Air Force had looked into a spinal immobilization
system called a SKITS (utilised a vacume mattress) that was being developed
by Air Methods. The Air Force needed a replacement for it's aging spinal
immobilization and traction unit it used for transport. I got to fly and
play with the system. In speaking with people that actually were secured in
the device they had remarked on the comfort. As for immobilzation the unit
had some problems specially when rotating the patient. The unit was a
seperate spine bed on a frame that allowed you to turn the patient.

I have done long tranpsorts in the civilian sector as a flightnurse in
Alaska. Some transports were as much as two to three hours in the air (fixed
wing) combine that with ER time makes for a long time for the patient on the
backboard. I have in recent years after seeing some reseach done at WHMC
here in SA on with a vacume mattress, felt that when combined with some sort
of ridged support would be far superior for the patient.

Gregory J. Rupert, Capt USAF, NC, CFRN
San Antonio TX

-----Original Message-----
From: flightmed-admin@flightweb.com
[mailto:flightmed-admin@flightweb.com]On Behalf Of Ken Lawson-Williams
Sent: Saturday, January 04, 2003 10:29 PM
To: flightweb editor
Subject: Rigid Spine Boards


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.

_______________________________________________
Flightmed mailing list
To unsubscribe or change your email address, go to
http://www.pairlist.net/mailman/listinfo/flightmed


_______________________________________________
Flightmed mailing list
To unsubscribe or change your email address, go to http://www.pairlist.net/mailman/listinfo/flightmed