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.

18 November 2012

Isn't it about time we look at alternatives to long spine board torture? (UPDATED 11/20/2012)

UPDATE 11/20/2012: Justin Schorr from The Happy Medic has recommended an article on EMS World on this same topic. Please go here and read it.

Over at Rogue Medic, he has posted another entry about spinal immobilization. You can go here to read about it, but he reports that there are several agencies that are doing away with or limiting the use of long spine boards.

Thank. You.

I think it is high time that this idea of putting a curved body on a straight and flat board is done away with. There are other options that need to be investigated and tried.

I think about a recent incident that a patient who was up and walking around earlier, after an incident, and in fact drove himself home and then called 9-1-1, and upon our arrival was placed on a board (I was an observer), even though he met all criteria in any clearance protocol. During the ride to the hospital on the smooth riding ambulance (note sarcasm) I had the opportunity to watch the patient wince up every time the ambulance it a bump, and I watched him rock from side to side as we traveled down the road. I focused on a specific point on his right flank and observed what looked like at least four inches of travel up and down as he rocked from side to side.

So what was accomplished? His movement was not restricted. His comfort was severely compromised. And I would venture that his spine, if it was not injured before the ride, probably did not feel too good afterwards.
And the board was placed upon a stretcher with the bolstered mattress...

I think it would have been more appropriate, if spinal injuries were really potentially present, to have placed the patient directly on the stretcher, maybe a c-collar in place, with a set of towel/blanket rolls to help stabilize the head.

But back to the LSB, I think that the design of many of them compounds the discomfort. Looking at several at a local trauma center recently, many of them are truly flat, and some even arch in the middle. A few are contoured, somewhat, but even they are uncomfortable more than, say, 90 seconds.

Is there any scientific proof that placing people with curves on flat boards, ineffectively strapped to that board, with poorly performing commercial CIDs?

If we are going to continue this barbaric practice, we need to include certain caveats-

1. Padding has to be placed at different places, particular in the voids that exist between the shoulders, the small of the back, and behind the knees. Additionally, we need to place some sort of padding under the head.

2. If we are going to use a cervical immobilization device (CID), it has to perform better than the average disposable commercial device, cannot easily move, and must take into consideration the dynamic and non-stable environment of the back of the average American ambulance.

3. We have to realize that the strapping methods we currently use (clip straps, tied straps, and spider straps) do not restrict movement from side to side unless we utilize some sort of padding (rolled blankets or towels) to fill in the voids between the patient’s body and the straps.

I tried it once and the only way I could place a patient on a spine board, reasonably comfortable, and restrict all motion from side-to-side and end-to-end required four or five straps (with eight or ten contact points on the board), a folded towel under the head, a folded blanket in the small of the back and another under the shoulders, a rolled towel under the knees, and four blankets rolled up and placed on the sides, pus the rolled up blankets for head rolls. Seven blankets (plus the two needed to keep the patient warm) and two towels.

Admittedly I don’t do that for every patient I put on a long spine board, mainly because I usually don’t have that many blankets on an ambulance on any given day (and if I put them on the ambulance co-workers in times past usually take them off or use them without replacing them and a lot of hospital EDs like to hide their blankets).

But then, the question remains- Is there any benefit to placing a patient on a long spine board?

And another question that I have to ask- If we are unwilling to do away with the practice of torturing immobilizing patients on long spine boards, are there better alternatives than a long flat board and poorly performing CIDs?

1 comment:

Christopher said...

A scoop stretcher with a blanket is not horrible. Granted, you're trading spinal pain for pressure on your flanks.

It never made sense to me that the LSB would somehow help since it is exerting upwards pressure along the vertebrae at every contact point. If we wanted to limit movement of the vertebrae ("EVEN A TINY BUMP WILL RENDER THEM PARALYZED") we shouldn't be putting any pressure on them.

In wilderness settings we're taught to use a big fleece parka as a CID, and it is far more comfortable (and limiting) than a commercial CID. Perhaps one of those travel pillows you buy will be the next EMS C-collar?