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Backboards vs Vacuum Mattress
does back boards really induce complications? especially in trauma patients?
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Replies to This Discussion
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Permalink Reply by Bill Grass on -
If the pt is left on the board for an extended period of time, they can start getting skin breakdown. The boards are obviously uncomfortable and I've heard many pt's say they don't know if their hurting from the accident or if they hurt because of the board. I have never worked with a service that uses the vacuum mattress, seen them just never used them. Hope this helps
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Permalink Reply by Robert McComas on
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I would like to offer an alternative to both back boards and vacuum mattress. As an instructor for our EMS group, I have taken to advancing the idea of sccop stretchers to be used. There is very little discomfort for the pt and spinal alignment can be maintained at the same time. Application is quick and easy and have found in training that the group picks up on this quickly.
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Permalink Reply by Bill Grass on
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Regardless of what device you use, the focus should be to get them off of the backboard as soon as possible.
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Permalink Reply by Bill Grass on
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LOL I hear ya! We had a cot strap cut just the other day. I agree padding the board seems to be a lost art, working for a hospital based service I get to see the results of pt's on boards for extended periods, so I pad whenever possible.
Chance Gearheart said:This. In addition, too many crews just throw the patient on a backboard without padding it or padding void areas. Pet peeve of mine.
Atleast with a backboard you don't have to worry about the new medical residents at the trauma center getting scissor happy with your 2000 dollar vac mat.
Bill Grass said:Regardless of what device you use, the focus should be to get them off of the backboard as soon as possible.
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Permalink Reply by Chris Turner on -
There is something about C-Spine controll and LBB that people don't understand: Most people don't need it! I don't remember the actual numbers but it's something like less than 1% of our patients actually have a cervical injury, yet we continue to do it because it is the "Standard Of Practice" carried over from the days of Jonny and Roy. I view this in the same light as if we were administering Nitro to EVERY patient that complained of ANY kind of pain. Yes, you will eventually give it to someone with AMI, but we are doing more harm than good here.
We all know the problems caused by immobilizing (pressure ulcers, more pain, ect) but something else to consider is the fact that while we may fully immoblize with a collar and LBB, that doesn't help with patient straining against the straps. I argue that a patients can do more damage to their cervical injury just by fighting and straining due to their discomfort rather than relaxing on the cot or in a vacuum mattress.
I would like to challange all of you reading this to take a closer look at your vacuum mattress (if you have one) or borrow one to play with. I want you personally to lay on the ground and have your coworkers immobilize you with it and then again with the LBB using standard practices. Pay special attention to the way your spine moves AFTER you are fully immobilized. Have your mates pick you up and walk around with you on both devices and then talk about each experience.
The mattress lacks some of the tensile strength that the board has, BUT if you cary it properly at the sides and not the ends, it actually works better than the board. Not to mention no more bulky CID equipment, only a roll of good 2" tape is needed. The only instance where I can see a mattress not working is vehicle extrication. However, if you have a LBB that splits, all you have to do is place the board on the mattress and pull.
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Permalink Reply by K C Nickels on -
It is my belief that we should move toward the Curved-Scoop style spine boards. The Curve of the board is going to fit the patient and padding can be added. The newer plastic Ferno Scoops are another option that is more comfortable. Of course I have seen medics roll a supine patient onto a scoop versus breaking it apart for a hip fracture. I also believe we should have protocols and education on field clearing of spinal injuries. Obviously this would require a good... no Great QA / QI program. And how about taking another look at KED's and thier use. If the patient is stable and depending on complaints and findings on assessment, why must we automatically place the patient supine. Outside of the box what are the options?
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Permalink Reply by Semper Paratus RN, PSEMT-D on -
According to my instructor and based my experience, spine boards produce 75% of stress at the spinalcord of a trauma patient plus the not-truly-secured body of the patient in the spine board even it was strapped securely.. in vacuum mattress, the patient will only recieve 25-35% of stress in the spinal cord due too mattress fills the gap example, it hug the curvature of the spine that it makes less stress at the back. the downside, I think, of the vacuum mattress is that you can't put simple BP cuff in the arms of the patient due to the whole mattress is hugging/secured the body of the patient.. in using scoop stretcher, it was advice and easy to use in flat surface but in uneven terrain like in mountain rescue, likewise, spineboard is more usable.. I hope this experience of mine would help others
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Permalink Reply by Duncan Hitchcock on -
Backboards, backboards, backboards. After over 35 years in the EMS business it is still my dream that someone would do a truly evidenced based study on backboards. This study, in my dreams, would look at their actual need for application and their design. Made be even develop standardized means of application in different situations. And standards for how long a patient can be left on one.
I know, I'm a dreamer. But that's one of the things that keeps me going even after 35 years.
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Permalink Reply by Chris Turner on
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I agree very much. I didn't mean to give the impression that I am anti-LBB. Instead, I am trying to just get people to consider other options than when we know doesn't work well. A mattress is not THE answer, no more than spyder straps, c-collars, or any other device..is about proper patient care.
You are perfectly true as far as the other problems in our field. We have a lot of lazy people out there...wether it is sizing a collar, padding a board, or not properly straping someone down. I say a lot of the problems could be traced back to our poor education system.
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Permalink Reply by dr-exmedic on -
Chance Gearheart said:
Oh, see, I think they're the greatest thing since bread was first sliced--but then, I got sick of seeing mis-sized collars coming in time after time really quickly. :) If we expect a pt to be in a collar for any length of time, the first thing we'll do is slip them into one of our adjustable collars.The adjustable C-Collar is the worst invention since cocaine, in my book.
In addition to the obvious supply chain simplification and space savings, people don't come in just 4 sizes. Adjustable products (other than the Stif-neck Select) seem to recognize this. In fact, if someone's really going to be in a collar for a while, they'll get a Miami J, which is A) adjustable and B) comes in multiple shapes for different body habitus. I can't expect every medic unit to carry 5 different shapes of collar but I think the adjustable is the best way to go.
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Permalink Reply by K C Nickels on
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I have to agree with the good doctor. We carry 6 adult and 4 ped Select 3 collars. Instead of carrying 4 or 5 of each size which most would end up dirty and thrown in the trash because of their rare use.
Most of the time the collar is a reminder to the patient and the medic to limit movement. If you do not properly place the patient in a head bed and tape along with first strapping the patient it is all for show. I still contend that the break apart style backboards are a great option. The break apart are curved so they will fit the patient better and yes if the patient is not supine they can be rolled and supported on this style of board. The newer plastic ferno scoop is another option and padding can be added prn. One size does not fit all. You have to think beyond the national registry test.
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Permalink Reply by Joe Paczkowski on -
In regards to the learned bad practices and adjustable c-collars.
[dripping sarcasm] You mean that "No-necks" really aren't appropriate for everyone?:face of shock and dismay: [/dripping sarcasm]
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