Spinal board

Last updated
Spinal board
Immobilisation plan dur.png
Spinal motion restriction with a long spine board
Other names
  • long spine board (LSB)
  • long back board [1]
  • spineboard [2]
  • backboard [3]

A spinal board, [4] is a patient handling device used primarily in pre-hospital trauma care. It is designed to provide rigid support during movement of a person with suspected spinal or limb injuries. [5] They are most commonly used by ambulance staff, as well as lifeguards and ski patrollers. [2] [6] Historically, backboards were also used in an attempt to "improve the posture" of young people, especially girls. [7]

Contents

Due to lack of evidence to support long-term use, the practice of keeping people on long boards for prolonged periods of time is decreasing. [8] [9]

Extrication uses

The spinal backboard was originally designed as a device to remove people from a vehicle. After a time people were simply kept on the spine board for transport without evidence supporting this need. [5] [10]

Medical uses

A spinal board is primarily indicated for judicious use to transport people who may have had a spinal injury, usually due to the mechanism of injury, and the attending team are not able to rule out a spinal injury. [11] The person should be transferred from the board to a hospital bed as soon as possible. [11] For comfort and safety reasons, it is recommended to transfer the person to a vacuum mattress instead, in which case a scoop stretcher or long spine board is just used for the transfer. [12]

Despite its history of use, there is no evidence that backboards immobilize the spine, nor do they improve the person's outcomes. Additionally, cervical spine motion restriction has been shown to increase mortality in people with penetrating trauma and can cause pain, agitation, respiratory compromise, and can lead to the development of bedsores. [11] [13]

Adverse effects

Common clinical issues found with spinal boards include pressure sore development, inadequacy of spinal motion restriction, pain and discomfort, respiratory compromise and effects on the quality of radiological imaging. [4] For this reason, some professionals view them as unsuitable for the task, preferring alternatives. [14]

It is advised that no patient should spend more than 30 minutes on a spine board, due to the development of discomfort and pressure sores. [5]

Backboards were invented to be a "highly polished surface" to move a person to an EMS bed, not to be used as spinal securing device.[ citation needed ]

Construction

Head immobilizer at the top of the backboard. Head Imobilizer.jpg
Head immobilizer at the top of the backboard.

Backboards are almost always used in conjunction with the following devices:[ citation needed ]

Spine boards are typically made of wood or plastic, although there has been a strong shift away from wood boards due to their higher level of maintenance required to keep them in operable condition and to protect them from cracks and other imperfections that could harbor bacteria.

Backboards are designed to be slightly wider and longer than the average human body to accommodate the immobilization straps, and have handles for carrying the patient. Most backboards are designed to be completely X-ray translucent so that they do not interfere with the exam while patients are strapped to them. They are light enough to be easily carried by one person, and are usually buoyant.

Alternatives

The vacuum mattress may reduce sacral pressures compared to backboards. [15] The conforming nature of the vacuum mattress means that people can be kept immobilized on it for longer periods of time and the immobilisation offers superior stability and comfort. [16] The Kendrick extrication device is another alternative. [17]

Related Research Articles

Hemicorporectomy is a radical surgery in which the body below the waist is amputated, transecting the lumbar spine. This removes the legs, the genitalia, urinary system, pelvic bones, anus, and rectum. It is a major procedure recommended only as a last resort for people with severe and potentially fatal illnesses such as osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis. By 2009, 66 cases had been reported in medical literature.

<span class="mw-page-title-main">Airway management</span> Medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

<span class="mw-page-title-main">Major trauma</span> Injury that could cause prolonged disability or death

Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.

<span class="mw-page-title-main">Clearing the cervical spine</span> Process of determining the existence of a cervical spine injury

Clearing the cervical spine is the process by which medical professionals determine whether cervical spine injuries exist, mainly regarding cervical fracture. It is generally performed in cases of major trauma. This process can take place in the emergency department or in the field by appropriately trained EMS personnel.

<span class="mw-page-title-main">Vacuum mattress</span> Device used for patient immobilisation

A vacuum mattress, or vacmat, is a medical device used for the immobilisation of patients, especially in case of a vertebra, pelvis or limb trauma. It is also used for manual transportation of patients for short distances. It was invented by Loed and Haederlé, who called it "shell" mattress.

