It makes sense that when we think a bone is broken, we immobilize it in a long, rigid splint. This helps with pain and prevention of further injury. Applying this concept to spinal immobilization is problematic, however. This spine is a curved structure and strapping it down to a long, rigid board doesn't make a whole lot of sense. The utility of backboards at preventing further spine and spinal cord injury has never been proven, but we certainly know it causes pain and leads to decubitus ulcers in our patients. In this month's feature film, Dr. Michael Bohanske takes a close look at why the nation wide trajectory for EMS providers is to abandon the backboard for spinal immobilization.
Presented at the Maine Medical Center Winter Symposium in March, 2017 at Sugarloaf Maine.
MICHAEL BOHANSKE, MD
Division of Emergency Medical Services
Department of Emergency Medicine
Maine Medical Center
1. National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. Position Statement: EMS Spinal Precautions and the Use of the Long Backboard. Prehospital Emergency Care. 2013;17(3):392-393.
2. Geisler, WO, Wynne-Jones, M, and Jousse, AT. Early Management of the Patient with Trauma to the Spinal Cord. Excerpta Medica International Congress Series No. 110, Proceedings of the Third International Congress on Neurological Surgery, Copenhagen. August. 1965.
3. National Athletic Trainers Association. Appropriate Prehospital Management of the Spine-Injured Athlete Updated from 1998 document. 2015.
4. Maine Emergency Medical Services. Maine EMS: Prehospital Treatment Protocols. December 1, 2015. Available: www1.maine.gov/ems/documents/2015Protocols_maine_ems.pdf
5. Clemency, B, et al. Compulsory Use of the Backboard is Associated with Increased Frequency of Thoracolumbar Imaging. Presented: National Association of EMS Physicians. New Orleans, LA. January, 2017.
Posted by Jeffrey A Holmes, MD