A few weeks ago when I started to write this I was toying with the titles “Burn Backboard Burn” or “It’s Backboard Burning Time,” but given that by some miracle the EMS Gods have answered my prayers out here in Saskatchewan, those headlines now seem a little too aggressive.
I recently had a rash of spinal injuries and was repeatedly frustrated with our spinal immobilization protocol. I simply didn’t agree with it and felt like I had gained enough experience to adequately argue why our standard procedure was B*S.
I remember in paramedic school having the fear of God put into me regarding what would happen if we didn’t have someone on a board who was later found to have “needed it” aka: a spinal injury. We were told all kinds of nasty things: we’d get sued, lose our license to practice, go to jail, and maybe even Hell.
Unfortunately what I and many others discovered as we delved into our careers is that the board is both a saint and a curse. It can be an excellent extrication tool. The scoop has become my personal favorite. But watching my patients suffer increased pain and discomfort as their minutes (hours) crept by on the board was also torturous to me.
I became especially skeptical about the use of boards as best practice for long transports- interfacility transfers even. The spinal immobilization the board was supposed to provide caused many of my patients to wiggle and shimmy (amongst much complaining) in an attempt to get away from gnarly pressure points. I felt like a fraud as I gently convinced them that being on the board was for “their own good”, when it was so obviously making the situation worse.
Now here is the miracle! This September 5th I received an email from SCOP stating that there was to be a SIGNIFICANT change to our spinal immobilization protocol. The highlights are;
“Evidence-based research suggests in-line stabilization of the neck and spine can be equally as effective using alternative methods, without the need to use a spine board.
Limiting the amount of time a patient is placed on a spine board reduces risks such as respiratory compromise, discomfort, aspiration, and delays in transport associated with placing a patient on a spine board for prolonged periods of time.”1
Boo-yaa! This change was made in other countries years ago because it is…evidence based! This is proof that our profession is moving away from old school methodology that “this is the way we’ve always done it” to challenging our practices, evaluating them, and adapting to new findings. EMS is a relatively new profession and this change in ideology is a massive step towards gaining respect in the medical field that we so crave (and on many levels deserve).
A few more details from the new protocol manual;
“Spinal Motion Restriction (SMR) can be maintained by application of a rigid cervical collar and securing the patient firmly to the EMS stretcher. A long backboard, scoop, or other extrication device may be used to extricate the patient from their initial position to the stretcher. Patients should be removed from the device as soon as practical.
Patients should only be transported on such a device if it is impossible to remove them due to manpower or patient condition considerations.”2
I just want to add a couple more notes of evidence from some people who get paid to write, unlike me.
An article by Kenny Navaro from EMS1.com states:
“Cervical collars along with other spinal motion restrictions should, in theory, protect the spinal cord from further injury following a traumatic event. However, the spine must be subject to a considerable amount of force to produce a fracture, and it is reasonable to believe the relatively low-energy movements produced during extrication and ambulance transport are unlikely to result in additional injury.
Further when primary injury does occur, muscle spasms in conscious patients work to increase resistance to movement and may therefore prevent the injury from worsening. It seems reasonable, then to conclude that the risks of dangerous spinal movement during extrication may have historically been overemphasized[6, 7].”3
According to an article by Mark Jonas, CFRN, the (American) National Association of EMS Physicians states:
“There is evidence that backboards result in harm by causing pain, changing the normal anatomic lordosis of the spine, inducing patient agitation, causing pressure ulcers, and compromising respiratory function. The only practical value of backboards is for extrication to a transport vehicle. Once extricated, patients should be taken off the backboard. Backboards should not be used for spinal immobilization. Placing ambulatory patients on backboards is unacceptable.”4
Exactly. I win.
SCOP- I am so proud of you for getting on board with getting off the board! In fact- you almost beat Texas to the punch. Next time.
PS: Here is a better article than mine… http://www.emsworld.com/article/10964204/prehospital-spinal-immobilization
************SCOP CHANGES to NOCP 2011 Edition 2****************