Transition to new SMR protocol

[WildlandEMT89]

When are backboards ever a must?

We use them more for working codes now.

 

[Accelerator]

When are backboards ever a must?

...and how do boards save time?

I know of no better way to move unconscious unresponsive patients in houses where you can't get the cot into.

 

[PotatoMedic]

Mega mover!

 

[Tigger]

I know of no better way to move unconscious unresponsive patients in houses where you can't get the cot into.

I prefer the scoop. Once they are on the cot you can remove the scoop, eliminating any risk of pressure sores or other uncomfortables.

As for codes, I prefer the floor. If we transport, a board or scoop will be used.

 

[chaz90]

Reeves! But yes, I do think backboards have their place as extrication tools.

 

[Accelerator]

I prefer the scoop. Once they are on the cot you can remove the scoop, eliminating any risk of pressure sores or other uncomfortables.

As for codes, I prefer the floor. If we transport, a board or scoop will be used.

Sadly we lack scoops. A few of our local volunteer fire departments have scoops for wilderness rescue purposes.

For codes unless it's a doa we pretty much have no choice but to transport. It's nearly impossible to get orders for cease efforts.

 

[NomadicMedic]

I also vote Scoop or megamover. I'd never seen a reeves until I moved to DE.

As an aside, an unconscious, unresponsive person is going to get worked where they are. But, after that, they'll leave on a tarp or scoop. There's no way a narrow, slippery plastic board is the best way to move a patient out of a house.

 

[LACoGurneyjockey]

Breakaway flats anyone...? Soft, secure, and don't require any patient movement to get them out.

 

[COmedic17]

There's (typically) two types of medics. The first ones will argue that any trauma needs to be backboarded because....well...its trauma. Then there's the other type who hates backboards, has read the articles that they aren't necessarily beneficial and don't want to backboard anyone.

And then there's me. I'm kind of a pain in the butt that way.. But regardless....

There are times I say back boarding is an absolute must. Then there are times I have the patient walk to the cot. Theres another post where everyone was against back immobilizing a particular patient but I was all for it. I am very circumstantial.

Yes, studies say backboards cause skin breakdown, don't completely immobilize the spine, put unneeded pressure on areas of spine, can cause pain, etc. but you know what sucks even more? A severed spinal cord.

I believe (when I say "I believe" it's my personal opinion) that most "trauma" patients do NOT need full spinal immobilization. I believe there are some circumstances where it's borderline neglectful not to immobilize to some degree. My protocols allow a type of "wiggle room" where I can substitute scoop style boards for a backboard. I LOVE SCOOPS. Part of the reason backboards are being questioned is the logrolling moves the spine more then previously thought. With the scoop- you avoid that. There's also less "voids" to pad. But I determine who needs immobilization based on a large amount of factors. Age- do they probably have some degree of osteoporosis? Are they on drugs/etoh that might minimize pain? Previous injury- is part of their spine "fused" from a previous surgery? Location of pain,vitals, etc. but there has been times I have immobilized when others may not of. But in the rural areas of my county, I trust the fire people moving the patient on a scoop as opposed as moving them by any other means ( a lot aren't even EMTs). The scoop doesn't put pressure on the spine (unless scoliosis or kyphosis is present. But that's not the "average" patient).I board(scoop) when I have a reasonable belief that they have legitimate trauma to their spine/vertebrae and I am concerned that movement might cause injury to the cord. If I'm not concerned with that, then I won't.


There's an argument that back boarding (scooping) takes time- when you have 6 firefighters, an EMT, and yourself, it lakes less then 60 seconds (even less with a scoop, again, I love scoops)


Just use common sense. You don't have to " pick a side". You can choose what you believe is best for the given for the situation.


Would I immobilize a pt with no neck back pain who self extricated after an MVA and is strolling around and was wearing a seat belt? No.
Would I immobilize a or with multiple GSW, not alert and orientated, poor vitals, and I can't guarantee one bullet didn't clip the spine? Then they would probably get the scoop.

But 99% of my patients who are immobilized get taken off on the cot because I feel movement is minimal on a cot. I will bring a scoop into the hospital to use it to move them to the hospital bed though.


*shrugs*

I am comfortable with a happy median between the two.

 

[COmedic17]

****i do backboard( using a longboard) during cardiac arrests. It's easier to move them (especially down stairs) and it's a great CPR board.

 

[PotatoMedic]

I do not believe backboards have ANY use for spinal immobilization. I believe full body vaccume splints are good for spinal immobilization.

I do believe extrication boards ("backboard") can be useful in other situations.

 

[RocketMedic]

Would I immobilize a pt with no neck back pain who self extricated after an MVA and is strolling around and was wearing a seat belt? No.
Would I immobilize a or with multiple GSW, not alert and orientated, poor vitals, and I can't guarantee one bullet didn't clip the spine? Then they would probably get the scoop.

COmedic17, the first patient certainly doesn't need a scoop, but the second patient is actually actively harmed by immobilization. Bullets don't "clip" the spine and cause "poor vitals", they hit anatomically-vital centers like the descending aorta and punch holes.

 

[gotbeerz001]

I use a variety of immobilization techniques including:
- nothing
- collar only
- collar + half vacuum splint
- half vacuum splint only
- KED only
- KED + collar
- collar + scoop
- vacuum splint + scoop
- collar + long board
- vacuum splint + long board

These are all determined by methods of extrication, pt anatomy, time and extent of injury / presence of deficits.

I like options.

 

[COmedic17]

COmedic17, the first patient certainly doesn't need a scoop, but the second patient is actually actively harmed by immobilization. Bullets don't "clip" the spine and cause "poor vitals", they hit anatomically-vital centers like the descending aorta and punch holes.

My "gangbanger" who was running, most definitely got hit on the spine and severed his spinal cord. This was comfirmed by the hospital. The BP was in the 80s. After two liters unchanged. Passed a week or so later. Aorta was not hit. But liver was ( several GSWs). Also GSW to side of head.

 

[RocketMedic]

And how, pray tell, did a spine board help in that situation?

 

[Tigger]

Here's the thing. NOTHING we do in the field besides telling someone to lie still and not move around a whole bunch has any effect on so called spinal immobilization. Nothing. Nada. Zilch. Spine boards do nothing. KEDs generate more movement getting them into it. C collars are usually poorly fitted but even when done right have little to back them up. Vacuum mattresses work in theory, but have no evidence supported them. Guess what else was used because of that reasoning, long backboards.

If the patient has a spinal cord injury, it's done. It's not going to get worse because you touched them. Be careful moving them, but let's stop pretending that we have any evidence of benefit from any of these techniques, because we don't and they've been well studied.

And so help me god if someone comes in and pulls the whole "I had a patient who turned out to have a C5 fx and thank god I boarded them cuz they'd be messed up now." NO. You affected that injury in no way. None.

 

[highglyder]

I ran into this issue a lot during my medic training. My FTO likes to backboard everyone. His reasoning is that "you don't want to find out that patient had a brain bleed and you didn't C-spine them". it was very hard to keep my mouth shut to get through training faster.

Soooo...hemorrhagic CVA = possibke spinal injury? If that's one's mentality, c-collars and LSBs should bd as available as public defibs. Just think how messed it is that normal day to day occurences suddenly mean spinal injury the second we are in the picture. Kid fell from monkey bars, boxer boxing, trip and fall.... we should all be paralysed!!