RE: Rigid Spine Boards

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

Thanks Gregory,

My feelings exactly. We can run 8 hour fixed wing + 3 hour response to patient who usually has already been immobilised another hour, then destination delays of up to 2 hours make 15 or so hours for the poor guy. Currenttly use vacuum on top of rigid (for handling ease and stiffening) but looking at combi-carrier+vacmat combination. 

Still trying to find published research on backboard appropriateness (or lack thereof).

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.


--- "Gregory J. Rupert" <gregoryrupert@sprynet.com> wrote:
>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-----
>Wrom: XIMQZUIVOTQNQEMSFDULHPQQWOYIY
>[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.
>
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