Backboards- How long is to long?

[MedicPrincess]

What is the maximum amount of time a patient should be left to lay on a backboard, without being screened for clearance?

I wonder, because last night here in the ER we had a girl come in at 1645 hrs. She had been in a physical altercation with her supervisor. She was complaining of neck pain so EMS had full spinal precautions in place. We were REALLY busy here, and when they walked in the charge nurse at first told them to leave her in triage. The medic said "She's complaining of neck pain." So they put her in a room. They then proceded to put her BEHIND all the other patients we had that were in rooms and had already been triaged.

At 1810 I went into her room to register her. She was still straped to the backboard with collar on. The Dr had not been in there yet. He had not even been made aware he had an EMS patient.

I went out to check where she was in line to be seen and there were still 6 people in front of her. About this time the DR asked about the EMS patient he thought we had coming in. (I should interject here, the ER I am working in right now is "Technically and ER" however, we are more of a doc in the box with x-ray and lab onsite...so Ambulances can drop patients here, but there are very few times they actually do.) So anyway, the nurses say "She's here, but she's stable so you can do these first.

I left at 1945 hours and she was STILL on that backboard, fully immobilized. I looked this morning and it was almost 2100 hrs before the Dr got in there to see her. (he had about 6 lacerations in front of her, 2 of them were pretty big...so lots of sewing to do).

So from the time she was backboarded, at about 1630 hrs until the time she was seen was almost 4 1/2 hours on the board. Does that seem long to any of you?

Now keep in mind, when I am at work, I am "JUST a registrar" to one of the nurses (who happened to be the charge nurse last night). So if I would have asked she would have got all pissy and her ego stepped on. To all the other nurses I am an EMT, in nursing school, so they tend to answer my questions.

 

[Wingnut]

There's so much to say, but how to say it???

You know the poor thing had to be terribly uncomfortable, I truly do feel for her.

It is safer for her to stay on the backboard obviously until C spine is cleared

The nurses/docs are busy, but would it have killed them to get her cleared so they could at least make her comfortable while waiting?

We have NO say what so ever when doing our time in the hospitals. I think a janitor has more say than we would, I usually keep my opinions to myself (unless asked) and keep the questions for those who like to teach or for appropriate times.

I could go on a tangent about the healthcare system but we all know how it works. Sadly it means people get lost in the crowd and some people have to deal with discomfort. I've been to the ER and waited hours upon hours to see someone, and then there's times (like last night) I went in, and got treated immediately and very well. Then again my husband had to come from work to take me and he was in full uniform, after clarifying several times that I was not in custody I got golden treatment. I've also worked in ER's as we all have and tried to keep up with the patients/treatments/complaints/orders and know how easy it is to forget someone or get caught up in other things no matter how much you care or how hard you try.

It sucks but all we can do is our best as medical providers and as patients and hope that the majority of the time everyone wins.

 

[Jon]

Now, I'm winging this, but I belive that ATLS guidelines say Pt. off board within 5 minutes of arrivial. Also, I belive that after 90 minutes, i think, is when you start to have skin breakdown.

Problem is, we can't clear C-spine in the field, and even if we could, because of the neck pain, she still would have had a board.

However, the doc should have either cleared her or at least ordered the films soon after arrivial.

Jon