Back boarding question

[fakingpatience]

This was not my call, but I was in the ER, and helped the crew who took it, so I don't know all the details.

The crew was called to our local hospital to take a patient to the large trauma center in the city. Pt had fallen from a tree yesterday, but decided not to get seen at the ER, as she had cut up her face pretty badly, and was unable to see well enough to drive herself. Came in today w/ complaints of facial trauma (had one lac on forehead down to bone, and other swelling), and back pain. Our local hospital doesn't have CT or MRI, but they did an x-ray of pt's spine, and found a couple fractured vertebrae (I don't remember which, sorry!) Pt was sitting up in hospital bed with a C-Collar on. The hospital stated that the patient had to be put onto a backboard prior to transport to the trauma center.

Here is where I am confused. If the pt injured herself yesterday, and was already up and walking around, even though we now know she does have fractured vertebrae, can't we assume at this point that the fractures are stable? I was under the impression that if a patient was walking around for that amount of time, they had essentially 'cleared' their own c-spine of an unstable fracture, and therefore, even if they had a fracture, it would make no difference being back boarded or not, but the back board would cause additional pain. The crew who took this call didn't question why she needed to be boarded, so I couldn't find out the official answer. I asked them if, they had received this call today to the patients house, of a patient who fell yesterday, and was complaining of back pain, would they back board, and they all agreed no.

What is the benefit of back boarding this patient solely for transport?

[HERBIE1]

This was not my call, but I was in the ER, and helped the crew who took it, so I don't know all the details.

The crew was called to our local hospital to take a patient to the large trauma center in the city. Pt had fallen from a tree yesterday, but decided not to get seen at the ER, as she had cut up her face pretty badly, and was unable to see well enough to drive herself. Came in today w/ complaints of facial trauma (had one lac on forehead down to bone, and other swelling), and back pain. Our local hospital doesn't have CT or MRI, but they did an x-ray of pt's spine, and found a couple fractured vertebrae (I don't remember which, sorry!) Pt was sitting up in hospital bed with a C-Collar on. The hospital stated that the patient had to be put onto a backboard prior to transport to the trauma center.

Here is where I am confused. If the pt injured herself yesterday, and was already up and walking around, even though we now know she does have fractured vertebrae, can't we assume at this point that the fractures are stable? I was under the impression that if a patient was walking around for that amount of time, they had essentially 'cleared' their own c-spine of an unstable fracture, and therefore, even if they had a fracture, it would make no difference being back boarded or not, but the back board would cause additional pain. The crew who took this call didn't question why she needed to be boarded, so I couldn't find out the official answer. I asked them if, they had received this call today to the patients house, of a patient who fell yesterday, and was complaining of back pain, would they back board, and they all agreed no.

What is the benefit of back boarding this patient solely for transport?

Depends on WHERE those fractures are. Could be a sublexation, could be a spinous process that was chipped off- hard to say without knowing the details of the injury. A wrong turn of the head could damage or even sever the spinal cord. It has happened. Sitting on an immobile ER bed is also not the same as transporting in a bumpy ambulance where a sudden jolt, turn, or movement could be bad news.

[Chief1C]

Better safe than sorry, suppose the ambulance wrecks? What if it to death, but there will be a lot of moving around at the TC. She would benefit from being immobilized. Keep someone from having her move just right, so that some stray bone fragment tears into an important structure. Though, I'm guilty of this myself, as a patient. Struck downward, w/ LOC, walked into the ER w/ head, neck, and T-spine tenderness; and asked why immobilize me now, wouldn't I know if something was wrong? Response from a good friend and well respected TC physician. A loud, harsh... NO!

[Richard B the EMT]

There is the undocumented anecdotal story of the Football player got tackled hard, shook it off, and seemed OK. On the sidelines, he tilted his head back to drink some gaterade, and the head tilt completed a transecction of his spinal cord.

Now, from training: better to overtreat and not need, than to undertreat what was needed.

[Lone Star]

When I had my motorcycle wreck last November, I tried to tell the ER staff that I thought my wrist was broken. They assured me that everything was 'just fine' even though there was heavy edema and obvious deformation of the wrist.

I'm pretty sure I was being dismissed as not knowing what I was talking about, but when I returned to the same ER a few hours later, it was confirmed that the wrist was broken. There's this misguided notion that "if I can move it, it must not be broken". That isn't always the case.

Just because the patient was up and walking around is not a guarantee that there were no spinal fractures, and once those 'unknown fractures' were revealed by x-ray; the only acceptable treatment at that point was to immobilize prior to transport. It's no different than the splinting of my wrist once it was acually confirmed that it was broken.

In addition to Richard's story about the football player, there's also the undocumented anecdotal story of the MVC patient who is up and walking around the crash scene, when someone calls their name. The patient turns their head to see who is calling them and instantly becomes an instant quadriplegic.

As Richard also stated, it's better to overtreat than undertreat.

[ERDoc]

Longboards are used to keep the pt immobile for transport. As was discussed in another thread on immobilization, there is no evidence that a c-collar or longboard do anything. Can turning the head or twisting the back provide enough force to injure the spinal cord? I doubt it, but don't have any studies to back it up. As Richard has brought up, we've all heard that story of someone who turned and paralyzed themselves, but can anyone provide proof of this story? We've all seen pts who were injured one day and didn't receive any care for a few days and did not end up paralyzed.

[zippyRN]

the long board is the wrong device for this scenario - vacuum mattress please TYVM...

[PCP]

the long board is the wrong device for this scenario - vacuum mattress please TYVM...

What is a vacuum mattress?

In this scenario we would be using the clamshell for sure for the transport as stated it helps stabalize the pt and helps keeping the pt from turning their head and possibly becoming paralyized. If I was called to the pt. house and she was complaining of back pain along with the fall she would be getting the full package deal no doubt about it

I enjoy having my license and I inted on keeping it!

[Chief1C]

It's a vinyl frame, full of round pellets. You suck the air out, and it fully conforms to the shape of the patient. A novel idea, we purchased a BoundTree "Vacuum Spine Board" w/ an extra scoop for Wilderness extrication. Used it in training, the only problem is it sticks to the patient if it's warm out. So placing a sheet over it is good practice. It's easier, we found, to scoop the patient onto the mattress, rather than trying to log roll them onto it.

[PCP]

It's a vinyl frame, full of round pellets. You suck the air out, and it fully conforms to the shape of the patient. A novel idea, we purchased a BoundTree "Vacuum Spine Board" w/ an extra scoop for Wilderness extrication. Used it in training, the only problem is it sticks to the patient if it's warm out. So placing a sheet over it is good practice. It's easier, we found, to scoop the patient onto the mattress, rather than trying to log roll them onto it.

That is AWESOME I have never seen or heard of one of these being used in Canada. Hmmm learn somethig new every day