<span class="mw-page-title-main">Casualty lifting</span> Procedures to lift someone onto a stretcher

Casualty lifting is the first step of casualty movement, an early aspect of emergency medical care. It is the procedure used to put the casualty on a stretcher.

<span class="mw-page-title-main">Vehicle extrication</span> Process of removing a person trapped in a vehicle

Vehicle extrication is the process of removing a patient from a vehicle which has been involved in a motor vehicle collision. Patients who have not already exited a crashed vehicle may be medically or physically trapped, and may be pinned by wreckage, or unable to exit the vehicle because a door will not open.

<span class="mw-page-title-main">Spinal cord injury</span> Injury to the main nerve bundle in the back of humans

A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. It is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions.

<span class="mw-page-title-main">Cervical collar</span> Medical device used to support a neck

A cervical collar, also known as a neck brace, is a medical device used to support and immobilize a person's neck. It is also applied by emergency personnel to those who have had traumatic head or neck injuries, although they should not be routinely used in prehospital care. They can also be used to treat chronic medical conditions.

<span class="mw-page-title-main">Kendrick extrication device</span> Extrication brace for motor vehicle accidents

A Kendrick extrication device (KED) is a device used in extrication of victims of traffic collisions from motor vehicles. Commonly carried on ambulances, a KED is typically used by an emergency medical technician, paramedic, or another first responder. It was originally designed for extrication of race car drivers. Typically used in conjunction with a cervical collar, a KED is a semi-rigid brace that secures the head, neck and torso in an anatomically neutral position. Its use is claimed to reduce the possibility of additional injuries to these regions during extrication, although its value has been questioned, as there is a lack of evidence to support its use. The original KED was designed by Richard Kendrick in 1978.

<span class="mw-page-title-main">Scoop stretcher</span> Device used for moving injured people

The scoop stretcher is a device used specifically for moving injured people. It is ideal for carrying casualties with possible spinal injuries.

<span class="mw-page-title-main">Cervical fracture</span> Medical condition

A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck. Examples of common causes in humans are traffic collisions and diving into shallow water. Abnormal movement of neck bones or pieces of bone can cause a spinal cord injury, resulting in loss of sensation, paralysis, or usually death soon thereafter, primarily via compromising neurological supply to the respiratory muscles and innervation to the heart.

<span class="mw-page-title-main">Advanced trauma life support</span> American medical training program

Advanced trauma life support (ATLS) is a training program for medical providers in the management of acute trauma cases, developed by the American College of Surgeons. Similar programs exist for immediate care providers such as paramedics. The program has been adopted worldwide in over 60 countries, sometimes under the name of Early Management of Severe Trauma, especially outside North America. Its goal is to teach a simplified and standardized approach to trauma patients. Originally designed for emergency situations where only one doctor and one nurse are present, ATLS is now widely accepted as the standard of care for initial assessment and treatment in trauma centers. The premise of the ATLS program is to treat the greatest threat to life first. It also advocates that the lack of a definitive diagnosis and a detailed history should not slow the application of indicated treatment for life-threatening injury, with the most time-critical interventions performed early.

A traction splint most commonly refers to a splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod(s) to mimic normal bone stability and limb length, and a mechanical device to apply traction to the limb.

Stabilization is a process to help prevent a sick or injured person from having their medical condition deteriorate further so that they can be treated. Examples include while the person is waiting for medical treatment and in the intensive care unit.

Whole body vibration (WBV) is a generic term used when vibrations (mechanical oscillations) of any frequency are transferred to the human body. Humans are exposed to vibration through a contact surface that is in a mechanical vibrating state. Humans are generally exposed to many different forms of vibration in their daily lives. This could be through a driver's seat, a moving train platform, a power tool, a training platform, or any one of countless other devices. It is a potential form of occupational hazard, particularly after years of exposure.

Grady straps are a specific strapping configuration used in full body spinal immobilization.

<span class="mw-page-title-main">Helmet removal (sports)</span> Emergency medical procedure

In sports medicine, helmet removal is the practice of removing the helmet of someone who has just experienced a sports injury in order to better facilitate first aid. Obvious causes include head and neck injury, or both, with no immediate means of excluding neck injury in the athlete who may be unable to give a history.

<span class="mw-page-title-main">Airtraq</span> Device used for tracheal intubation

Airtraq is a fibreoptic intubation device used for indirect tracheal intubation in difficult airway situations. It is designed to enable a view of the glottic opening without aligning the oral with the pharyngeal, and laryngeal axes as an advantage over direct endotracheal intubation and allows for intubation with minimal head manipulation and positioning.

