Spinal Immobilization - Tool of Choice

[N2DFire]

O.K. - discussion seems to have gotten a little stale in here (to me at least) so here's a new topic to chew on.

Now - exclude any Clearing C-Spine in the field protocols and say that you MUST immobilize someone - what's your tool of choice and why?

- Standard Long Spine Board (LSB) aka Full Back Board (FBB)
- Scoop Stretcher
- Vacuum Mattress

Recently there was an article (July '06 JEMS - Out of Sight, Out of Mind: A Dangerous Practice. A.J. Heightman) regarding the use of a scoop stretcher over a LSB (when log rolling a pt) for spinal immobilization.

Also I read a article (forgive me but I can't recall when/where just now) regarding the use of vacuum mattress for spinal immobilization. It also stated the newer models are coming with reinforcing strips in the upper half (similar to a KED) for added immobilization.

The basic premise of both articles was that these alternate devices are just as effective (if not more so) in immobilizing the spine while at the same time are more comfortable and require less manipulation / movement of the Pt. to apply - thereby reducing the possibility of causing or furthering injury to the spine.

The floor is now open for discussion & debate.

[needlejockey]

I've never used a vacuum system so I can't comment on personal experience with it, just on stuff I've read or noticed from magazines and journals.

All I've usually had access to is the LSB. KED was rarely used, but I've found some interesting uses for it.

I do like the scoop. I have only two issues with it as a primary spinal imobilization system. One is that you can't check the patient's back to assess it. Granted that may not always be necessary on low mechinism of injury patients with no LOC and no AMS. If any of those three were present then I prefer a full body check. The other issue I have is I've found that strapping a person to one rarely is as stable and immovable as a good ol' fashioned LSB.

The vacuum systems seem rather nifty. You still get to roll the patient to check their rear, so that's a plus. It's form fitting, so that also works well with patients with protuding injuries. Plus once they are in it the whole unit sits on the squishy cot pad, something I am assuming would be more comfortable than the hard LSB for the patient. My only real concern with them is twofold. Part one is the length of time required to achieve vacuum. Second part is my worry that something would happen and vacuum would fail.

[Scotttt]

LSB is prefered. I wouldn't even think of of using anything else for full spinal immobilization, really. I've found the scoop to be best for those rare situations where the patient is in too much pain to be rolled, thus you scoop them up and either place them on a stretcher or onto a long board. I've never used the KED, I probably will never use the KED.

[mitllesmertz1]

LSB is prefered. I wouldn't even think of of using anything else for full spinal immobilization, really. I've found the scoop to be best for those rare situations where the patient is in too much pain to be rolled, thus you scoop them up and either place them on a stretcher or onto a long board. I've never used the KED, I probably will never use the KED.
you really need to read the article then, Scottttt.
They did a farily valid test comparing a scoop vs BB, measuring the amount of movement of spine, ease of use, and pt comfort.
In all 3 areas the scoop was found to be superior.
The sccop was as effective/more effective in immobilization, and every "pt" found it more comfortable.
And the KED gets used alot on peds around here :)
Might be time for everyone to rethink what we're doing.

Oops, what the hell am I saying, we can't do that... :rolleyes:

[DaSharkie]

How dare you insinuate that we should change what we have been doing for years!!!!! You have some nerve to question the methodologies that have been used over the past 30 years!!!!!

I have not read the entire study, I can't seem to get access to it without paying $$$$$ and I am too cheap to do that.

I do prefer the combi-carrier. You can use it as a backboard or a scoop depending upon your needs. And they are much more comfortable for the patient - apparently more secure as well.

Considering that skin breakdown that can lead to a decubitus ulceration can occur in some cases in less than 20 minutes, this is something that deserves a better look.

[Scotttt]

you really need to read the article then, Scottttt.
They did a farily valid test comparing a scoop vs BB, measuring the amount of movement of spine, ease of use, and pt comfort.
In all 3 areas the scoop was found to be superior.
The sccop was as effective/more effective in immobilization, and every "pt" found it more comfortable.
And the KED gets used alot on peds around here :)
Might be time for everyone to rethink what we're doing.

