II. Indications: Maintenance of spinal immobilization for emergency vehicle transport
- Extrication from accident scene
- Allows for easier transfer of patient from difficult conditions by multiple rescuers
- Wilderness rescue (e.g. mountain terrain) may make use of scoop stretcher or Stokes basket
- Once extricated and patient on firm cot, consider alternatives to Backboard (see below)
- Serious mechanism of injury (suspected or evident Spinal Injury or neurologic deficit)
- High energy mechanism
- Spine deformity
- Focal neurologic deficit
-
Traumatic Injury and does not meet all criteria for spine clearance
- Glasgow Coma Scale (GCS) 15
- No spinal tenderness to palpation or anatomic deformity
- No neurologic complaints or exam findings
- No distracting injury
- No Intoxication (drugs or Alcohol)
- Age <65 years
III. Contraindications
- Spine Boards are not intended for in-hospital Spine Immobilization
- Avoid immobilization in penetrating head, neck or torso Trauma without spine injury findings or focal neurologic deficit
IV. Precautions
- Remove patients from Spine Board within 20 minutes of emergency department arrival
- Patients on Spine Board must have 1:1 observation to intervene for Vomiting, change in mental status or attempts to move
- Maintain full spinal precautions after Spine Board removal until spine fully cleared
- Emergency department gurneys offer adequate firm surface for spinal support (Cervical Collar is also required)
- Use slider boards in-hospital to transfer patient from gurney to diagnostic equipment (maintain full spinal precautions)
- Do not leave patients on slider boards for extended periods of time
- Consider intubation and sedation in uncooperative patients unwilling or unable to maintain spinal precautions
V. Adverse Effects
-
Pressure Sores (especially in elderly)
- Remove patients from Spine Board within 20 minutes of emergency department arrival
- Aspiration
- Patient unable to turn head if they vomit
- Continuous 1:1 observation until off board
- Impaired respiratory function
- Spine Board immobilization restricts pulmonary expansion
- Impaired Trauma Evaluation
- Spine Boards interfere with an adequate physical exam and lead to increased imaging
VI. Management: Alternatives to Backboard for spinal immobilization (for EMS)
- Indications
- Patient ambulatory at the scene
- Protracted transport time
- Other indications for Spine Immobilization as above
- Technique: Spine Immobilization
- Rigid Cervical Collar AND
- Supine on cot AND
- Consider head block AND
- Consider securing patient to gurney (e.g. via Seat Belts across chest, Abdomen, Pelvis, and legs)
- Technique: Self Extrication (replaces standing takedown) for ambulatory patients with spinal tenderness
- Rigid Cervical Collar applied first
- Patient ambulates to cot with or without assistance
- Patient lies in supine position
- Patient secured to cot as above
VII. Technique: Spine Board Clearance
- Attempt to remove all clothing prior to Log Roll
- Push Spine Board straps under patient's lateral decubtus side (side that they will lie on when Log Rolled)
-
Log Roll (requires 4 people)
- Attendant at head
- Maintains control of head and neck and directs the Log Roll ("Roll on 3 - 1,2,3 - Roll")
- Attendant at torso
- Rotates torso into lateral decubitus position
- Attendant at Pelvis, hips and legs
- Rotates hips and leg into lateral decubitus position
- Provider at back
- Removes the Spine Board
- Walks the spine from cervical through sacral examining for focal tenderness, deformity, crepitation
- Observes skin for wounds, Bruising
- Additional measures in significant Trauma
- Examine perineum
- Rectal Exam (evaluate tone, blood)
- Attendant at head
- Spinal Precautions
- Maintain spinal precautions until full spine clearance based on history, exam and imaging as indicated
- See Precautions above
VIII. References
- (2008) ATLS, American College Surgeons, Chicago, p. 184-5
- White (2014) Prehosp Emerg Care 18(2): 306-14 [PubMed]