<span class="mw-page-title-main">Spinal precautions</span> Efforts to prevent movement of the spine in those with a risk of a spine injury

Spinal precautions, also known as spinal immobilization and spinal motion restriction, are efforts to prevent movement of the bones of the spine in those with a risk of a spine injury. This is done as an effort to prevent injury to the spinal cord in unstable spinal fractures. About 0.5-3% of people with blunt trauma will have a spine injury, with 42-50% of injuries due to motor vehicle accidents, 27-43% from falls or work injuries, and the rest due to sports injuries (9%) or assault (11%). The majority of spinal cord injuries are to the cervical spine, followed by the thoracic and lumbar spine. Cervical spinal cord injuries can result in tetraplegia or paraplegia, depending on severity. Of spine injuries, only 0.01% are unstable and require intervention.

References

  1. "Online training manual for Neann Long Spine Board". Neann.
  2. 1 2 Whatling, Shaun. Beach Lifeguarding. Royal Life Saving Society.
  3. Sen, Ayan (2005). "Spinal Immobilisation in Prehospital Trauma Patient". Journal of Emergency Primary Health Care. 3 (3). ISSN   1447-4999.
  4. 1 2 Vickery, D. (2001). "The use of the spinal board after the pre-hospital phase of trauma management". Emergency Medicine Journal. 18 (1): 51–54. doi:10.1136/emj.18.1.51. PMC   1725508 . PMID   11310463.
  5. 1 2 3 Ambulance Service Basic Training 3rd Edition. IHCD. 2003.
  6. "Red Cross Lifeguard Management Guide".{{cite web}}: Missing or empty |url= (help)
  7. Cf. Jane Eyre by Charlotte Brontë, Chapter 3.
  8. Sundstrøm, Terje; Asbjørnsen, Helge; Habiba, Samer; Sunde, Geir Arne; Wester, Knut (2013-08-20). "Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review". Journal of Neurotrauma. 31 (6): 531–540. doi:10.1089/neu.2013.3094. ISSN   0897-7151. PMC   3949434 . PMID   23962031.
  9. Singletary, Eunice M.; Charlton, Nathan P.; Epstein, Jonathan L.; Ferguson, Jeffrey D.; Jensen, Jan L.; MacPherson, Andrew I.; Pellegrino, Jeffrey L.; Smith, William “Will” R.; Swain, Janel M. (2015-11-03). "Part 15: First Aid". Circulation. 132 (18 suppl 2): S574–S589. doi: 10.1161/CIR.0000000000000269 . ISSN   0009-7322. PMID   26473003.
  10. Wesley, Karen. "Weighing the Pros & Cons of Current Spine Immobilization Techniques". JEMS. Retrieved 16 May 2015.
  11. 1 2 3 National Association of EMS Physicians and American College of Surgeons Committee on Trauma. January 15, 2013 Position Statement: EMS Spinal Precautions and the Use of the Long Backboard
  12. Morrissey, J (Mar 2013). "Spinal immobilization. Time for a change". Journal of Emergency Medical Services. 38 (3): 28–30, 32–6, 38–9. PMID   23717917.
  13. "The Evidence Against Backboards". EMS World. Retrieved 15 May 2015.
  14. Tasker-Lynch, Aidan. "Spinal Boards do NOT work". 18 (1). Emergency Medicine Journal: 51–54.{{cite journal}}: Cite journal requires |journal= (help)
  15. Maschmann, Christian; Jeppesen, Elisabeth; Rubin, Monika Afzali; Barfod, Charlotte (2019-08-19). "New clinical guidelines on the spinal stabilisation of adult trauma patients - consensus and evidence based". Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 27 (1): 77. doi: 10.1186/s13049-019-0655-x . ISSN   1757-7241. PMC   6700785 . PMID   31426850.
  16. Luscombe, MD; Williams, JL (2003). "Comparison of a long spinal board and vacuum mattress for spinal immobilisation". Emergency Medicine Journal. 20 (5): 476–478. doi:10.1136/emj.20.5.476. PMC   1726197 . PMID   12954698.
  17. The trauma handbook of the Massachusetts General Hospital. Philadelphia: Lippincott Williams & Wilkins. 2004. p. 37. ISBN   9780781745963.