One of my first really successful posts years ago was “A Short Take on Long Boards” where I found myself piling on the negatives regarding our habitual dependence on the Long Spine Board. I do not feel as though I can take any credit, however, for agencies such as the Palm Beach Florida Fire Department or the New York City Regional Medical Advisory Committee who have since chosen to abandon the practice of its use. Many others have made their displeasure of the practice clear in endless commentaries on the topic. And the photo above on the “Proper Placement of Backboard” garnered many “Likes” on social media. It is the traditional reliance on the backboard, in an attempt to totally immobilize patients, based predominately on the MOI that has lead some to parody the practice in a clever cartoon episode. As a matter of fact, the only evidence I could find to support the use of the spine board as an immobilization device for transport was this randomized clinical trial setting it up against a vacuum mattress splint in a false dichotomy that I could only hope is a mocking satire. In an even deeper insult to our immobilization practice, Dr. Bryan Bledsoe, emergency physician and EMS textbook author, has also gone on to suggest limiting use of the rigid cervical collar as well. Suddenly, the topic of immobilization seems to be much more fluid.
Still, I fear some may have gone too far in calling for the removal of the LBB from ambulances everywhere. In general, we are often all too willing to jump from one bandwagon to another in an “all or nothing” dance to be more “evidence-based” than the next medic. I have heard colleagues suggest that the KED is the rightful heir to the immobilization throne, but in my mind that is like replacing the standard stretcher with a stair chair. In some cases one may be more appropriate than another, but the recognition that a tool has limitations does not mean it should be replaced in every instance. We simply need to become more aware of when to use it, not just remove the tool from the toolbox altogether. I feel we have done the same thing with response times, if they don’t ALWAYS matter, then they NEVER matter (but that is a topic for another post.)
The backboard remains a flexible extrication tool that is widely available and already well understood by first responders. Furthermore, it can be adapted for other uses. Another topic that is hot in EMS right now is High Performance CPR. While the basics of CPR have been around for decades, we are learning better ways to apply it and even understanding more about the science behind the mechanics of how it works. We know, for instance, that the patient must be on a firm platform for effective compressions and the backboard fits that need very well. More recent research also suggests that tilting the compression platform to a semi-fowlers’ position decreases ICP for better brain perfusion. Instead of introducing a new device, the backboard can be adapted to this use by raising the head about the height of your bag.
It is great when we can improve the efficacy of our work without adding anything to the expense of it! The most difficult change is in our attitude.