Spinal Immobilization Techniques

[AnthonyM83]

Just wondering specifics of how other agencies do their spinal immobilization.

Do you actually use padding? Under knees? In between knees? Blanket over the board itself? On EVERYONE?

How do you immobilize head? Do you use head wedges? Cheese blocks. The styrofoam triangles and head pad? Rolled up blankets. Does it depend on patient?

Do you use backboards always? Or do you have the hard foam boards?

Spider straps? "Box Method"? Straps that click in like an X over chest? Binders? (Pre-ripped sheets that wrap around)

Do you ALWAYS immobilize cervical if immobilizing lower back? Vice-versa?

Do you use tape over the neck? Does it go straight across or angled up (perpendicular to the forehead tape).

Do you use the arm straps? What do you do for unconscious patient's extremeties. Leave one arm out for IV? All in and you unwrap later for IV access?

ETC ETC ETC

Give me specifics. Pictures if you can, of either someone immobilized (blur out face, etc) or of student immobilized, or of the equipment at least.

[Happiness]

Well I will try to do this

#1 We use the clam shell (scoop) for our spinals for many reasons and the one reason I like the most is that x-rays can be taken and the pt dosnt have to be disturbed also you dont need to roll the pt as far as you do with the board. We will use the back board when the pt needs to be extracated from a car and there the pt will stay.

#2 I will package the pt in the position of how I found him if he cant tolerate having legs being moved then I will use padding to help keep him in that position also if the neck cant be aligned without pain then there it stays. If his legs are straight there is a blanket that is place between his legs and they are then zap strapped into place. We use the headbed when nessary and then sandbags or towels are placed beside their head. The head is taped down last and I do the big X and to make it easier to do this well I place the O2 tank under the clam shell to creat a good sized space so the tape can be placed farther under for better stabbility.

#3 We will use spider strap on the board but when using the clam shell the straps on that are sufficiant.

#4 If I need to do a spinal the neck will also be embolized along with it. I generally dont tape down the neck as if I need to check a corroid pulse its hard to do and the clam shell realy dosnt have a place to do that easily.

#5 If I need to immobolize the arms I will tuck them under the straps or if on a board Triangular bandages are use to tie them together.

Heres a cute story about hard collars. A young man was in the hospital waiting to be medivaced for possible c spine fractures. I go in and he is laying on the bed coller undone and he is moving around (probably a good indication that all is ok)but me being me I said to him with his girlfriend sitting beside him "You know you might have a fractured neck and if you keep moving around, you may do more damage. If that happens then you could be in a wheel chair for the rest of your life. If that happens you may never have sex again as you know it SO you might want to stay still" The girlfriend stands up and looks him in the eye and yells "STAY STILL". And to think I always thought it was the man that was more worried about his penis.

[Chief1C]

Do you actually use padding? Under knees? In between knees? Blanket over the board itself? On EVERYONE?

Usually a thin blanket over the board, under their back; maybe a towel across and under the small of their back. If they're smaller or have specific injuries, we'd use either rolled or folded blankets to fill in voids between extremities, or straps and extremities. I also always put a towel under their ankles and tie the feet together with cravats or quikstraps.

How do you immobilize head? Do you use head wedges? Cheese blocks. The styrofoam triangles and head pad? Rolled up blankets. Does it depend on patient?

Ferno CID Pad/Block/Strap Sets or Laerdal Speedblocks, which work really well for pedi victims.

Do you use backboards always? Or do you have the hard foam boards?

Foam boards? We only have plastic spine boards.

Spider straps? "Box Method"? Straps that click in like an X over chest? Binders? (Pre-ripped sheets that wrap around)

Spider straps

Do you ALWAYS immobilize cervical if immobilizing lower back? Vice-versa?

If you're immobilizing the spine, what good does it do to only immobilize half of it?

Do you use the arm straps? What do you do for unconscious patient's extremeties. Leave one arm out for IV? All in and you unwrap later for IV access?

Our spider straps have wrist cuffs on the center strap.

[tniuqs]

'AnthonyM83' date='01 November 2009 - 08:17 AM' timestamp='1257085066' post='228188']

Just wondering specifics of how other agencies do their spinal immobilization.

Another great topic: and the controversy concerning LB spinal precautions and the huge cash invested for all types of gimmicks, I promise I will try to keep on topic

Do you actually use padding? Under knees? In between knees? Blanket over the board itself? On EVERYONE?

