Sunday, May 11, 2014

EMS Evolution: Relaxation of Spine (Back) Boarding Rules Ahead?

Not sure if anyone has noticed or not, but the National Athletic Trainers' Association has a new blog directed to professionals and students in the field.  Content is generated via professionals from around the country, and a couple of days ago one was brought to my attention.
You can read it here.

While the post doesn't delve into specifics, it does state that several protocol changes are occurring in the area of spine boarding...most notably the prospective omission of the use of spine boards with suspected cervical injuries.  EMS appears poised to begin transporting certain cases (I am unsure at this point as to which ones) with a cervical collar only.   As Dr. Swartz points out, this should really spur ATC's to meet with their local EMS provider(s) to discuss their current protocols and how it might affect your overall management.    I'll certainly be looking forward to the upcoming position statement...

In the meantime, consider my curiosity piqued.  Two questions linger for me:
Are backboards even effective?
Are cervical collars even effective?
So, I did a bit of searching and this is what I found.

This article challenges conventional wisdom (perhaps a better term is conventional practice) regarding the blanket use of cervical collars.  In fact, validation for challenging the efficacy of cervical collars was studied a decade ago.  Which ultimately lead me to this article, which was a real eye opener.  There are a number of valid points the article raises, and one of them is the topic of patient comfort.  Having seen a full body vacuum splint used when I was in France a few years ago, I can honestly say it makes a lot of sense to potentially use one of those as compared to a traditional spine board.  It seemed far more comfortable compared to it's stiff counterpart.

So after becoming  more convinced evidence is lacking, I stumbled upon  Neurosurgery PreHospital Cervical Spinal Immobilization After Trauma, which states virtually the exact opposite of what other studies are saying. 

Needless to say, it will be very interesting to see how this situation develops, both regionally and nationally.  While I fully realize I'm not answering any definitive questions here, I am trying to illustrate the difficulty clinicians face when attempting to best care for their patient.  That headache, neck and/or back pain may be exacerbated by the very tools we use to "safely" care for them.   



2 comments:

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  2. The recent article in the July NATA News titled, "Spine Boarding in Athletic Trauma;
    A PARADIGIM SI-IIFT", speaks to this topic directly. As I prepare to teach my students airway access and equipment removal of the equipment laden athlete, I will mention my premonition that in 5 years we will be removing equipment on the field and no longer spineboarding for precautionary reasons. What a 180. Just a premonition!. I'm on board with these changes, no pun intended!

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