Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Comments on Pennsylvania Eliminating Backboards for Potential Spinal Injuries

 
There were several comments to Pennsylvania Eliminating Backboards for Potential Spinal Injuries that indicate that I was probably not clear enough in my explanation of the protocol change in Pennsylvania. Backboards are not being completely eliminated, but the requirements to extricate/transport patients on backboards has been eliminated.

The use of backboards as extrication devices should be rare if we do what is best for the patients. The use of the backboard during transport should be the kind of thing that causes hospital staff to come look at the ancient artifact, like DeLee suction, rotating tourniquets, or knives for blood letting.
 


DeLee Suction.
 


Blood letting.

 
Would there ever be a situation where DeLee suction rotating tourniquets blood letting backboarding is best for the patient?

The backboard requires more manipulation than other extrication methods, since it requires manipulation to get the patient onto the backboard at the scene and again requires manipulation to get the patient off of the backboard onto either the EMS stretcher or the hospital stretcher. Hospitals are not leaving patients with unstable spinal injuries on backboards. So the backboard is probably going to be the least commonly used extrication device.
 

There is no evidence that use of a backboard is safe.

There is no reason to believe that placing a patient on an extrication device that is so uncomfortable that it encourages movement, such as the backboard, is safe.

There is no evidence that manipulation of a patient with an unstable spinal injury onto a backboard is safe.
 

The scoop is only going to require some manipulation to get the patient onto the scoop, but the scoop could be separated and then slid together under the patient, separated to remove from under the patient on the stretcher, so that will probably result in the least manipulation of the spine and be the most commonly used extrication device

A sheet may not provide adequate support for the head of an unconscious patient, but a backboard only provides support after we manipulate the patient’s head onto the board.

There is no evidence that scoops, or sheets, or vacuum mattresses, improve outcomes, but they should result in less manipulation of any spinal injury. The whole hypothesis of backboarding is to limit/prevent movement of the spine, but backboards do not do appear to limit or prevent movement of the spine.

We keep making excuses for harming our patients.

Where is the evidence that backboards are effective?

Where is the evidence that backboards are safe?

In the absence of valid evidence of safety and efficacy, we have little justification for applying backboards to patients.

.

Pennsylvania Eliminating Backboards for Potential Spinal Injuries

 
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:[1]

 


 

What are the full steps to be performed for someone suspected of having an unstable spinal injury?
 

Restrict Spinal Motion

Apply Rigid Cervical Collar[1]

 

We are beginning to realize that collars are probably also not be such a great idea,[2] but this is only one step to decrease the harm we cause for no apparent benefit.
 

If ambulatory,

Allow patient to move to stretcher mattress with minimal spinal motion3 [1]

 

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.
 

If nonambulatory,

Use backboard, scoop/orthopedic stretcher, vacuum mattress, or other device to move patient to stretcher with minimal spinal motion4,5 [1]

 

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[1]

 

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.[1]

 

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.[1]

 

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.
 
 

Alameda County
CA
 

Albuquerque-Bernalillo County Medical Control Board
NM
 

Bend Fire and Rescue
Bend, OR
 

Bernalillo County Fire Department
NM
 

CentraCare Health
Monticello, MN
 

Chaffee County EMS
CO
 

Connecticut, State of
CT
 

Durham County EMS
NC
 

Eagle County Ambulance District
CO
 

HealthEast Medical Transportation
St. Paul, MN
 

Johnson County EMS
KS
 

Kenosha Fire Department
Kenosha, WI
 

Macomb County EMS Med Control Authority
Macomb County, MI
 

Maryland, State of
MD
 

MedicWest Ambulance
NV
 

Milwaukee EMS
WI
 

North Memorial Ambulance & Aircare
Minneapolis, MN
 

Palm Beach County Fire Rescue
FL
 

Pennsylvania, Commonwealth of
PA
 

Pewaukee Fire Dept
Pewaukee, WI
 

Rio Rancho Fire Department
NM
 

SERTAC (Southeast Regional Trauma Advisory Council)
WI
 

Wichita-Sedgwick County EMS System
KS
 

Xenia Fire Department
Xenia, OH
 
 

Outside of the US –
 

NHS (National Health Service)
England (UK?)
 

