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Backboards and Spinal Trauma

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ABlevins's picture
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Kentucky
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August 13, 2015
Backboards and Spinal Trauma

What is everyone's opinion or protocol on using backboards during extrication or for immobilization? Our level one trauma center near us has lobbied the state successfully to change the state's trauma protocol limiting the use of backboards, especially in distance transports greater than 20 minutes. This was met with resistance from paramedics and emergency physicians alike, even though the research and clincial evidence shows that long board immobilization can be extremely detremental to a patient's long term recovery. What are the protocols like for those that are working on the track regularly regarding this issue when the paramedics or on scene physican suspects significant spinal trauma?

Jeff Milges's picture
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Palm harbor Florida
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August 18, 2015

There is a growing trend to use LSB less and less in the field, or for Paramedics, and in some cases EMTs to "clear" the patient of any spinal injuries. I do think that on the street we immobilize too many patients, more out of liability concerns than actual injuries. I however, tend to follow my protocols that were developed, and implemented, when they had the best data at the time to come to their conclusions about the need to  backboard somebody. I don't have the "Sheepskin" on my wall so I can't make my own decisions about this.

Things come and go in EMS, remember MAST? They worked great in Viet Nam due to the transport times from the battlefield. In the US, due to lack of training, ER Physicians and RN's were cutting them off and wondered why the blood pressure dropped and the patient died. Most tracks are on the outskirts of towns because people don't want to hear roaring engines late at night. What works in a Urban setting like a city, won't work in rural areas. Doctors have to remember that their hospital is not the center of the universe.. there are parts of our country wher transports could be over an hour. There are not helicopters on the roof of every hospital.

What I do know is that even a simple ground level fall with only a minor abrasion on the palm of my (63) year old patient with only shoulder pain, ended up having a fractured neck. The FD on scene didn't even want to help me backboard the patient because they didn't think it was necessary. But it was the Mechanism of Injury that made me not be cowled by their remarks. There were numerous other calls over the decades that followed the same trend. A BS call that had serious injuries that would have been overlooked by EMTs or Paramedics.

There are a very few tracks that even have medical protocols for their safety teams. Most tracks I know of, the crews have to beg, borrow, or misapproprate their medical equipment, because the track won't cut loose the funds. The track managers need to be educated, to trust their safey team leader to know whats best for their drivers and the facility as a whole.

The other side of the coin is that an EMT or Paramedic cannot even function at their skill level without haveing a Medical Director. Some jurisdictions are lucky where an EMT is covered by Medical Direction when he is not working at his regular job assignment, but working on the side as an EMT at a track on a saturday night.

But, I do see the need to utilize spinal restrictions on any patient who has crashed into a wall, or even under a trailer at less than 25 mph. I mean, lets face it, we are responding to a crash at 200mph while it is still occuring! We see how violent it is.

We may be amazed when a drivers climbs out on his own, but usually the "OH  S%*!"  response we have during a crash means we should consider the possiblity of head and neck injuries. Most drivers, even with possible spinal injuries will refuse treatment due to high levels of adrenaline which can mask pain until later. Spinal Cord swelling can take up to 20 minutes to manifest itself, and usually after they are back in their pit or trailer. Concussion or sub dural hemotoma are other considerations that are often over looked.

So, EMTs will work under their local protocols since they don't want to be sued, or disciplined for deviating from their protocols. Tracks with rescue crews wearing shorts and T-shirts (I'm profiling") won't change becuase they apparently dont know any better.

Track safety teams need to educated themselves on what works and does't. For us, a KED doesn't fit into a contoured race seat. Its ok for street cars drag racing at the track. There are other options such as the Shoehorn, Speedboard, Extricator, and others.

Usually any driver who does not self extricate has something going on with him that may not be immediately evident. Its best to err on the side of protecting the driver from further harm. Until we have a portable x-ray machine and a licence higher than an x-ray tech (Radiologist) we have to look at the mechanism of injury, the patients protest (or lack of) and go with your training. I've been on a backboard, I know their not comfortable, but comfort, or spending the rest of their life in a wheel chair breathing thru a trach is an easy decision. After all, you also have to live with it.

hcisneros's picture
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Miami, FL
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August 30, 2015

It is my understanding the latest homologation of racing seats from the FIA require a quick disconnect for the entire seat to extricate drivers while still sitting in their seat. I would assume this is through a large roof hatch. What do we know about this latest homologation and the implications?

keithwyss's picture
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Fort Wayne, IN
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December 8, 2015

Most EMS protocols allowed use of LSB's as needed for patient removal/extrication and as seen fit per mechanism of injury.  An interesting question is how effective are they to begin with.  I have significant experience with vacuum mattresses and splints...much more effective with far fewer side effects. 

Bottom line- we still need to do what is proper in our clinical judgement...and talking about it later is great.

 

Keith

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