The National Association of EMS Physicians and the American College of Surgeons Committee on Trauma have made their Position Statement on spinal immobilization for EMS publicly available. So, now what?
It is hard to argue with their findings:
- Long backboards are commonly used to attempt to provide rigid spinal immobilization among emergency medical services (EMS) trauma patients. However, the benefit of long backboards is largely unproven.
- The long backboard can induce pain, patient agitation, and respiratory compromise. Further, the long backboard can decrease tissue perfusion at pressure points, leading to the development of pressure ulcers.
- Utilization of backboards for spinal immobilization during transport should be judicious, so that the potential benefits outweigh the risks.
I know that I have been torn in my own mind while strapping an octogenarian to a rigid long backboard when the only indication for such treatment was that she slipped on the floor of a rest home. Neurologically she may appear completely intact with a normal level of consciousness (GCS of 15), no complaints of numbness, lacking any spinal deformation or distraction injury. However, our protocols say she must be strapped to a rigid device without padding and subjected not only to the jolts of our handling, but every bump of a threshold as the stretcher is wheeled outside and then she continues to suffer the uneven pavement between the Emeritus Senior Living facility and the hospital. If she wasn’t sore due to the fall, she will definitely feel it by the time she is seen by a physician. I know I am protecting myself from any potential injury lawsuit, but am I really protecting my patient?
The Prehospital Emergency Care statement suggests criteria where use of a long backboard would not be indicated. Part of that definition includes the following recommendation:
- Spinal precautions can be maintained by application of a rigid cervical collar and securing the patient firmly to the EMS stretcher…
While I can imagine the greater comfort for my patient and even see the potential for improved spinal protection, it remains just a thought until the concept is adopted by my Medical Director and written into our protocols before I can actually change my behavior. While I applaud the new recommendations in this position statement, I feel powerless as I continue to apply a non “evidence-based” treatment to my patients. The primary restraint to change is not medical evidence, however; it is a lack of confidence that the field EMS personnel can make proper judgement calls on when the treatment is indicated or not. What I fail to understand is how it would be significantly different as we are already given specific latitude to make that call only it is constrained by a far more conservative set of criteria. Here is hoping a change can happen soon.