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Old 11-26-2008, 01:32 AM   #1
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How to backboard

My question is: in the following scenario, how would you get the patient on to a backboard?

Call received as a fall in the home; patient with back pain.

You arrive to find a person in their 80s sitting upright, but in a recliner. Indications are that the patient tripped and took a fall. There was little or no pain at first and patient's spouse had helped patient get up and into the recliner. Severe pain has now set in in the lower back. Patient uses a walker and cannot stand or walk without the use of the walker.

How would you get this patient on to a backboard?

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Old 11-26-2008, 01:57 AM   #2
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Slide it under legs and hips and slide them down the board. Lay flat and strap down!
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Old 11-26-2008, 02:03 AM   #3
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so your talking about a seated immobilization situation, right?

do we maybe have a device specifically designed for just such a call.

the ked isnt just for extrication from a motor vehicle.

if its deemed necessary, ked them and then transfer to a long board. once their in the ked, you have much greater latitude in how you can move them.

what i mean by if its deemed necessary is if a board is actually needed. how about a little lateral thinking. is this action going to help my patient or hurt them? you have an 80 y/o female s/p fall from standing height resulting in low back pain. minimal mobility at baseline. taking her from the chair, putting her onto a hard flat board and strapping the question mark right out of her back is very painful, especially in the case of arthritis, osteoporosis and all the other degenerative bone and joint diseases. so is the board really necessary? is there a peripheral neurological deficit(sensation/movement)? is there a palpable deformity? is the pain reproducible with light touch? its it mobile? is there anything to lead you down the road to a spinal injury dx or are you looking at minor muscular/skeletal discomfort after a fall?

maybe this patient would be better off being transported in a position of comfort instead of being unnecessarily tortured. i understand a lot of protocols dont allow for the emt to actually be able to think for themselves. but you have to understand that protocols dont cover every situation and sometimes you have to think outside the box and see the big picture. in some cases where the emt has been drilled mercilessly into believing that spinal precautions are required, they will do quite a bit more harm than good.
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Old 11-26-2008, 02:05 AM   #4
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I'd say this is one indication for the KED. We'd probably GS though.
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Old 11-26-2008, 02:16 AM   #5
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I agree with Kev. If and only if there was any other indication of spinal injury would I have immobilized this patient. 80 y/o female; we have to consider the patient. In all likelihood the patient is suffering from arthritis and or osteoporosis and may have underlying medical problems that will be aggrevated by being immobilized unnecessarily. Also, the patient was able to move since the fall and situate herself in the nice comfy recliner. Spinal immobilization is not as harmless a procedure as many think. Try spending a few hours on one!

The patient may not have a true position of comfort - they're obviously in pain while at rest in the recliner otherwise we wouldn't be there, but one of our objectives is to reduce pain and suffering. Spinal immobilizing this patient would do the opposite.

Personally I'd help the patient on to the stretcher, find the position most comfortable and support with blankets/pillows, etc. I'd consider analgesia before moving the patient, probably Entonox if the patient tolerates it.

Nifty thinking though! If the patient is stable and immobilization is truly warranted then take the time to do proper a immobilization; KED and then board. Otherwise as reaper said, legs & hips on board, slide down and strap!

Last edited by Kendall; 11-26-2008 at 02:22 AM.
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Old 11-26-2008, 04:29 AM   #6
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Dum, where is the pain in the back, can you estabish if it is soft tissue?

Other than that i'd be looking at ked, Is it one of these nifty electric recliners?
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Old 11-26-2008, 07:16 AM   #7
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Yeah, Kev got it. I did not read the scenario, just BB from a chair.

I would defiantly use a KED on that lady, if warranted. Most elderly do not take a LSB very well. If you need to immobilize them, some times I will use a scope stretcher. It is a little more comfortable and can be taken out without rolling them.

Guess I should read the posts better at 0200!
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Old 11-26-2008, 07:27 AM   #8
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Hey guys and gals! I really appreciate the answers to my original question. Here's another related question. Some of you have indicated that you would first try to determine if the source of the pain was soft tissue or bone related. Here's my next question. Expressed as a percent, what is your confidence level that you could detect/determine a potentially crippling spinal fracture during an assessment? By the way I'm relatively new and have never actually encountered a "known spinal injury."
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Old 11-26-2008, 09:43 AM   #9
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Personally, I would palpate the spinal column itself. Chances are if there is no s/s of paresthesia, etc. then I would transport in position of comfort. If there is no history of spinal problems and it appears to be paravertebral muscular spasms then a safe and smooth transfer to a position of comfort with pillow and blanket immobilization. Remember all one is doing on a LSB is preventing movement and not actually splinting.

One can not be 100% certain, hence the reason we still use immobilization devices however; there is more and more research displaying that crippling injuries occur during the even and not while being treated. Does this remove us from immobilizing no but also consider on the MOI and possibly related injuries.

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Old 11-26-2008, 11:32 AM   #10
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