Spinals @ MX

[OzMedic]

Ok, just to save confusion... This is how I would and do package a spinal patient:

(we use rolled up hand towels for head blocks)

Right or Wrong??

Simple answer from my perspective: Right for extrication (and very short transports), Wrong for transports! If you do not have a vac mat to transfer the patient on to then place them on your normal stretcher and utilise towel rolls for the head and folded triangular bandages to tie the legs/feet (together, not to the bed). While I validate what emsbrian said about padding the voids with the use of backboards, I feel that in practice it is far to inexact. How can you actually tell if you have the right amount of padding once the patient is on the board? The same goes for KED's for that matter! Additionally I also try to utilise a scoop stretcher instead of a backboard in the same way shown in your picture (they suck on the beach though). This reduces the amount of logrolls necessary when transferring the patient and allows for a more neutral spinal position.

[whit72]

OZ medic wrote:

Backboards are extrication devices only and should not be utilised to transport spinal patients on! Taping/strapping the head only potentiates the problem and increases the risk of injury exacerbation and aspiration. Studies utilising CT imaging have demonstrated the inappropriateness of this approach not matter how much the patient is trussed to the board (this goes for KED type devices as well). The most efficient method of immobilisation is the full vacuum mattress, if this is not available then scoop/back board the patient onto your stretcher mattress and place 1 towel rolled from both sides under the patients head to minimise lateral movement. Do not tape the patients head in any circumstance!! Again these methods have been shown to be the most spinal friendly by the utilisation of CT imaging.

Although I have read a few studies stating these exact facts, to state no-one should be secured to a spine board and their head not taped is dangerous. I am sure his medical control might have a different opinion of this. You area may be a little more progressive then most, but to throw out a blanket statement that no one should be placed on a long board could cause problems for all parties involved. Whether the findings are substantiated or not people have medical control to answer to. I suggest discussing it first with them before making any personal decisions about not using standard c-spine immobilization practices

The whole idea of c-spinal immobilization is coming under fire, however it is in its infancy and should not be condoned until more studies have been conducted. I have read numerous articles condoning both sides of the argument. Whether I agree or disagree is a moot point. The fact is that proper c-spinal immobilization using standards that have been set forth is still recommended. Deviation from this could be problematic, even though its effectiveness is be questioned.

[OzMedic]

Although I have read a few studies stating these exact facts, to state no-one should be secured to a spine board and their head not taped is dangerous. I am sure his medical control might have a different opinion of this. You area may be a little more progressive then most, but to throw out a blanket statement that no one should be placed on a long board could cause problems for all parties involved. Whether the findings are substantiated or not people have medical control to answer to. I suggest discussing it first with them before making any personal decisions about not using standard c-spine immobilization practices

The whole idea of c-spinal immobilization is coming under fire, however it is in its infancy and should not be condoned until more studies have been conducted. I have read numerous articles condoning both sides of the argument. Whether I agree or disagree is a moot point. The fact is that proper c-spinal immobilization using standards that have been set forth is still recommended. Deviation from this could be problematic, even though its effectiveness is be questioned.

If you read my posts again you will see that I actually say that people should not be transported on backboards, not that they should not be used! Additionally, patients should be strapped to the board for safety just not their heads. The problem being that even in ideal situations (which we rarely work in) it is almost impossible to strap a person to a board/stretcher so well that there is no movement of the spine, however when you strap their head it's not going anywhere so any movement of the rest of the spine increases the risk of potentiating injury. This has been found to be more risky than if the head is left unstrapped and excessive movement prevented with towel rolls etc. As for my medical control, it absolutely contraindicates the strapping of heads to boards or stretchers in any way shape or form. Hope this clears things up!

[Timmy]

So the way the picture shows is ok for transporting short distances? Which is all I do, just from the track back to the first aid center then the paramedics will be called and the patient is then their problem.

As far as taping their head down, if I’m stretchering a patient back to the first aid centre by foot how would I stop their head from moving side to side? I wouldn’t imagine rolled up hand towels would do any good as were walking over bumps, jumps and holes…

Also if the patient has a sever spinal injury we wont move them until the ambulance arrives, just saves double handling.

[1EMT-P]

OzMedic, I have to respectively disagree with you when you say that people should not be transported on backboards... Have you ever taken care of an injuried skiier with bi-lateral femur fractures & a fractured pelvis on a ski slope?

