If, in moving through your life, you find yourself lost...go back to the last place where you knew who you were, and what you were doing, and start from there. Bernice Johnson Reagon.

01 February 2012

We Don't Get Extra Points For Doing Things The Hard Way....

Oh, what a tangled mess
I don't like doing extra work. I don't mind doing what it takes to get the job done, but adding a bunch of extra steps because, well, everyone else does it that way, to me, is rather stupid. So,I am always looking at the things I do in the course of my job to see if I can make it easier, faster, and/ or safer.

So in the course of the past few years, I was constantly frustrated with the way that me and my co-workers used our long backboards and straps. It just seemed that every time I had to put a patient on a backboard, it was really frustrating the way that the straps became tangled and stuck. Add to that the times that the straps either didn't line up or the buckles were not compatible, on top of the strap buckles getting stuck under the patient and/or the backboard, well, it made me want to cuss more than a few times.

The picture at the right shows how we store our backboards in the compartment on the ambulances. Some of our fire trucks around these parts also carry long backboards, as well, and they typically have the straps affixed in the same way. Sometimes the straps are 'tucked-in' to look a little better, but most of the time, when you take a backboard out of the compartment, what you see to the right is what you get.

To clarify, we use the long backboards with pins in them. The straps that we use are the plastic, disposable kind that have plastic buckles and hooks.

The problems I have experienced with the straps stored in this matter are that the straps have to be unfastened before the patient can be transferred to the long backboard. And this often means having to untangle them. Before the patient is placed onto the board, generally the straps have to be 'spread out.And then, as the patient is positioned onto the board, the straps find their way under the board or under the patient or both. This causes problems sometimes trying to sort them out, especially when the patient is, shall we say, a little overweight. The pictures below highlight some of that.

When you first get the board to the patient's side you have to unbuckle and untangle the straps.
The straps then have to be spread out in the hopes of getting them in position to move the patient onto the board. And the 'spread out' straps are easy to get where they don't need to be- under board, under patient, and under foot.

Note how two of the straps are under the board and patient. Doesn't happen all of the time, but more often than not.

And one strap is all the way under the patient to the other side, which requires lifting the board and patient... good thing she does not weigh 375 lbs.!

So I started looking at a way to do things better, easier, and quicker. And this is what I came up with.I've used this method on many occasions and it works really well. If I could only get my co-workers to give it a try. So here it is.


 The picture above shows how the board looks when you take it out of the compartment. Everything is neat with no tangled mass of straps. The pictures below show how to set it up.

To start, take the two long (female) ends of two straps, and attach them to the uppermost pins on each side. These straps should be positioned to crisscross over the shoulders to help prevent the patient from sliding forward.

Moving towards the foot of the board, skip the next pin, and attach the two short (male) ends on each side as shown.

Connect the buckles, snug them down, and then thread the running ends through the upper opening (the same ones that the long ends are attached at), as shown. 

Now, take one strap, seperate the ends, and attach them as shown at the same pin that the other two short ends are attached to. In this case, a short end goes on one side and the long end goes on the other.

Now, moving towards the  foot end again, skip over the next pin, and then on the next ones, attach the short and long ends again, however they will be opposite of the upper strap. That is. as you are looking at the board, there should be a long and short end on the same side on each side. This allows for the top two straps to be crisscrossed, while the waist and lower leg straps go straight across.

With the straps set up in this manner, the board, with the straps still in the 'stowed' position, can be positioned at the patient, either beside the patient as shown, or at the head or feet of the patient. This way there is no tangling or bad placement of the straps.

As the patient is positioned onto the board, the straps are still in the stowed position, and they still are not tangled or in a position to get under the patient or board.


Now, with the patient on the board, unbuckle the straps. If any part of the straps are under the board (remember those running ends?), it can easily be pulled out since all of the buckles are on top of the board.

Towards the foot end of the board, those buckles two are above the board, and the running ends are easily accessed for adjustment.

Not the easy access to the buckles.

Everything is ready to go to get the patient secured and ready to go.

The straps are easily placed and adjusted...

And now the patient is ready to go... The patient is secured in a rapid, organized manner, and your protocol directed "10 minute scene time" is preserved...

So that's it. An easier (and quicker) way to attach the straps to the backboard. It takes no longer than the crisscross method used by everyone now, but it avoids some of the pitfalls I see time and time again. If you want more pictures, or have questions, let me know at 9echo1mailbag@gmail.com.

I want to thank the folks at Raleigh Fire Department (RFD) E8, RFD Captain Brian Sherrill, and RFD Fire Academy Recruit Class #35, Wake County EMS4/A, and Mrs. 9-ECHO-1 for their help in getting the pictures done.

And finally, if you're an FTEP candidate and you're riding with me as your FTO, this is required knowledge. Good, maybe, for a '5' rating...

Ya'll be safe!


17A1 said...

For a system using the quick-clip type straps, why not keep them packaged until use? When you are going to use them, clip them to the board and attach them as you normally would. I think this prevents a lot of tangles; however, means the system needs to buy new straps frequently. From looking at how the boards are "decon-ed" at hospitals, this wouldn't be a bad thing for patients.

What do you think about spider straps (when properly stored)?

9-ECHO-1 said...

I like the spider straps, properly stored and properly designed. There are a few different designs, and some of them, while lokking cool, well, in practice aren't that great. But the vast majority of my brethren around these parts dont' like the spider strpas, I believe, becasue of the added effort to store them properly. As to attaching the straps when ready to use, I would prefer this. But, there comes a couple of issues. First, our straps come in packages of three. Why I don't know, other than they are sold that way. Second that leads to storage issues. I would prefer a bag with a collar, a CID set-up (I prefer blanket rolls to any commercial CID out there), and a set of five straps, along with a couple of towels for padding and such. But, I am sort of out voted around here, since we strive for uniformity and standardization, which sort of stifles creativity, but I digress.

BH said...

Agree with 17A1. I always though the entire point of quick-clips was to "quickly" attach to the board once the patient is on it. I've never had a board job go well when the straps are already attached. patient always gets poked by buckles, straps under the board, etc just like you alluded to.

Incidentally, I've also noticed that using the X configuration with quick-clips allows for much more lateral movement by the patient than I'd like- for some reason, only 9-footers seem secure to me when strapping that way. Maybe I'm doing it wrong...?

9-ECHO-1 said...

I totally agree with quick clips being carried separately, and then attached when you need them. But, our straps come in packs of three, and you either wind up using four or five. To me, the ideal solution would be a bag with a c-collar (we use an adjustable one), four or five straps, a roll of 2" tape, and a couple of towel/blanket rolls (personally, I have not found a single commercially available, disposable CID, that works anything like a couple of blanket rolls).

And yes, the x-configuration dows allow for lateral movement- a fifth strap alleviates that. The primary purpose, in my mind, is that the x-configuration, when properly applied over the shoulders, prevents forward motion during transport. I had the terrible misfortune to have a patient slide forward, off the board and into the "captain's chair", during an emergency stop. We were using a spider strap that did not have a v-shaped shoulder strap. I have seen just about the same thing happen with just lateral straps.