All of the above, I work for a number of services when faced with just a LSB absolutely a blanket or some form of firm padding on the board and not just justified by comfort alone but the reduction of noxious stimuli hence a decrease in stress ileus and also for flight prep, this results in reduction in amounts of sedation and analgesia required.

How do you immobilize head? Do you use head wedges? Cheese blocks. The styrofoam triangles and head pad? Rolled up blankets. Does it depend on patient?

If I have a KED or OSS thats my preference, previso time and acuity and Canadian C spinal criteria, I doubt that there are really any studies available, but body first head second.

Do you use backboards always? Or do you have the hard foam boards?

If I have a clam shell thats my preference, but whatever is available really, but I do bitch to services that have Wooden Boards from the Jurassic period, Happi and I are on the same page Scoop (clamshell its called in BC) then on a board for flight prep ALL secured as one, as turbulence sucks.

Spider straps? "Box Method"? Straps that click in like an X over chest? Binders? (Pre-ripped sheets that wrap around)

A crap shoot for me, properly applied all are effective although I hate the stupid Velcro strap ONLY type, the "spider type" Velcro is great stuff.

Do you ALWAYS immobilize cervical if immobilizing lower back? Vice-versa?

If you don't then don't bother at all, just have them walk to the truck, way easier on MY back that way <insert sarcasm>

Do you use tape over the neck? Does it go straight across or angled up (perpendicular to the forehead tape).

No opinion, except that I no longer tape over the Mandible closed after my training with the USA military application with the OSS, wasting time attempting to secure a movable joint AND trying to close an AIRWAY when a patient is on there backs.

Do you use the arm straps? What do you do for unconscious patient's extremeties. Leave one arm out for IV? All in and you unwrap later for IV access?

This is where the "spider type straps" IMHO are superior nothing like breaking an arm going through a doorway.

Pictures if you can, of either someone immobilized (blur out face, etc) or of student immobilized, or of the equipment at least.

PM me and I have a Training Power Point with Pictures and a comparison with SKED vs Spineboard and Stokes litter for Woodland Forest Fire Downed Aircraft Response and the manpower needed for each ... bit of a pet peeve of mine.

'Happiness'

Heres a cute story about hard collars. A young man was in the hospital waiting to be medivaced for possible c spine fractures. I go in and he is laying on the bed coller undone and he is moving around (probably a good indication that all is ok)but me being me I said to him with his girlfriend sitting beside him "You know you might have a fractured neck and if you keep moving around, you may do more damage. If that happens then you could be in a wheel chair for the rest of your life. If that happens you may never have sex again as you know it SO you might want to stay still" The girlfriend stands up and looks him in the eye and yells "STAY STILL". And to think I always thought it was the man that was more worried about his penis.

OH sure as if you would not do the same thing, if it were your main squeeze ....

Edited November 1, 2009 by tniuqs

[Quakefire]

Do you actually use padding? Under knees? In between knees? Blanket over the board itself? On EVERYONE?

Not normally, but occasionally a flannel on the board, especially for MVA's or anything outside in the rain, keep a flannel under the head of the stretcher and throw it on right before the patient, so he doesn't get more wet

How do you immobilize head? Do you use head wedges? Cheese blocks. The styrofoam triangles and head pad? Rolled up blankets. Does it depend on patient?

Our service uses the orange ferno blocks and straps usually but we carry headrolls too

Do you use backboards always? Or do you have the hard foam boards?

Our protocols only allow spinal immobilization on a LSB or KED, we also carry wooden short spinebords for some reason, no one uses them. Our scoops are the old metal kind and therefore not suitable for spinal immobilization.

Spider straps? "Box Method"? Straps that click in like an X over chest? Binders? (Pre-ripped sheets that wrap around)

We strap with an X over the chest and one across the pelvis, sometimes a 4th strap for the legs depending on the patient, but there are some services that have nice vacuum backboards and other goodies

Do you ALWAYS immobilize cervical if immobilizing lower back? Vice-versa?

Depends on MOI, chances are yes unless we are moving them from hospital to hospital

Do you use tape over the neck? Does it go straight across or angled up (perpendicular to the forehead tape).

We use the velcro straps, angled as much as possible on the chin of the collar and across the forehead, same with head rolls just with cloth tape

Do you use the arm straps? What do you do for unconscious patient's extremeties. Leave one arm out for IV? All in and you unwrap later for IV access?

