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Long spine boards are a commonly used patient movement device in EMS. In most circumstances, a patient will be secured to a long spine board for spinal immobilization to prevent further spinal injury and if suspected spinal cord injury exists.
Long spine boards can also be used any time a patient needs to extricated from an area and needs to be carried by EMS professionals (i.e., unconscious patients that need be carried downstairs, vehicle accidents that end up off the roadway where patients need to be carried back to the waiting stretcher, etc.).
CONTRAINDICATIONS: Contraindications to long spine board use include
- pelvic instability and
- hip fractures, or
- conditions that otherwise prevent the patient from being log-rolled or directly lifted.
Long spine boards consist of a hard plastic or wooden material that is more narrow on one end and has multiple handles for carrying and select places for straps to be anchored.
Long spine boards are approximately two and a half feet to three feet wide at the head of the device and two feet wide at the foot of the device.
LOG ROLL: Patients with potential spinal cord injury will be log-rolled onto the long spine board, with their shoulders and head at the wider end of the device.
Cervical collars will have already been applied to any patients with suspected of potential spinal cord injury prior to the log roll into the long spine board.
After the log roll is completed, the patient may be too high or too low on the long spine board and may need to be repositioned at this time.
- EMS professional number one will be in position at the head of the patient, holding manual in-line cervical stabilization, and communicate to the team that the patient needs to be repositioned.
- To reposition the patient, EMS providers numbers two and three will position themselves, one professional on either side of the patient, and grab the most sturdy handhold possible (usually, the patient's arms, legs, or clothing, making sure not to grab an injured area); preferably with palms down.
EMS professionals two and three will maintain proper body mechanics, keeping their backs straight and heads up.
On EMS professional number one's count to three,
- EMS professionals two and three pull the patient towards the foot of the device, while EMS professional number one continues to hold manual in-line cervical stabilization.
The patient should be positioned centered on the device, by pulling over and down. Once this is this case,
- EMS professional number one will communicate that the team will now pull the patient up on the device.
EMS professionals two and three will maintain proper body mechanics, keeping their backs straight and heads up.
On EMS professional number one's count of three,
- EMS professionals two and three pull the patient towards the head of the device until the patient is fully positioned correctly on the device.
The patient should always be pulled down and over, before being pulled up, to prevent further spinal injury as much as possible; pulling from the side of the patient could aggravate or increase any spinal damage or pain.
Now that the patient is correctly positioned on the device,
- the patient's body should be secured to the device.
Typically, on a long spine board, the torso is secured with straps first, then the abdomen or waist and then the lower body. If a cervical collar has been placed on the patient, the patient's head is secured to the long spine board by placing commercial styrofoam head blocks or rolled-and-taped towels on either side of the patient's head, and then taping the patient's head and block devices to the board. EMS professional number one will continue to hold manual in-line cervical stabilization while EMS professional number two will place one end of the tape (either traditional duct tape or tape that comes with the commercial head blocks) on one side of the long spine board, then guide the remaining length of tape underneath and against the chin of the patient/c-collar, and then finally to the remaining side of the long spine board.
A second piece of tape will be applied in the same fashion, just across the patient's forehead.
- All extremities should be assessed for circulation, motor function, and sensation prior to and after immobilization to a long spine board.
It is at this time that EMS professional number one can release manual in-line stabilization of the patient's cervical spine.
- Any voids or obvious spaces of distance between the patient and the long spine board will be padded with towels, blankets, or bulky dressings.
At this time,
- the log roll of the patient with proper repositioning and correct immobilization has been completed.
The log roll can be performed without the cervical collar if no suspicion of neck injury exists. Full immobilization may not be necessary, either. It is often that patients are log rolled and secured to a long spine board only to facilitate movement up or down stairs or through other circumstances where the patient cannot be initially loaded onto the mainly-used wheeled stretcher.
Short Spine Boards
Short spine boards are also known as CPR boards and allow for the patient's torso to be secured and immobilized with the use of much less space, and thus they are ideal for use in tight spaces (i.e., vehicles, cramped spaces in homes, etc.), but this is at the cost of not providing support for the legs of patient.
