Re: Rigid Spine Boards

["Jim Kendrick" <jim.kendrick@worldnet.att.net>]

This is an area that needs to looked at here in the US . I remember that
there was some data up on flight web a few years ago about a period of an
hour or two tissue breakdown begins.

Jim Kendrick

----- Original Message -----
From: "Ken Lawson-Williams" <Macgyver@FlightMedicMail.com>
To: <flightmed@flightweb.com>
Sent: Sunday, January 05, 2003 4:14 PM
Subject: RE: Rigid Spine Boards


> 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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> >
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