Spineboard, correct usage?

[Bernhard]

Hi,

in Germany, at least in my beloved state of Bavaria, we'll see more and more usage of the "spineboard". All new ambulances are equipped with a long backboard since several years and finally the providers apparently found them in the compartments wondering what this thing will do if switched on.

And since they start to recognize it as a fancy equipment thingy from THE UNITED STATES OF AMERICA everyone sees on TV series and in movies, it seems to be the greatest gift to german EMS since the invention of wheel(cart)s.

As if we never had our beloved vacuum mattresses (since >30 years, probably even lot more) and scoop stretchers (since around 20 years)...on every ambulance by now.

Studying various sources and experiencing the backboard in various situations (classroom training, life excercises and rare real calls), I have a certain impression about it's worthiness. In short my point of view is: if used as a "pick up aid" only in situations were a scoop stretcher or other less disturbing techniques don't help, a spineboard is a great thing. Especially in confined space situations and if to carry a patient over sharp edges (where the scoop stretcher usually will hook).

However, I really don't see it as a transportation aid in the ambulance. With our vacuum mattresses (required equipment) a patient is more comfortable (one word: lordose) and splinted individually but complete. This includes full protection against sideway movement.

But I don't want to really discuss the pro's and con's, so sorry for the long intro, but I wanted you to see where I come from.

So, the real questions are: How do you properly

1. fix a patient on a spineboard against side movements? Our backboards seem to be a bit slippery and even if pinned down by a spider strap several body parts can slip sideways. Our modern vacuum mattresses even have a polster between the legs to stabilize them from all sides - how is this adressed in proper spineboard fixing?
   
2. transport the patient on a backboard in the ambulance? Is there any special hold or something like that? I don't trust a slippery thing simply put on a stretcher...it seems it can go ballistic any time since it could only be fixed with the normal patient straps on the stretcher - which are designed for a patient directly laying on the stretcher including a lot more friction between the fitting surfaces.
   
3. address the problem of lordose (the "S"-form of the spine), shoulder supporting, and leg supporting (the body is NOT flat!)? Is there a rule about filling those "holes"?
   
4. make a patient more comfortable for a longer transport? Is there a rule about padding the direct contact parts between board and skin (hip, shoulders, head)?
   

And I mean: "really, according to training books, should be, if done all right and not the quick & dirty solution".

How are things really done in US or should be done and how are we influenced by TV over here. I don't like TV to teach me things in EMS...some seem to see it other way round (honestly, i suppose some ITLS/PHTLS trainers just copy things totally unreflected). Any others non-US but using spineboards may be helpful for my understanding of the real thing, too.

I sure have made some research, but "padding" and such things are always addressed within a side comment or such in the documents I found. Can't believe that this is just not needed.

Thanks for your input,

Bernhard

P.S.: if someone missed me the last few months - I was still there, but slightly exposed to other things in life. May happen again.

[paramedicmike]

Bernhard,

Have you read any of this thread? I think you might find it pertains to your questions.

[JakeEMTP]

Actually, we're moving away from full spinal immobilization. But when we do use a backboard, I use the torso straps in a crisscross pattern so the straps go over the shoulders of the patient and the legs secured with another strap. Remember to pad the voids between your patient and the board using towels or extra linens, whatever it is you use there (something I see overlooked constantly). Using the straps on your stretcher, especially the shoulder straps will secure your patient safely whilst in the ambulance I have found.

Depending on the transport time, I may place a folded towel under the head and shoulders for pt. comfort. If you have ever been on a backboard, you would know just how uncomfortable it really is. Torturous some might say. For really long transports, I will medicate the pt. for comfort. 2mg of Versed usually does the job for openers. I have had some MD's question this practice but once I explain my reasoning, they're usually ok with it. Mostly though, I don't have a problem.

[mobey]

. For really long transports, I will medicate the pt. for comfort. 2mg of Versed usually does the job for openers. I have had some MD's question this practice but once I explain my reasoning, they're usually ok with it. Mostly though, I don't have a problem.

Interesting that you choose sedation as pain control?

[Arctickat]

I use these.

[Bernhard]

Have you read any of this thread? I think you might find it pertains to your questions.

Oh! I searched about it a bit before writing that much, but obviously missed this thread. Thank you for pointing me to it! (BTW, I had a similar topic started a year or so ago, but this wasn't exactly the same even if it already covered some of the questions a bit, now just wanting to get specific).

EDIT: that thread gives almost all the answers I wanted - including study citation etc. I almost intended to write an article about "spineboad myths" in a german EMS magazine, seeing the strange use of backboarding more and more here. This mostly comes from wrong understanding of the U.S. settings and ignoring the other tools we have. Now it seems I just have to ask ERDoc to give permission for translating his presentation! Great!

I use these.

(Spiderstraps) Well, we too. But the patient still is able to move a bit (intended or by driving forces) - especially the legs. I've seen some impressing videos on youtube about providers padding and securing patients with several additional tapes and rolled blankets. But this looks a bit time-consuming (not to say inefficient). However, what would be the real textbook spineboard practise?

BTW, what do you about the "lordose gaps" and the pain on the contact spots? The spider straps alone just secure the patient and don't address these issues, or?

Edited July 31, 2012 by Bernhard

[Arctickat]

Prior to placing the patient onto the board I cover it with a 4x folded flannel sheet to provide some padding. In my primary ambulance I use the criss cross straps over the shoulder to the opposite hips, then again from the hips to the opposite feet. One last strap across the hips.

Edited July 31, 2012 by Arctickat

[Bernhard]

Remember to pad the voids between your patient and the board using towels or extra linens, whatever it is you use there (something I see overlooked constantly). [...] Depending on the transport time, I may place a folded towel under the head and shoulders for pt. comfort.

That's what I thought. Is it really textbook practise? If so: which?

What we see here in TV _and_ ITLS/PHTLS courses as genuine U.S. technique is just the board and straps. I wonder why those courses don't address the other issues I mentioned (yes, asking the german trainers didn't provide a sufficient answer, therefore I'm asking those who constantly work with them and whom I trust more on this: you in EMTcity).

Using the straps on your stretcher, especially the shoulder straps will secure your patient safely whilst in the ambulance I have found.

I have yet to try this - we have a CPR dummy here with additional extremities and significant body weight for rescue simulations. this will be my victim for some braking tests. Poor Anne!

Edited July 31, 2012 by Bernhard

[Bieber]

The best use for a backboard is to prevent an unnecessary vacuum in one of the ambulance's outer compartments.

[fakingpatience]

I honestly hate using the backboard, but under current protocols get in trouble if I don't use it on many patients.

One trick I have found for "padding the voids" is to lay our thick blanked folded up 4x on the backboard. With this it is almost the same width of the backboard, and provided a much softer surface for the patient to be laying on. The downside is that it is warm, and can get scratchy, irritating some patients. Another idea to help the back be straighter is to put a couple pillows under the patient's bent knees. This helps flatten out the back and is more comfortable for patients.

As far as securing the backboard to the stretcher, we have shoulder straps for our stretchers. I put those through the 2 top straps of the backboard, then buckle them into the waist stretcher strap. I put the 3 other stretcher straps over the backboard and pt and secure them, although I suppose it would be more secure to slide the straps through the side holes on the backboard (where you have the backboard straps), to prevent additional movement. I have never really ran into the problem of the backboard moving too much on the stretcher.

If I were you I'd be working to stop the usage of backboards, rather then teach the EMS personnel to pad and secure the board better.