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

- Rogue Medic

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

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