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.

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Comments

  1. Amen, brother! I can’t emphasize enough how much I loathe any protocol that emphasizes backboards. I loathe even more services that don’t even understand current criteria for backboards, let alone emerging mindsets on eliminating them. The fire services I deal with put anyone who has endured even the most minute physical trauma on these medieval devices…because reasons.

  2. as a PA medic we started reducing backboard use approximately 2 years ago. Started reducing c-collar use last 6 months ago. Had 2 pts recently with neck pain, but no nuero deficits. Neither got a collar until we got to ED where MD ordered Philly Collars on both. Of course both had collars taken off after CAT scan cleared them. I’ve been using the Orthopedic Stretcher for moving significant spinal, pelvic & long bone injuries for the last 20 years. Wish vacuum litters were better accepted in the US. I would like to acknowledge the progressive Medical Directors in Eastern PA for helping move EMS forward through Evidenced Based Medicine.

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