Medical directors should already have every EMS provider in Pennsylvania following the new Statewide BLS Protocols, but the procrastinators have until July 1, 2015 to get everyone to aggressively avoid using backboards.
We should not be manipulating the potentially injured spines of patients to get them onto backboards for no known benefit, while possibly causing permanent disabilities or other significant harms.
Excessive motion of the spine may worsen spine fractures or spinal cord injuries (especially in patients with altered consciousness who can’t restrict their own spinal motion), but immobilization on a long spine board may also cause pain, agitation, respiratory compromise, and pressure ulcers. Patients with the following symptoms or mechanisms of injury should be assessed to determine whether restriction of spinal motion is required:
What are the full steps to be performed for someone suspected of having an unstable spinal injury?
Restrict Spinal Motion
Apply Rigid Cervical Collar
We are beginning to realize that collars are probably also not be such a great idea, but this is only one step to decrease the harm we cause for no apparent benefit.
Allow patient to move to stretcher mattress with minimal spinal motion3 
This is just recognizing that people have been walking to stretchers without sudden onset of paralysis, so manipulating the patient’s spine onto a flat board for no known benefit was never a good idea. It was just dogma, that went unquestioned for too long.
Use backboard, scoop/orthopedic stretcher, vacuum mattress, or other device to move patient to stretcher with minimal spinal motion4,5 
We could use a sheet, since manipulating the patient onto a backboard, or other device, may result in much more movement of the spine than sliding a sheet under the patient and using the sheet to lift the patient.
Use CID may be used to further restrict spinal motion
The typo is not important, but we can consider putting some sort of blocks next to the patient’s head to keep the head of an unconscious patient from flopping around.
Transport on stretcher mattress without backboard if patient ambulatory or if scoop/orthopedic stretcher can be removed with minimal patient motion.
Again, the use of a sheet to move the patient may be the preferred method, since the use of the sheet may produce the least manipulation of the spine. We are trying to minimize the manipulation of the spine, not trying to defend some dogma that there is only one right way of doing things, regardless of outcomes. The patients’ outcomes are what matter, not adherence to the protocol at the expense of the patients.
The protocol clearly does not limit us to using backboards, scoops, orthopedic stretchers, or vacuum mattresses.
Using a sheet to move the patient, so that it does not produce more manipulation that would be produced by using these other devices appears to be encouraged, if not required. We are supposed to use the method that is least likely to harm the patient, which probably makes a backboard the least acceptable method.
This protocol also applies to assessment of patients before inter-facility transfer for injuries from a traumatic mechanism unless a medical command physician agrees that the patient may be transported without restriction of spinal motion.
Any suggestion that a patient is going to be manipulated back onto a backboard should result in a firm, No, thank you.
I am not a lawyer, but I wouldn’t be surprised to see law suits against EMS agencies/providers who continue to cause harm with backboards, when there are less harmful alternatives available and no protocol/standard of care to defend this abuse of patients by placing them on backboards.
Pennsylvania is the largest state (not all states have statewide protocols, so this is often only at the agency level) to do this and joins a growing list of EMS agencies that are putting patients ahead of superstition –
Agencies/EMS Systems Minimizing Backboard use –
Let me know if I should add your agency to this list.
Albuquerque-Bernalillo County Medical Control Board
Bend Fire and Rescue
Bernalillo County Fire Department
Chaffee County EMS
Connecticut, State of
Durham County EMS
Eagle County Ambulance District
HealthEast Medical Transportation
St. Paul, MN
Johnson County EMS
Kenosha Fire Department
Macomb County EMS Med Control Authority
Macomb County, MI
Maryland, State of
North Memorial Ambulance & Aircare
Palm Beach County Fire Rescue
Pennsylvania, Commonwealth of
Pewaukee Fire Dept
Rio Rancho Fire Department
SERTAC (Southeast Regional Trauma Advisory Council)
Wichita-Sedgwick County EMS System
Xenia Fire Department
Outside of the US –
NHS (National Health Service)
St. John Ambulance