Back boarding question

[fiznat]

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.

Well they were all wrong. There is no criteria in any accepted c-spine clearance protocol that considers how long a person has been walking around. It doesn't matter if the injury was yesterday, we should be backboarding these patients in the field.

If a physician tells you he took an x-ray of the spine and is recommending that the patient be secured to a long board for transport, just do it. I don't see what the issue is here.

[HERBIE1]

Well they were all wrong. There is no criteria in any accepted c-spine clearance protocol that considers how long a person has been walking around. It doesn't matter if the injury was yesterday, we should be backboarding these patients in the field.

If a physician tells you he took an x-ray of the spine and is recommending that the patient be secured to a long board for transport, just do it. I don't see what the issue is here.

I think you are misunderstanding the original question. To me, the OP was about WHY it would be necessary to fully immobilize a person who has already been walking around with their injury for an entire day. Does it look awkward seeing someone sitting in a bed with a c-collar on- sure.

Maybe I'm wrong, but I don't think the person had any intention of refusing such a request.

[Doczilla]

We have been teaching EMTs for years that backboarding a) immobilizes the spine, and is harmless to the patient. Neither is true.

Every EMT instructor seems to know of someone who knew someone who treated someone with an unrecognized spinal injury who was neurologically intact and then turned one way and paralyzed themselves because they weren't immobilized. It has never been reported in the medical literature.

I usually have to give explicit instructions regarding not immobilizing transfers from other facilities on a LBB. C-Collar and laying them flat will do just fine.

'zilla

Edited November 28, 2010 by Doczilla

[Chief1C]

I suppose, depending on how long they're on the board, if you totally over analyze it.. Immobilizing them could be fatal. Elderly patient, maybe a little diabetes. Gets a pressure sore, gets infected, sepsis sets in, they die. I used the Back Raft, I'm on the fence. It could lead to hypothermia, it doesn't stay inflated when it's cold, it stays cold for a good while, leaves an adhesive mess on the board, which is a b*tch to remove. Anyhoo.. Lortab. Tired, when I get very tired, I over think things.

[DwayneEMTP]

LBB seems to be in the same category as resps during CPR. Lots of evidence that we're hurting people with them, but very little to show that we're helping anyone with it.

In this scenario I would likely follow Dr.s orders unless there was an obvious reason to question them. And then I would quarter a blanket before putting them on it. Lots of variables that haven't been discussed, but in this scenario, either for the transfer or at their home, from a science based medicine point of view, spinal precautions would be 'cover your ass' only with no provable benefit to the pt and some possible detriment.

Dwayne

[Richard B the EMT]

If a physician tells you he took an x-ray of the spine and is recommending that the patient be secured to a long board for transport, just do it. I don't see what the issue is here.

OK, that becomes the orders from a higher medical authority. As noted, just do it.

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?

I never figured out how to use "Snopes" to get either verification or denial. Somebody with that knowledge...? Please?

[HellsBells]

Better safe than sorry, suppose the ambulance wrecks?

Really? Really? This is your response? By that logic we should transport every pt on a longboard, just in case there is a crash.

[fakingpatience]

I think you are misunderstanding the original question. To me, the OP was about WHY it would be necessary to fully immobilize a person who has already been walking around with their injury for an entire day. Does it look awkward seeing someone sitting in a bed with a c-collar on- sure.

Maybe I'm wrong, but I don't think the person had any intention of refusing such a request.

Thank you Herbie, you are absolutely correct; I was not questioning the doctors call, I am merely asking questions about it, to help me learn. I don't think anyone would go against what a doctor says to do unless you have an absolute argument why it would be detrimental to your patient.

Here is my thoughts on boarding a patient who has already been up and moving around for a significant amount of time (not relating to the example from the original call). How would sitting still on a cot in the ambulance cause the patient to move in any direction they had not already? Instead the backboard is going to cause increased pain, and if you don't pad properly (and I don't know many people who do) could cause more movement of the back when you bump up and down.

I am lucky with my company now, where we have liberal back boarding protocols. We don't need to board every fall (from standing) w/ possible head injury/ ETOH/ drugs on board, only if they have a specific complaint of neck/ back pain.

Dwayne, I have seen you mention putting a folded blanket on the backboard before boarding your patient before. I was going to try this on my call, but my partner disagreed, saying that the blanket would cause the patient to slide around to much on the backboard. What has been your experience with this?

4c6: I used to have vacuum splint at my old agency, and I loved them for splinting extremities. I have never seen a full body vacuum splint though! It makes since that it would work better (it does the padding for you), and I would assume it would be more comfortable for the patient... through it doesn't take much to be more comfortable then a LBB

[Chief1C]

Really? Really? This is your response? By that logic we should transport every pt on a longboard, just in case there is a crash.

I believe it was clear than I was sarcastically playing on the "what if" it to death scenario. I stated my view. Probably all of us have had someone with a painless spinal fracture. Especially with the frail elderly and nursing homes.

[zippyRN]

Well they were all wrong. There is no criteria in any accepted c-spine clearance protocol that considers how long a person has been walking around. It doesn't matter if the injury was yesterday, we should be backboarding these patients in the field.

if you cannot apply the criteria for selective immobilisation then appropriate immobilisation is indicated , and as fiznat points out no 'clinical clearance' or selective immobilisation guideline includes time since the incident as a factor.

If a physician tells you he took an x-ray of the spine and is recommending that the patient be secured to a long board for transport, just do it. I don't see what the issue is here.

the initial issue is a red herring - if the providers at that ED can't or won't clear the neck then the patient should be immobilised for transfer to a facility that can provide the further care.

the question actually is

what (if any ) method (s) of immobilisation are best for the patient on this transfer , especially if it;s a transport of several hours duration.

my own opinion is that neither the long(extrication)board or the scoop stretcher are appropriate for the job and that they pose as many problems as they solve in a secondary transfer scenario.

the gold standard would be to scoop onto a vac mattress and transport that way ideally with a proper C-spine immobilisation collar (i.e. an Aspen or Vista) rather than an extrication collar, there is a school of thought that well strapped onto a stretcher with collar and head blocks is adequate, the principle problem there is 2-fold - its a 4 or 5 person roll if they vomit rather than one or 2 for someone well secured to a long extrication board or in/ on a vac mattress and the issues related to crash suvivability in a vehicle without a CEN compliant trolley and locking system and extra straps to replicate the strapping on a long extrication board ...

The consensus opinion given in the likes of JRCALC on how long someone should be on a long extrication board is less than 30 minutes, although the practicalities of transporting to the initial recieving facility may make that hard to achieve, I certainly would not advocate placing someone back on a long board as a routine matter for secondary transfer especially if the journey is going to be more than 20 -30 minutes , but equally if their neck or back is not yet cleared and immobilisation is indicated due to actual or potential unstable spinal fractures they must be appropriately immobilised for that secondary transfer.