St. John Ambulance
New Zealand
 

Norway
 

QAS
Queensland, Australia
 
 

Footnotes:

[1] Spinal Care
2015 Pennsylvania Statewide BLS Protocols
261 – BLS – Adult/Peds
pp 59 – 61
Protocols in PDF Download Format.

[2] Why EMS Should Limit the Use of Rigid Cervical Collars
Bryan Bledsoe, DO, FACEP, FAAEM, EMT-P and Dale Carrison, DO, FACEP
Monday, January 26, 2015
JEMS
Article

.

Why EMS Should Limit the Use of Rigid Cervical Collars

 
Well, should EMS limit the use of rigid cervical collars?

As with the rest of anecdote-based medicine, or hunch-based medicine, we have been doing this for decades without any evidence of benefit. Do we know what we are doing?

But you have to prove that this is harmful, otherwise we cannot withhold the standard of ignorance.
 


Image credit.     Regardless of brand. A perfect fit – every time. Right?
 

Where does the burden of proof rest? In medicine, it is supposed to be the responsibility of the person treating to convince the patient that the treatment is more likely to be beneficial than harmful. This is informed consent. Informed consent is often overlooked and replaced with a blanket consent for the doctor (or designee, such as nurse, EMT, medic, . . . ) to do whatever the doctor thinks is a good idea.

Is there any valid evidence that a backboard, or KED (Kendrick Extrication Device), or rigid cervical collar will improve any outcome?

Not for the backboard or KED, but we know that the rigid cervical collar is beneficial because it stabilizes the neck and we would not use it if it didn’t work.

That is the same excuse made for using a backboards, or a KED, without evidence. Is there any valid evidence?

Can I get back to you on that?
 

Even though there should be no need to go further in criticizing rigid cervical collars, in the medical fields, we like to believe that what we have been doing is good and not harmful, because we don’t want to think of ourselves as harming our patients. Ironically, this attitude stops us from eliminating harmful treatments. We harm our patients to protect ourselves from having to admit that we were harming our patients.

For those who insist on evidence of harm, Dr. Bryan Bledsoe and Dr. Dale Carrison have provided us with a thorough evidence-based explanation of the ways that rigid EMS collars can harm our patients.
 

Interestingly, one of the first protocols that significantly changed spinal immobilization practices came out of several EMS agencies in Northern California. In a rather sweeping protocol change, they elected to forgo rigid C-collars and use soft collars.[1]

 

Do rigid cervical collars decrease manipulation of the neck/spine? Do rigid cervical collars protect patients from disability?

Read the article for a discussion of the evidence and of what we assume.

The argument in favor of backboards and collars is similar to the argument in favor of mandatory vaccination for school. It is a minor inconvenience for many, that protects against death/disability of some.

There is plenty of evidence for the vaccine argument. Vaccines are safe. Vaccines save lives. Vaccines are worth it. What about rigid EMS collars? Do they protect against death/disability?
 

Go read the article and find out.
 

Dr. Bledsoe and Dr. Carrison provide plenty of evidence to support their conclusions. What do the supporters of rigid cervical collars have?

Footnotes:

[1] Why EMS Should Limit the Use of Rigid Cervical Collars
Bryan Bledsoe, DO, FACEP, FAAEM, EMT-P and Dale Carrison, DO, FACEP
Monday, January 26, 2015
JEMS
Article

.

Florida County Eliminates Use of Magic Backboards for Possible Spinal injuries

 

More medical directors are rejecting the superstition that it is acceptable to harm patients to prevent fear of law suits.

There is no evidence that backboards do anything to protect the spine, but there is plenty of evidence that backboards cause harm.[1]
 


 

All treatments have side effects, so we need to have evidence of benefit to justify exposing our patients to those side effects. A treatment that does not provide any benefit to the patient exposes the patient to the side effects, but does not provide any benefit. This is indefensible, but many doctors, nurses, paramedics, basic EMTs, and others continue to defend this magical thinking and oppose EBM (Evidence-Based Medicine).

Fortunately, the defenders of superstitious nonsense seem to be losing support for belief in the magical properties of backboards.
 