As with all devices in EMS, only professionals that have been trained and are comfortable with the short spine board should be involved in the use of the device.
► Use of short spine boards is limited and they are usually only utilized until immobilization to a long spine board is practical and possible.
Short spine boards are often used as support on plush surfaces like beds or stretcher mattresses, placed between the plush surface and the patient by a log roll or similar move, to facilitate effective CPR. The patient's torso can be immobilized to the short spine board by several straps that anchor to the device.
The Kendrick Extrication Device (K.E.D.) is a device that is used in vehicle extrication to remove victims of traffic collisions from motor vehicles. In some instances, neither a short spine board nor a long spine board is practical or able to be utilized when a patient needs spinal immobilization.
This is often the situation in vehicle accidents that require extrication or any time a patient is in the seated position and has suspected spinal trauma requiring immobilization.
- altered mental status,
- penetrating chest trauma, and
- any injury of the torso that is incompatible with circumferential pressure to the torso (i.e., flail chest, rib fractures, etc.).
The vest-type backboards were designed for removal of Formula One racecar drivers from their vehicles after an accident and are used in EMS today by most services.
As with all devices in EMS, only professionals that have been trained and are comfortable with the vest-type backboards should be involved in the use of the device.
A vest type backboard consists of a tough sturdy, rigid material that fits behind a patient and is secured by multiple torso straps and legs straps for torso/back immobilization.
The vest type backboard also has an extending portion that is designed to secure the patient’s head, maintaining spinal integrity. The vest type backboard has multiple handles for EMS professionals to lift a securely fastened patient out of a vehicle or other situation in which the patient has been immobilized in the seated position.
IMPLEMENTATION: To correctly apply a vest type backboard, at least two EMS professionals are required. When it has been determined that a patient who is found in a seated position requires spinal immobilization,
- EMS professional number one will apply manual in-line spinal stabilization of the patient until EMS professional number two applies an appropriately sized cervical collar.
When the cervical collar is correctly applied,
- EMS professional number one will continue to hold manual in-line stabilization of the patient’s cervical spine throughout the application of the vest type backboard.
- EMS professional number two will place the opened vest-type backboard device behind the patient and position the device snugly under the patient's arms.
- EMS professional number two will then gently but firmly wrap the vest type backboard around to the front of the patient and begin securing the straps in the order accepted by local protocols.
The torso of the patient is always secured to the vest-type backboard before the leg straps and head is secured. Each leg strap should be threaded underneath the seated patient's legs as close to the groin as possible and secured firmly to prevent movement of the device or movement of the patient within it.
Once the legs of the patient are secured,
- the head-and-neck pad that is included in the commercial vest-type backboards packaging is placed behind the patient's head to close the gap between the patient’s head and the vest type backboard.
Also included with commercial vest type backboards are the head straps which are used to secure the patient's head to the device. Wing-like structures connected to the area where the patient's head sits in the device should over the sides of the patient's face and allow for velcro straps to be applied that immobilize the patient's head to the vest type backboard device. These velcro straps should be applied as tight as possible, in the same fashion as the straps or tape used to secure a patient's head to a long spine board during supine patient immobilization.
One strap is placed over the patient’s forehead, and the other strap is placed under the chin of the patient against the cervical collar.
Only after properly securing the torso straps, the leg straps, and the patient’s head, can
- EMS professional number one release manual in-line stabilization of the patient's head.
At this time, EMS professional number two will pad any voids or obvious spaces between the patient and the vest type backboard device.
- Extremity circulation, motor function, and sensory perception should all be evaluated before and after any immobilization.
Once the vest type backboard is correctly applied,
- both EMS professionals will take up position, one on either side of the patient, and while using proper mechanics and keeping their heads up and backs straight the team will lift the patient at the same time and move the patient to a waiting stretcher or other patient movement device that is close by and prepared.
Once the patient is placed supine on the patient movement device and secured to it,
- the leg straps of the vest-type backboard can be loosened and readjusted and then tightened, with the patient’s legs flat.
- Circulation, motor function, and sensory perception should all be reassessed after this adjustment.
Proper use of the vest-type backboard device takes practice and effective team communication and is the best way to move a seated patient with a suspected spinal injury.