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

- Rogue Medic

Another System Eliminates Backboarding for Potential Spinal Injuries

 
As of March 1st 2014, the Long Spine board will not be used by Johnson County EMS to transport patients.

Another system moves away from historical dogma – as a matter of fact, that is the language used to describe this change.
 

Other than historical dogma and institutional EMS culture we can find no evidence-based reason to continue to use the Long Spine board as it currently exists in practice today. The evidence that does exist regarding the Long Spine board is overwhelmingly negative.[1]

 

We need for more systems to place the care of patients above the care of historical dogma and institutional EMS culture.
 


Click on images to make them larger.
 

We need to stop basing decisions on What if . . . ?

Where is the evidence that transport on a Long Spine board is a good idea?

That is a healthy list of unhealthy side effects.

Consider giving the list above to patients and telling them that these are the risks we will subject them to if we transport them on Long spine boards. How often would would we obtain informed consent?

The first question should be – What is the possible benefit?

Well, . . . .

The hypothesis that transporting patients on Long Spine boards protects the unstable spine from further injury has been tested only one time.

That hypothesis failed miserably.

 


Out-of-hospital spinal immobilization: its effect on neurologic injury.[2]
 

The rate of disability doubled with spinal immobilization.

If we gave epinephrine (Adrenaline) and we cut our rate of resuscitation in half, how long would we continue to use epinephrine?

If we gave furosemide (Lasix) and we cut our rate of intubation doubled, how long would we continue to use furosemide? Ooopsy – some of us still do and furosemide probably produces a much greater increase in the rate of intubation than just doubling it.

How can we keep claiming that we are helping patients?
 


 

Thank you to Bill Toon, PhD of the recently ended EMS EduCast and the not so recently ended EMS Research Podcast for the information.

Footnotes:

[1] Johnson County EMS System Spinal Restriction Protocol 2014
Ryan C. Jacobsen MD, EMT-P, Johnson County EMS System Medical Director
Jacob Ruthsrom MD, Deputy EMS Medical Director
Theodore Barnett MD, Chair, Johnson County Medical Society EMS Physicians Committee
Johnson County EMS System Spinal Restriction Protocol 2014 in PDF format.

[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.

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Comments

  1. Wow. Just wow. I wish more systems could open themselves up to science, reason, and logic and come to this conclusion amongst others with regards to what kinds of torture we put upon our patients in the name of “it’s the standard”. Oh well, progress is occurring at least, and that’s happy.

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