Palm Beach County Fire Rescue just became one of the first agencies in the state to stop the use of rigid backboards for spinal immobilization.[2]

 


 

Instead of using the backboard, patients will be placed on a padded stretcher. Cervical collars will still be used when necessary to provide cervical stabilization.[2]

 

“The new procedures will reduce pain and suffering of patients, reduce complications, decrease on scene times and reduce injuries to crews who are attempting to carry immobilized patients,” said Cpt. Albert Borroto in a news release.[3]

 

Palm Beach County Fire Rescue 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.
 
 

Alameda County
CA
 

Albuquerque-Bernalillo County Medical Control Board
NM
 

Bernalillo County Fire Department
NM
 

CentraCare Health
Monticello, MN
 

Connecticut, State of
CT
 

Durham County EMS
NC
 

Eagle County Ambulance District
CO
 

HealthEast Medical Transportation
St. Paul, MN
 

Johnson County EMS
KS
 

Kenosha Fire Department
Kenosha, WI
 

Maryland, State of
MD
 

MedicWest Ambulance
NV
 

Milwaukee EMS
WI
 

North Memorial Ambulance & Aircare
Minneapolis, MN
 

Palm Beach County Fire Rescue
FL
 

Rio Rancho Fire Department
NM
 

SERTAC (Southeast Regional Trauma Advisory Council)
WI
 

Wichita-Sedgwick County EMS System
KS
 

Xenia Fire Department
Xenia, OH
 
 

Outside of the US –
 

St. John Ambulance
New Zealand
 

Norway
 

QAS
Queensland, Australia
 
 

Footnotes:

[1] New Kansas EMS policy limits use of backboards
Tue, 01 Apr 2014
Rogue Medic
Article

[2] Palm Beach County Fire Rescue changes the way first responders handle patients
Katie Johnson
5:57 PM, Dec 10, 2014
5:40 AM, Dec 11, 2014
WPTV5 West Palm Beach
Article

[3] Palm Beach County Fire Rescue making changes for backboard use
WPTV Webteam
8:47 AM, Dec 10, 2014
7:35 PM, Dec 10, 2014
WPTV5 West Palm Beach
Article

.

Does Ignorance Lead to Faulty Assumptions?


 

Are these paramedics striking a pose?

Based on the quality of the image, it is difficult to tell what is going in in this picture that is supposed to get us to jump to sinister conclusions, but we can still examine the evidence.

One paramedic could be behind the patient, possibly maintaining manual spinal immobilization while they wait for equipment to extricate this apparently stable patient. Why do I think he is stable? They are able to wait for equipment to practice spinal immobilization voodoo, rather than rush him to the hospital.
 

In the photo, Glover’s truck is clearly smashed into a tree. One paramedic is posing outside of the truck and, when zoomed in, a second paramedic can be seen smiling inside the truck. The victim, said to be Glover, is also inside the truck in the driver’s seat.[1]

 

Did the paramedics even realize that a picture was being taken?

Since cameras have becomes small enough to put in just about anything, we do not know. We do not, but the people interviewed for this story are certain that they know what happened because of the picture above.

A reasonable person would recognize that a picture does not tell us what is going on in the minds of the people in the picture.

The news decided to make a big deal out of the suspicions of two people who were not even there.

This is Jake Glover. He was driving, passed out, and seems to have tried to kill the nice tree in the picture.

Fortunately, no children were in the area, so this is not a case of vehicular homicide. Jake Glover does not remember anything and does not appear to take any of this seriously. He may even be smiling on camera. It is all on the video.
 


 

This is where he was coming from, when Jake Glover drove across this front lawn to attack the dangerous tree.
 


 

Compare Jake Glover’s expression with the expression of this paramedic with an apparently neutral expression on his face, possibly looking in the general direction of the photographer. Since he has dark glasses on, we cannot tell what he is looking at.
 


 

Did the photographer yell something, hit the horn, or is there more apparatus coming from that direction to assist EMS? We do not know and nobody interviewed has any idea.

This is Raquelle Peters. She was not there, but she is certain that she knows what was going on at the moment that picture was taken – and it was nefarious.
 


 

This is Tayler Mihailoff. She was not there, either but she is also certain that she knows what was going on at the moment that picture was taken – and it was just as nefarious as her buddy thinks it was.
 


 

Here is Raquelle Peters demonstrating the appropriate pose for EMS when a picture is being taken.

