We all learned from early in our careers to immobilize trauma patients on long backboards. Whether it was in our first EMT class or some other type of ems training, we were taught that trauma patients were secured on backboards with spider straps and c-collars, no questions, right? Things have changed over the years with the introduction of criteria for clearing C-spines in the field to the point of that the National Association of EMS Physicians, in 2012, proposed a draft position statement that reads as follows:
The National Association of EMS Physicians Believes That:
- There is no evidence that the use of backboards reduces spinal injury or effectively provides anatomically appropriate spinal immobilization or protection.
- There is evidence that backboards result in harm by causing pain, changing the normal anatomic lordosis of the spine, inducing patient agitation, causing pressure ulcers, and compromising respiratory function.
- The only practical value of backboards is for extrication to a transport vehicle. Once extricated, patients should be taken off the backboard.
- Backboards should not be used for spinal immobilization. Placing ambulatory patients on backboards is unacceptable.
- In general, patients should not be transported or otherwise kept on backboards for any length of time.
What does this mean for us in the transport world? Backboards should be used for extrication and initial movement, but other methods of immobilization should be used for transport. In Alaska this is especially important considering the lack of roads and long periods of time from injury to arrival at definitive care. Because of Alaska’s notorious weather and the remoteness of where we live, work and play, it can be many hours or even days before a patient arrives at a hospital for complete evaluation and diagnosis.
You may already work for a ground or air ambulance service that limits the use of backboards. Patients placed in a C-collar and secured on an ambulance gurney, flight stretcher or preferably on a vacuum mattress are all acceptable methods of immobilization for transport. We still need to immobilize and secure patients with potential spinal injuries, but we must employ modes that cause no further harm. Even for short transports, if a backboard must be used, it can be beneficial to add padding and support prior to packaging. There are several low cost commercial devices available that help fill the voids between the spine and the board. These add support and reduce pressure points during transport. Even an hour on a board can cause skin break down which can be an access point for infection.
When you are working with patients who need spinal immobilization, think about the ramifications and employ the best method to safely secure the patient. That may not include the use of a backboard.