Oops, what the hell am I saying, we can't do that... :rolleyes:


You really seem to have some sort of complex that everyone other than you and one or two others, are traditionalists and against anything new as if somehow you are so much more enlightened than everyone else. :rolleyes:, :rolleyes:

I simply stated my preferance and observations. If you have evidence that suggests I act differantly then I'm all for reading it and reevaluating what I do.

Oh, and... :rolleyes:, :rolleyes:

[UKcyclist]

Over the pond, in sunny (at the moment anyway) London, we get our wrists slapped if we bring in a patient on a LSB having used a scoop first. Due to the short transfer time it is deemed inappropriate to take them off the scoop (plus you get it back from the hospital there and then, whereas they keep LSB till the patient is cleared) and put them onto a board. Plus you don t have to roll them to scoop them and provide more pelvic support, hence less spinal movement

[croaker260]

Having used all three, I have to say that I prefer the vacume matress (like a full body vacume splint). Unfortunately due to cost we have them only on our rescue team vehicles.

if they ever come out with a disposable vac matress (liek our disposable vac splints) then it would be worth a look.

We also use "back rafts" on our LSB to reduce pressure ulcers, and they also should reduce motion by design (you would have to see them to understand)

...that said, I am not against the scoop, except when it is very cold, because it will steal heat from a patient (at least ours which are metal). There have been times when I have removed them from an outside comparrtment and felt like my hands were stuck to them. Cant imagine being a lil' old lady in a nightgown made to lay on one.

Back boards will do the same, but I try to put down a blanket on them before I boad a pt. Also another reason to use a back raft, insulation.

[mcaldwell]

I have never used the vacuum mattress, but we scoop 85% of our spinals.

I am a firm believer, and have been for years, that a scoop causes less manipulation, and more comfort for the pt than the LSB.

If you are die hard LSB, at least please drop the old wooden boards, and get some of thenew contoured plastic units. They are Waaaaay more comfortable for the pt, and often easier to use and clean.

[mitllesmertz1]

I simply stated my preferance and observations. If you have evidence that suggests I act differantly then I'm all for reading it and reevaluating what I do.
Sorry I mistook this statement:
"I wouldn't even think of of using anything else for full spinal immobilization, really", as being from someone who is less than open-minded.
How could I ever get the idea that some people in EMS/Fire are not open-minded to new ideas?
:rolleyes: :rolleyes: :rolleyes:

[Scotttt]

Yeah, I wouldn't think of using anything else if I wasn't presented reason or evidence to use something else. If you have evidence and present it and I blatently reject it based on tradition then you may have a case that I am closed to new ideas. Other than questioning of spinal immobilization altogether, I haven't heard much in the way of new preferances for immobilization backed by any evidence other than anecdotes. Anyways... :rolleyes: :rolleyes: :rolleyes: :rolleyes:

[RFRDxplorer]

Here full backboards are used along with CID's or towel rolls.

KED's are commonly used during extrication but upon getting the pt. out of the car I have always been taught to put them on a backboard. (Is this common everywhere, ya never know.)

[the1141man]

Might be time for everyone to rethink what we're doing.

Oops, what the hell am I saying, we can't do that... :rolleyes:

No, indeed not. At least not in CA--we're "paid" to do, not think. Our state EMS Authority (and local/regional EMS administrations) will never let progress stand in the way of tradition. ;)

We've never tried vacuum splints around here...and scoop stretchers are in no way, shape, or form considered adequate spinal immobilization by our EMS administration. Apparently they don't read JEMS...*LOL* ;)

[OCFirePM]

I like to use duct tape and a piece of cardboard I find in the trash or gutter. If I can't use that, then I take the patient's shoelaces...

[JHR1985]

I rarely use a scoop. Only time I ever use it is for old ladies who have fallen and broken their hip. Otherwise, I use the LSB. Mainly, because thats the way i've been taught and the way our direction wants it done.