Really. Go watch the video. This is too silly to make up.
 


 

Hold on. Is Raquelle smiling in this picture?

This is an out of context image that could be perceived as smiling, especially when approached with the bias of There is evil smiling going on here.
 


 

Are these acceptable poses for paramedics?

According to the people complaining, based on their abundant experience with EMS, there are appropriate poses that should be implemented by EMS when someone takes a picture.
 


Posed picture from seniorjournal.com.
 
 


Posed picture from over61.info.
 

You can tell that the actors on the stretchers are extremely important to the EMS actors, even though the EMS actors are not looking at the actors on the stretchers. You can just tell how serious they are.

Sometimes it is appropriate to look at the patient while posing, but only if the patient is made out of plastic.
 


Posing paramedics from howtobecomeanemt.net.
 

Raquelle and Tayler would be so proud.

But this next picture might not be the way for EMS to pose.
 


Posing paramedics from internetmedicine.com.
 

Did anyone talk with the person who took the picture to find out what she thought was going on? Did she prompt the paramedics to pose? Did the paramedics seem to know she was there?
 


 

We don’t know, but this is news. Should we find out from witnesses or from people who weren’t even there?

There is nothing in the Twitter post about posing.

One person has his back turned and is clearly not posing.
 

Also read –

Irresponsible Posing? Absolutely.

No Apologies, Because America is a Victim Nation

Responsible Reporting and Credibility

Don’t rely on Dave Statter

UPDATE: TV station pulls report but fails to apologize & explain why it aired bogus story about smiling EMS crew

Thank you to Rachel for the link.

Footnotes:

[1] Paramedics pose for photo at crash scene
Posted: May 21, 2014 11:17 PM EDT
Updated: May 21, 2014 11:17 PM EDT
By myFOXDetroit.com Staff
Article

.

New Kansas EMS policy limits use of backboards

 


 

No, this is not an April fools prank, just another example of reason and sanity prevailing over EMS dogma.

Another large region in Kansas has stopped using backboards to transport trauma patients. 😀
 

The Wichita-Sedgwick County Emergency Medical Services System is no longer keeping patients on long spineboards when transporting them to the hospital, officials say.[1]

 

More people are realizing that manipulating patients onto boards does not protect patients from manipulation.

This is EMS, so dogma dies hard, but now that some EMS systems have pointed out that this EMS dogma is naked, it is just a matter of time until most of the country abandons this witchcraft.

We don’t quite have 150 years of tradition, unimpeded by progress, but we can eliminate tradition earlier than others.
 


 

I do have a problem with one statement –
 

The change was prompted by scientific studies that showed most patients do not need the boards during transport, officials said.[1]

 

There is no evidence that any trauma patient needs a board during transport.
 

“The issue of backboards has become more prominent in the last couple of years,” said Sabina Braithwaite, EMS System medical director. “We found that ‘Wow, we don’t have anything that shows this helps people,’ and there’s more and more evidence that it hurts people potentially.”

“Realistically, when you break your neck and go into the hospital they don’t keep you on a board there either.”[1]

 

Exactly.
 
 

Agencies/EMS Systems Minimizing LSB use –
 

Let me know if I should add your agency to this list.
 

Alameda County
CA
 

Albuquerque-Bernalillo County Medical Control Board
NM
 

Bernalillo County Fire Department
NM
 

CentraCare Health
Monticello, MN
 

Connecticut, State of
CT
 

Durham County EMS
NC
 

Eagle County Ambulance District
CO
 

HealthEast Medical Transportation
St. Paul, MN
 

Johnson County EMS
KS
 

Kenosha Fire Department
Kenosha, WI
 

Maryland, State of
MD
 

MedicWest Ambulance
NV
 

Milwaukee EMS
WI
 

North Memorial Ambulance & Aircare
Minneapolis, MN
 

Rio Rancho Fire Department
NM
 

SERTAC (Southeast Regional Trauma Advisory Council)
WI
 

Wichita-Sedgwick County EMS System
KS
 

Xenia Fire Department
Xenia, OH
 

Outside of the US –
 

St. John Ambulance
New Zealand
 

Norway
 

QAS
Queensland, Australia
 
 

Here are some articles on the problems with backboards –
 

EMS spinal precautions and the use of the long backboard.
[No authors listed]
Prehosp Emerg Care. 2013 Jul-Sep;17(3):392-3. doi: 10.3109/10903127.2013.773115. Epub 2013 Mar 4.
PMID: 23458580 [PubMed – in process]

Free Full Text in PDF Download format from NAEMSP.
 

