By Kelly Grayson
File this one under “tips to make ineffective and potentially harmful practices a little easier.” Despite the fact that a Cochrane Review of the available literature on prehospital spinal immobilization concluded that there is no evidence of benefit to patients with spinal injuries, and a growing body of evidence that it may indeed do harm to some, spinal motion restriction remains the de facto standard of care in most EMS systems.
Even with spinal clearance algorithms, we still backboard a lot of people. Whether or not EMTs in 2031 look back at us as woefully misguided for strapping our injured patients to hard plastic boards, right now in 2011, we owe it to our patients to make the procedure as smooth as possible.
We’ve all been there: we’ve carefully assessed our patient, had a partner hold manual stabilization of the cervical spine, applied a cervical collar, log-rolled the patient onto his side and checked his posterior torso, wedged a backboard in place, log-rolled him back onto the board…
… and then bent his back like a parenthesis as we pushed him laterally to center him on the spine board.
Sometimes it’s an error in communication causing the movement to be poorly coordinated among the rescuers. Other times the patient is large and difficult to move. Quite often, the patient’s bulky wallet in his hip pocket hung on the near edge of the board, causing you to do just what you were trying to avoid: excessive manipulation of the spine.
It’s actually pretty uncommon for a patient to be perfectly centered on the board after we’ve log-rolled them onto it. Most of them need to be shifted to some degree. The question is how you accomplish that centering movement with the least amount of manipulation.
To minimize manipulation, place the board about 18 inches higher than the patient’s head when you log-roll them onto their side. Wedge the board under the patient, and log-roll them back onto the board. You’ll find that the patient is still not centered on the board, with their feet and lower legs hanging off the end of the board and their head 18 inches too low.
Have the rescuer holding C-spine stabilization brace the head of the board against his foot. At his direction, the other rescuers grab the patient by the torso and the hips, and slide the patient up into the proper position on the board.
Centering the patient that way accomplishes the move by moving the patient along the long axis of the spine, rather than against it, and the end result is less potential manipulation of the thoracic and lumbar spine.
Practice it a few times with a manikin or a healthy volunteer, and then try it in the field. I’m betting you’ll find that it works better.