I avoid strapping a patients arms in, even though I have no IV access I need an arm for BP's and such. for an unconscious patient I take a triangular bandage and tie it in a loop, put their hands across their chest and loop it around their elbows, easy to get arms out and holds them in place nicely

[rock_shoes]

How about vacuum matresses? Does anyone here on the city deploy these devices? I'm very interested to learn more about these devices and what type of results those using them have had. My typical spinal precautions are very similair to happiness' as we both work in BC.

[scubanurse]

Do you actually use padding? Under knees? In between knees? Blanket over the board itself? On EVERYONE?

YES. If you have ever been on a backboard and not had padding you will always do this for your patients. Depending on the size I will place a small towel behind the knees, sometimes between the legs for patients with wide-set hips, and also if necessary and won't compromise immobilization, in the small of the back.

How do you immobilize head? Do you use head wedges? Cheese blocks. The styrofoam triangles and head pad? Rolled up blankets. Does it depend on patient?

We used the yellow head blocks for most adult patients. For peds, you have to adapt to the situation and size of the patient.

Do you use backboards always? Or do you have the hard foam boards?

We had only recently received the dual purpose scoop stretchers so I have never used them as a backboard, only for a hip or lower extremity injury. We used the plastic x-ray translucent backboards

Spider straps? "Box Method"? Straps that click in like an X over chest? Binders? (Pre-ripped sheets that wrap around)

Our county uses spider straps. If applied and trained on correctly, I find them easier. They should be applied so the first two straps create a harness affect on the patient and placed through the same hole on the backboard if possible and right up under the armpit.

Do you ALWAYS immobilize cervical if immobilizing lower back? Vice-versa?

Yes. In EMT-B we played around with this. If you immobilize the head first and the patient needs to be rolled to vomit, it is extremely difficult to hold the body in neutral alignment to prevent further injury. When the body is immobilized first, it is much easier to maintain that alignment as you can just roll as if they aren't on the backboard yet. If you need to immobilize the cervical vertebra, you need to do the thoracic and lumbar as well. So if you are going to immobilize one and not the other what is the point? If you have lower back injury the degree of suspicion goes up for other cord involvement in my mind. Why go half way??

Do you use tape over the neck? Does it go straight across or angled up (perpendicular to the forehead tape).

I was taught to use tape. I would attempt to do it in one continuous loop making an X on the sides of the head. So I would start high at the forehead then go low over the chin, then high then low. All the while attempting to overlap my tape so it was always in contact with the board as well as the other tape. This way if one strip would fail because it got wet, hopefully the others would hold well enough.

Do you use the arm straps? What do you do for unconscious patient's extremeties. Leave one arm out for IV? All in and you unwrap later for IV access?

Most of our spider straps had a strap for the hands to go into. Or use a triangular bandage and a makeshift handcuff technique (hard to explain). For an IV, we would usually take the arm out of strap it into the spider straps in a way that you have access to the AC.

Hope this helps.

Edited November 2, 2009 by scoobykate

[mobey]

I have used a vac board and lovedit. The pt never did complain about pain either (even on them busted ass Sask roads).. But, VERY constricting. Claustrophobic pts would hate it.

I use the standard LSB with 4 buckle type straps making 2 big X's. I do use the scoop when I can though... although it is pretty easy to not assess the back when doing so.

Hey tie 2 ends of a triangular together and slide it over the arms of an uncx pt.... as long as you put it higher than the elbows it keeps them from snapping off on a doorframe.

[tniuqs]

How about vacuum matresses? Does anyone here on the city deploy these devices? I'm very interested to learn more about these devices and what type of results those using them have had. My typical spinal precautions are very similair to happiness' as we both work in BC.

There was another thread on that way back, I was corrected with the cost they are way less expensive that I was initially informed I had one for medivac for one deployment, never used it for real although trained all my staff to use it and they do rock, no pun intended. The only problem in an austere setting very prone to getting holes on volcanic rock, put it in a SKED and that would be the best of all worlds IMHO especially when an MVC is 50 meters down an embankment.

I have pictures but for the life of me I cannot upload file size way too big.

cheers

Edited November 2, 2009 by tniuqs

[AnthonyM83]

Good replies. Keep them coming. As for not always immobilizing cervical and lower back together, there's a lot of duh type replies but i'm asking for a reason. This is often done in hospitals here even before xrays and haven't read text saying there's always correlation. A localized force to lumbar might not cause significant suspicion for cervical damage. To be clear i do full immobilization everytime but just presenting the thought. . . . . . . . . . . ps typing from a cellphone so sorry for the formatting . . . . . . . . .