EMS Spinal Precautions and the Use of the Long Backboard – Resource Document to the Position Statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma.
White Iv CC, Domeier RM, Millin MG; and the Standards and Clinical Practice Committee, National Association of EMS Physicians.
Prehosp Emerg Care. 2014 Feb 21. [Epub ahead of print]
PMID: 24559236 [PubMed – as supplied by publisher]
 

A re-conceptualisation of acute spinal care.
Hauswald M.
Emerg Med J. 2013 Sep;30(9):720-3. doi: 10.1136/emermed-2012-201847. Epub 2012 Sep 8.
PMID: 22962052 [PubMed – indexed for MEDLINE]

Free Full Text in PDF Download format from emsinternational.org
 

Out-of-hospital spinal immobilization: its effect on neurologic injury.
Hauswald M, Ong G, Tandberg D, Omar Z.
Acad Emerg Med. 1998 Mar;5(3):214-9.
PMID: 9523928 [PubMed – indexed for MEDLINE]

Free Full Text from Academic Emergency Medicine.
 

The Evidence Against Backboards – What does the spinal science say?
Bryan E. Bledsoe, DO, FACEP, FAAEM
August 1, 2013
EMS World
Article
 

For You Disciples of Spinal Immobilization…
… Bryan Bledsoe debunks your religion in the August issue of EMS World Magazine. And in that same issue, I take a dump on your altar. Our karma ran over your dogma.
August 1, 2013
by Kelly Grayson
A Day in the Life of an Ambulance Driver
Article
 

Why We Need to Rethink C-Spine Immobilization
By Karl A. Sporer, MD, FACEP, FACP
Created: November 1, 2012
EMS World
Article
 

Board to Death – The state of prehospital spinal injury care in 2013
Rommie L. Duckworth, LP
Created: July 15, 2013
EMS World
Article
 

In order to protect the c-spine, should we stop helping?
Mill Hill Ave Command
Saturday, December 15, 2012
December 15, 2012
Article
 

Another Nail in the Board
StreetWatch: Notes of a Paramedic
January 17, 2013
Peter Canning
Article
 

Does Spinal Immobilization Help Patients? – Who needs c-spine clearance?
Steven “Kelly” Grayson, NREMT-P, CCEMT-P AND William E. “Gene” Gandy, JD, LP
August 1, 2013
EMS World
Article
 

Plastic Snake Oil – EMS Spinal Immobilization
February 24, 2014
Life Under the lights
Article
 

Here is what I have written about other systems that do not require backboards for the transport of trauma patients –
 

More EMS Agencies Eliminating Backboards
 

Another System Eliminates Backboarding for Potential Spinal Injuries
 

The Slow, Agonizing Death of Conventional Spinal Immobilization
 

Stop the Madness! Reducing Unnecessary Spinal Immobilizations in the Field – Part I
 

The Lateral Trauma Position: What do we know about it and how do we use it
 

Footnotes:

[1] New Kan. EMS policy limits use of backboards – They will use backboards when moving patients to the ambulance, but then roll them onto a cot during transport to the hospital
EmailPrintCommentRSS
March 21, 2014
EMS1.com from The Wichita Eagle
By Kelsey Ryan
Article

.

Mounting Evidence Against the Long Spine Board in EMS – A Must Watch Video

 

Dr. Ryan Jacobsen explains that I have been using the wrong terminology for this piece of equipment. This is a picture of my padded spine board.

In this excellent video, he describes why and explains the problems with the use of backboards and the absence of any valid evidence to justify the use of backboards for transport.
 


 

The video is one hour and twenty-two minutes, so get comfortable, get some caffeine, and get ready to smile and learn.

And share this video.

There are currently only 188 views of the video. There need to be hundreds of thousands.

If you teach EMS, play this for your students, or just give them the link.
 


 

What is the basis for the backboard?

Let’s blame the people who touched the patient first, because EMS will go along with that.
 

