Spineboard, correct usage?

[craig]

it's a bloody extrication device....not really made to carry a patient.thats what scoops are for...then basket litters........

vaccum mattress or similar to transport with....never transport on a back board....

gee it's not rocket science people

[island emt]

If you have to use a backboard then fill all the voids down the sides, and place a BP cuff under the small of the back. Inflate it slowly till the pt is comfortable.

Foam swim noodles work well for between the legs and down the sides.

We have been using a selective spinal immobilization protocol for over ten years, which allows a lot fewer pt's to be boarded after exam and neuro testing.

Me personally: Prefer the scoop hands down.

[JakeEMTP]

Interesting that you choose sedation as pain control?

Not for pain control mobey. I use it for pt. comfort. I have Fentanyl or Morphine for pain control. As you know though, not all pt.'s require it. I just think it is bad form to transport someone for over 30 minutes of so on a backboard w/o making them as comfortable as possible.

it's a bloody extrication device....not really made to carry a patient.thats what scoops are for...then basket litters........

vaccum mattress or similar to transport with....never transport on a back board....

gee it's not rocket science people

Well, if it's your only option you have no other choice. Not that I disagree with you though. As I stated earlier, we are moving away from full spinal immobilization unless it is absolutely necessary.

[mobey]

Not for pain control mobey. I use it for pt. comfort. I have Fentanyl or Morphine for pain control. As you know though, not all pt.'s require it. I just think it is bad form to transport someone for over 30 minutes of so on a backboard w/o making them as comfortable as possible.

That was a bad play on words on my part there.

What I meant was patients most commonly complain of pain at contact points with the board (back of head, shoulderblades, pelvis, etc, as well as general lwr back pain). I give these patients morphine.

If they were generally squirmy or claustraphobic I may consder Midaz, but have never really had that.

Not disagreeing, just intrigued.

[Arctickat]

What I meant was patients most commonly complain of pain at contact points with the board (back of head, shoulderblades, pelvis, etc, as well as general lwr back pain). I give these patients morphine.

I tend to do what I can to massage their uncomfortable spots. The reason they're having the discomfort is because of the beginnings of a pressure ulcer.

"]] Main and Lovell examined interface pressures (IPs) experimentally

in volunteers on seven pre-hospital

support surfaces.4 They found that the highest

IPs at the sacrum and thorax were from the

conventional spinal board. Mean sacral readings

being 233.5 mm Hg and thoracic readings

of 82.9 mm Hg. Experimental studies have

suggested that a constant pressure of only 35

mm Hg exerted for two hours, or 60 mm Hg

for one hour is sufficient to cause irreversible

tissue damage

http://www.ncbi.nlm..../v018p00051.pdf

Masking that discomfort with pain meds does nothing to reduce or relieve the damage being caused by the board. Providing a return of capillary blood flow in the affected areas is what is required. Since my patients can be strapped to a board for as long as 6 - 7 hours I do everything I can to alleviate the pressure on contact points.

Edited August 1, 2012 by Arctickat

[mobey]

I tend to do what I can to massage their uncomfortable spots. The reason they're having the discomfort is because of the beginnings of a pressure ulcer.

http://www.ncbi.nlm..../v018p00051.pdf

Masking that discomfort with pain meds does nothing to reduce or relieve the damage being caused by the board. Providing a return of capillary blood flow in the affected areas is what is required. Since my patients can be strapped to a board for as long as 6 - 7 hours I do everything I can to alleviate the pressure on contact points.

That is a great point to put in this thread, as I have in many others.

Tricks like a BP cuff under the lwr back to inflate/deflate periodically, Tipping the board a bit and every half hour or so with towels under one side, and loosening/retightening one strap at a time to allow blood flow can alleviate alot of discomfort by actually solving the problem.

[rock_shoes]

You can also use a scoop to begin with, which is both spinal rated and dramatically more comfortable than a LSB.

Granted, I do come from an area where LSB's are considered to be extrication devices and unfit for patients for any more than the time it takes to scoop them off of it.

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Even better of course would be a correctly fitted vacuum mattress.

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[craig]

Well, if it's your only option you have no other choice. Not that I disagree with you though. As I stated earlier, we are moving away from full spinal immobilization unless it is absolutely necessary.

Trouble with that is a company that has that as "their ONLY choice" really isnt putting the best interest of the patient first now is it?....

[HARDCORE CAP]

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)?
   

1. to impede movement, straps and padding. we use 5 disposable straps: two criss crossed over the chest, one at the hips, over the femur, over the tibia. if secured properly the legs shouldn't slip sideways. the arms usually have free movement. if you have the hips and chest down securely the body shouldn't move much or at all despite ambo maneuvers

2. at my company we do just use the gurney. backboard on the gurney then use gurney straps. it's rare that the backboard will slide, usually the pt weight keeps the pad compressed and allows the board to catch the lip of the gurney. most of our boards also have texture, not 100% smooth.

3. padding, padding, padding. sheets, pillows, bandaging etc. basically whatever works

4. see 3

[Richard B the EMT]

I note that most of the posters are not in the United States.

My only experience with a Vacuum Matress was an arriving patient on an international flight, but I kind of liked what I saw. I might have felt better from my personal experience being on a board as a patient, especially with the NYC roads.