And as for change? Only so much talking to a brick wall someone can do before they give up


Sorry late night posting. I have fixed it

[krazyelfkith]

I rarely use a LSB. Only time I ever use it is for old ladies who have fallen and broken their hip. Otherwise, I use the LSB. Mainly, because thats the way i've been taught and the way our direction wants it done.

And as for change? Only so much talking to a brick wall someone can do before they give up
Eh? "I rarely us a LSB. ... Otherwise, I use the LSB" ?

[Bushwhacker]

Vac mats all the way, we can no longer(under our current med. Director) use Scope stretchers as a form of spinal imob. Just as effective as a LSB but way more comfortable, and close to bullet proof as far as the vacum issue goes.

[NHBasic25]

After trying a vacuum mattress at a conference I started looking for data and found several studies showing that vacuum mattresses provided immobilization comparable to a LSB with vastly better patient comfort. Given our transport times, comfort is not a trivial issue. One study using young, healthy volunteers showed that 100% developed back or neck pain after being strapped on an unpadded LSB for 30 minutes. Now think about an elderly patient with arthritis, tissue-paper skin, and no body fat -- is an LSB going to be the best care we can give? Our ski patrollers and wilderness folks also prefer the vac mat to the LSB.

The only real disadvantages are that you can't carry it from the ends, and it's not a good extrication tool.

[DrParasite]

question about the scoop stretcher (the old metal one anyway). when used to support the spine, what is actually supporting the spine? in ours anyway, both sides the the body are supported by the stretcher, while the spinal area itself has no support (the head area being the only possible difference).

[DaSharkie]

question about the scoop stretcher (the old metal one anyway). when used to support the spine, what is actually supporting the spine? in ours anyway, both sides the the body are supported by the stretcher, while the spinal area itself has no support (the head area being the only possible difference).

Nothing. Just the natural curvature of the body. But then again, when you actually lay onto a backboard, most patients have a natural curve as the musculature (or fat) comes around and the spine actually does not touch the board.

The exception to this being kyphotic or scoliosis patients, malnurished, underweight, etc.., where the spine actually protrudes from the back muscles and thereby causes the skin to contact the board.

With the combi-carrier (http://www.sands.ca/im040002.html or http://www.sands.ca/im040002.html) both sides are interchangeable, and as mentioned the device can be used as a backboard so that way you can just carry it in the rig as a backboard. Order them with the pins and you are good to go.

Personally, I think additional study should be done to confirm results. Always a good policy to NOT base a practice change on a solitary study.

Personal experience of mine agrees with these findings and I love these devices. The only downfall is the cost as they are pricier to buy.

That, and former co-workers of mine would be unable to use the LBB to surf down the street gutters after a good rain. :D

[RFRDxplorer]

Not sure if we still carry scoop stretcher.....I don't think so.

I think the last one we carried was given to the explorers.

Have we(explorers) used it? Not that I can recall.

[mcaldwell]

With the combi-carrier (http://www.sands.ca/im040002.html or http://www.sands.ca/im040002.html) both sides are interchangeable, and as mentioned the device can be used as a backboard so that way you can just carry it in the rig as a backboard. Order them with the pins and you are good to go.



Now that is an interesting looking unit. Anybody using one?

[RyanEMVFD]

Never used the vac mat. We mostly use LBB with headblocks and c-collars. Scoop stretcher is only used once in awhile. I just hate pinching patient's butts when putting the scoop together.

We still use the wooden backboards here. Their expendable, just as easy to clean and don't fit in the stokes baskets the FDs around here use. Plus the hospital hates them since the screws usually end up right where the x-ray picture is taken.

Several years ago we did try out a new type of plastic board that had foam inserts that made riding on one more comfortable for the patient. Haven't seen anything more from the company since than either.

[DaSharkie]

Now that is an interesting looking unit. Anybody using one?

I have used them in the past and like them a lot for a variety of reasons.

You just need to make sure you get the pins for straps so you can move them around easier and more quickly for proper securing of the patient.

Very easy device to use, and we boarded each other for training on them as well. Very comfortable considering the alternative being a LBB.