Mounting Evidence Against the Long Spine Board in EMS
Ryan C. Jacobsen, MD, EMT-P
Johnson County EMS System Medical Director
Assistant Professor of Emergency Medicine
Truman Medical Center/Children’s Mercy Hospital and Clinics
YouTube page
 

Thank you to Bill Toon, PhD for the link, for obtaining permission from Dr. Jacobsen to share this, and thank you to Dr. Jacobsen for making the video.

.

More EMS Agencies Eliminating Backboards

 

All of these departments are going to get in trouble for not using backboards – aren’t they?

Trouble?

For not harming patients with witchcraft?

Does that really happen?

Or is it just another EMS myth?
 


 

RIO RANCHO, N.M. (KOB) – When the call is made, firefighters and paramedics quickly respond to the scene of an accident. Their goal: get the victim out of harm’s way and to the hospital. Most first responders in the country still pick up a person and strap them onto a board similar to this one no matter what. That will no longer be the case in the City of Vision. Dr. Darren Braude, the Medical Director for the Rio Rancho Fire Department, says the feedback has been excellent regarding the new method.[1]

 

The typical response is –

But I could be sued and then the patient will own the department and this magic treatment prevents badness!!!11!!!!

Is there any truth to that?

I could be sued?

We can be sued for anything. The backboard has nothing to do with whether we can be sued. Frivolous law suits are expected to be dismissed by the judge. The plaintiff needs to convince a jury that there was harm as a result of our actions to win a law suit. I am not a lawyer, but this is what lawyers tell me.

The backboard, and the harm it may cause, may be what justifies a law suit being successful against us and our departments.

The backboard is a magic treatment.

Magic = belief that X works, even though there is no valid evidence that X works.

Using that definition, we can see that backboards are no better than magic.

There is no evidence that backboards prevent injury.

There is no evidence that backboards protect patients with unstable spinal injuries from disability.

There is evidence that backboards make disability more likely – disability is twice as likely with backboards.

Since there is no evidence of benefit, and plenty of evidence of harm, should we just stop pretending that we are good witches and helping patients? Clearly, we are not helping patients.
 


Image credit from Voodoo Medicine Man.
 


 

RESULTS:
There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04). This corresponds to a <2% chance that immobilization has any beneficial effect. Results were similar when the analysis was limited to patients with cervical injuries (OR 1.52; 95% CI 0.64-3.62; p = 0.34).
[2]

 

What is our liability?

We need to understand what we are doing, because ignorance is not a good defense.

If our defense is – I am too stupid to be competent – we should not expect to win any law suit.

If we were constantly asking, Is this going to be on the test? – well, real patient care situations are the test that really matter. Life is the test.

 

it may be common or customary for EMS providers to use a long spine board or collar, decisions of standard of care and negligence are not based on what is the best, reasonable care, not on what is usually done.66 [3]

 

If we are providing bad patient care, because that is what everyone else is doing, we are failing our patients.

We are failing the test.
 

Rio Rancho Fire Department, Albuquerque Fire Department, and Bernalillo County Fire Department will be making this change.

Thanks to Dr. Darren Braude and everyone else involved.
 

If I have not written about your system, tell me about how your system has eliminated the requirement to use a magic backboard for trauma.
 

Here is what I have written about other systems that do not require backboards for trauma –
 

Another System Eliminates Backboarding for Potential Spinal Injuries
 

The Lateral Trauma Position: What do we know about it and how do we use it
 

The Slow, Agonizing Death of Conventional Spinal Immobilization
 

Stop the Madness! Reducing Unnecessary Spinal Immobilizations in the Field – Part I
 

Footnotes:

[1] NM Fire Department Using Alternative to Backboards – Rio Rancho looks at new evidence on immobilization
Monday, March 10, 2014
JEMS
Article/Video

[2] Out-of-hospital spinal immobilization: its effect on neurologic injury.
Hauswald M, Ong G, Tandberg D, Omar Z.
Acad Emerg Med. 1998 Mar;5(3):214-9.
PMID: 9523928 [PubMed – indexed for MEDLINE]

Free Full Text from Academic Emergency Medicine.

[3] Board to Death – The state of prehospital spinal injury care in 2013
Rommie L. Duckworth, LP
Created: July 15, 2013
EMS World
Article

.