Also vomiting is not an issue if you manage the airway & pre-medicate your patients with an anti-emetic like Phenergan!

[Timmy]

I’m way out of my league here but 9 times out of 10 if you have a spinal patient they could possibly have a head injury so why would you give them Phenergan? It’s just going to make them sleepy… Plus Phenergan can cause nausea and vomiting. Wouldn’t giving something like Maxalon be a safer option?

[OzMedic]

OzMedic, I have to respectively disagree with you when you say that people should not be transported on backboards... Have you ever taken care of an injuried skiier with bi-lateral femur fractures & a fractured pelvis on a ski slope?

Also vomiting is not an issue if you manage the airway & pre-medicate your patients with an anti-emetic like Phenergan!

God this is tiring! I am so sick of answering BS responses to people that have not read all the posts or not read them properly. For a start I live in Queensland Australia so what do you think the chance is that I have extricated a patient from a ski slope? Every one of my posts has advocated the use of spine boards as an extrication device! I would consider moving a patient off a mountain an extrication. Further to that you would also of seen my advocation of a vacuum mattress for these types of patients (I believe they still work in the snow). You could even put the vac-mat on top of the backboard if it made you feel better. Your response to proper management of an airway does not make sense! If you feel that you can prevent aspiration in a patient that vomits while flat on their back while moving them off a ski-slope without log rolling the patient then please share you secret as it will definitely be a skill that I would value. As for the pre-medication I do always pre-medicate my spinal patients, however I utilise an anti-emetic that is probably more likely to prevent emesis than phenergan which is mainly utilised for nausea due to disruptions within the middle ear such as motion sickness vertigo and labyrinthitis due to it's inhibition of of signals from the vestibular apparatus to the emetic centre in the medulla. This means that vomiting due to head injury, morphine administration and many other aetiologies will still be likely to occur.

I place my posts on here in the hope that the people that read them will find the information interesting (or not) and stimulate them to do further research. I am more than happy to answer any queries in relation to my posts but silly snipes such as "my protocol says this" or "what about if this?" are not constructive in this context, especially when the information is there if the person had only read the post or used some common sense and adapted the information to their context. Please feel free to give ask questions or offer different opinions/information (backed up by evidence if possible) but try to keep it constructive. This way, we can further our knowledge and recognition as professional practitioners instead of a mob of protocol monkeys taking snipes at each other.

[1EMT-P]

OzMedic, Don't go getting your shorts in a bunch :!: The fact of the matter is that you made a statement about backboards without providing any documentation to support your statement. I have only seen one study on vacuum devices and it showed that the vacuum device provided somewhat better immobilization of the torso with less movement, but it also showed that the rigid backboard with headblocks provided somewhat better immobilization of the head.

[OzMedic]

OzMedic, Don't go getting your shorts in a bunch :!: The fact of the matter is that you made a statement about backboards without providing any documentation to support your statement. I have only seen one study on vacuum devices and it showed that the vacuum device provided somewhat better immobilization of the torso with less movement, but it also showed that the rigid backboard with headblocks provided somewhat better immobilization of the head.

Dude you just supported my argument, immobilising the head is easy. It's rigid with little mass, just tape it to something and it won't go anywhere. The problem is the body. It's floppy with a lot of mass and needs space to allow for ventilation. The reason I feel so strongly about this is that I have seen airways compromised on more than one occasion under the guise of cervical precautions that probably are more likely to worsen the risk of exacerbating cervical injury anyway (i.e, taping heads). Yes you are correct I have not provided the evidence which I will do when I get around to digging up the hard copy as I have not been able to find it easily online. As someone said the whole issue of cervical precautions is being questioned anyway as there is little documented evidence of benefit for any of it. The argument I am making is which method is most likely to provide the most stabilization of the entire head and spine as a whole and still allow emergency airway care. The problem of a fully immobilised head and a partially immobilised body is worse that a partially immobilised head and a fully immobilised body (I think Einstein had a theory about this). Another theory is that if there is partial movement of the body then the head should be allow to move a little to go with it but not allowed to flop around (this is the rolled towel/sandbag theory). Or try and immobilise the body as a priority and the head as much as possible which is the point of the vacuum mattress over the backboard.

Anyway there will always be different opinions and I do aploigise as my last post was placed when very tired.

[Timmy]

Ozmedic- If I followed the way you have described to immobilize a patient, would this stand up in court if something were to happen?